CAJ | 학술논문

目的探讨角膜异物伤后快速生长型分枝杆菌性角膜炎(RGMK)暴发的原因与控制措施.方法回顾性系列病例研究.调查2007年7月1日至8月5日南通一基层医院在角膜异物剔除术后暴发的11例(11眼)RGMK,了解患者的发病和初诊情况,以及当地医院、接诊医生和患者的工作场所,并采集标本做细菌培养.控制措施包括重视无菌操作,剔除角膜异物时摒弃戊二醛浸泡的角膜异物针,首选一次性针头,选用高压蒸汽法消毒替代戊二醛消毒液消毒等;治疗方法有局部和全身应用抗生素,5%碘酊烧灼清创病灶甚至角膜移植.结果 RGMK暴发感染的原因为异物本身带菌或使用的戊二醛难以杀灭快速生长型分枝杆菌,导致异物针带菌污染角膜造成感染.9例患者经局部和全身应用多种抗生素及5%碘酊烧灼清创病灶后治愈,2例以药物治疗无明显疗效,经角膜移植后治愈.结论 RGMK可在角膜异物剔除术后暴发流行,其对药物治疗反应慢,顽固性病例可经角膜移植而治愈.加强劳动防护,重视无菌操作,提高消毒灭菌质量,异物剔除术毕使用多种抗生素,术后密切随访观察等有利于预防和减少RGMK的发生.
목적 탐토각막이물상후쾌속생장형분지간균성각막염(RGMK)폭발적원인여공제조시.방법 회고성계렬병례연구.조사2007년7월1일지8월5일남통일기층의원재각막이물척제술후폭발적11례(11안)RGMK,료해환자적발병화초진정황,이급당지의원、접진의생화환자적공작장소,병채집표본주세균배양.공제조시포괄중시무균조작,척제각막이물시병기무이철침포적각막이물침,수선일차성침두,선용고압증기법소독체대무이철소독액소독등;치료방법유국부화전신응용항생소,5%전정소작청창병조심지각막이식.결과 RGMK폭발감염적원인위이물본신대균혹사용적무이철난이살멸쾌속생장형분지간균,도치이물침대균오염각막조성감염.9례환자경국부화전신응용다충항생소급5%전정소작청창병조후치유,2례이약물치료무명현료효,경각막이식후치유.결론 RGMK가재각막이물척제술후폭발류행,기대약물치료반응만,완고성병례가경각막이식이치유.가강노동방호,중시무균조작,제고소독멸균질량,이물척제술필사용다충항생소,술후밀절수방관찰등유리우예방화감소RGMK적발생.
Objective To study the cause and control of outbreaks of rapidly growing mycobacterium keratitis (RGMK). Methods This was a retrospective case series study. Eleven eyes of 11 patients with RGMK following corneal foreign body trauma were participants in a study at the local hospital. Case histories were taken at the local hospital and patient's workplaces were investigated, and environmental cultures were taken to identify potential contaminants in the new outpatient offices, examination rooms and the patient's workplaces. The control measures stressed the importance of aseptic technique, foreign body removal with disposable needles as opposed to a foreign-body spud soaked in 2% glutaral. The patients received local and systemic antibiotic therapy,lesion cleaning followed by cauterization with tincture of iodine (5%) and even keratoplasty. Results The outbreaks of RGMK were traced to nonsterile foreign bodies or foreign-body spuds treated with frustrane glutaral. Infections in 9 cases were successfully treated with a regimen that included a combination of antimicrobial agents and local lesion cleaning followed by cauterization with 5%tincture of iodine. Two cases that had a poor response to 6 months of antibiotic therapy were successfully treated by keratoplasty. Conclusion RGMK can occur in an epidemic fashion following corneal foreign body trauma. RGMK has a long response period to medical management and the recalcitrant infections can be resolved by keratoplasty. Enhanced workplace protection, attaching importance to aseptic techniques, improved sterilization, multiple antibiotic therapy and close follow-up after removal will help to prevent outbreaks of RGMK.