CAJ | 학술논문

目的通过结膜囊及玻璃体液细菌培养及玻璃体腔注射抗生素等措施研究眼球内异物伤继发急性眼内炎的诊断及预防策略.方法采用病例对照研究,以2010年1月到2010年12月因球内异物伤行一期急诊手术者48例为研究对象,每例患者手术前均取结膜囊分泌物及玻璃体液作细菌培养,术毕均于玻璃体注射万古霉素1 mg及头孢他定1 mg.回顾收集2010年以前同等情况病例但未采取眼内注射抗生素病例48例作为对照组,对比分析两组病例细菌培养结果及眼内炎的发生率,视力恢复情况等.结果对照组眼内炎发生率为14.58％(7例),注射组为2.08％(1例),两组比较有显著差异(P＜0.05).两组结膜囊细菌培养阳性率均低,注射组为2例(4.17％),对照组1例(2.08％),阳性菌均为表皮葡萄球菌.而玻璃体液细菌培养阳性率较高:注射组细菌培养阳性率17.39％(8例),即潜在感染率为17.39％,与实际发生率2.08％有显著差异(p＜0.05)；对照组细菌培养阳性率14.58％(7例),即潜在感染率为14.58％,与实际发生率14.58％(7例)一致.结论眼球内异物伤一期眼内注射抗生素可以减少继发细菌性眼内炎的发生率,为二期手术提供良好的手术条件及相对好的视力预后.玻璃体液细菌培养阳性率远高于结膜囊细菌培养,更接近继发眼内炎的发生率,对眼球内异物伤继发眼内炎的诊断和治疗有较好的指导意义.
목적 통과결막낭급파리체액세균배양급파리체강주사항생소등조시연구안구내이물상계발급성안내염적진단급예방책략.방법 채용병례대조연구,이2010년1월도2010년12월인구내이물상행일기급진수술자48례위연구대상,매례환자수술전균취결막낭분비물급파리체액작세균배양,술필균우파리체주사만고매소1 mg급두포타정1 mg.회고수집2010년이전동등정황병례단미채취안내주사항생소병례48례작위대조조,대비분석량조병례세균배양결과급안내염적발생솔,시력회복정황등.결과 대조조안내염발생솔위14.58％(7례),주사조위2.08％(1례),량조비교유현저차이(P＜0.05).량조결막낭세균배양양성솔균저,주사조위2례(4.17％),대조조1례(2.08％),양성균균위표피포도구균.이파리체액세균배양양성솔교고:주사조세균배양양성솔17.39％(8례),즉잠재감염솔위17.39％,여실제발생솔2.08％유현저차이(p＜0.05)；대조조세균배양양성솔14.58％(7례),즉잠재감염솔위14.58％,여실제발생솔14.58％(7례)일치.결론 안구내이물상일기안내주사항생소가이감소계발세균성안내염적발생솔,위이기수술제공량호적수술조건급상대호적시력예후.파리체액세균배양양성솔원고우결막낭세균배양,경접근계발안내염적발생솔,대안구내이물상계발안내염적진단화치료유교호적지도의의.
Objective To investigate the strategy on diagnosis and prophylaxis of endophthalmitis associated with intraocular foreign bodies (IOFB) by germiculture of conjunctiva,germiculture of humor vitreous and intraocular antibiotic injection. Methods A case control study was conducted,48 patients with penetrating eye trauma and retained IOFB in emergency operation in 2010 were divided to the study group,and another 48 patients with penetrating eye trauma and retained IOFB before 2010 were divided to the control group.Both groups were accepted the same cure and germiculture of conjunctiva,germiculture of humor vitreous,but the study group accepted intraocular antibiotic injection with 1mg vancomycin and 1mg ceftazidime supernumerary. Results The incidence of endophthalmitis in the control group was 14.58％ (7 patients) and in the study group was 2.08％ (1 patient),there were different.Both groups got low masculine rate in germiculture of conjunctiva,but high masculine rate in germiculture of humor vitreous,there were no different. Conclusions Intraocular antibiotics are effective in the prevention of acute posttraumatic bacterial endophthalmitis in eyes with retained intraocular foreign body.The germiculture of humor vitreous is better than the germiculture of conjunctiva for diagnosis posttraumatic bacterial endophthalmitis.