中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
35期
2466-2469
,共4页
曲利军%董晓光%孙士营%谢立信
麯利軍%董曉光%孫士營%謝立信
곡리군%동효광%손사영%사립신
角膜疾病%眼感染,真菌性%角膜溃疡%眼内炎
角膜疾病%眼感染,真菌性%角膜潰瘍%眼內炎
각막질병%안감염,진균성%각막궤양%안내염
Corneal diseases%Eye infections,fungal%Corneal ulcer%Endophthalmitis
目的 探讨避免治疗失败的临床策略.方法 对青岛眼科医院1999年1月至2008年12月期间收治的真菌性角膜溃疡导致眼内炎患者的发病原因、入院前治疗经过、临床特征和实验室检查结果进行回顾性分析.结果 47例眼内炎患者以农村居民(95.7%)为主.眼外伤是真菌性角膜溃疡的最主要病因(66.0%).3例患者在发病后曾应用激素药物.在患者首诊医院中,一级医院、二级医院和三级医院分别占68.1%、17.0%和14.9%.各级医院相应真菌性角膜溃疡正确诊断率分别为31.3%、62.5%和71.4%.患者从发病到入我院治疗平均时间为(29±23)d.镰刀菌属是最常见的致病菌属(91.5%),其中前3位菌种分别为茄病镰刀菌(48.9%)、尖孢镰刀菌(31.9%)和串珠镰刀菌(8.5%).21例患者进行了抗真菌药物敏感性试验,前三位敏感药物分别为那他霉素(88.9%)、伏立康唑(78.6%)和两性霉素(61.9%);前三位耐药药物分别为咪康唑(90.5%)、氟康唑(66.7%)和伊曲康唑(61.9%).结论 基层医院首诊正确诊断率低、非敏感药物使用和患者就诊不及时是真菌性角膜溃疡导致眼内炎的主要原因.提高基层医院诊疗水平,重视药物敏感性检测以及完善社会保障体系和转诊制度是避免治疗失败的有效措施.
目的 探討避免治療失敗的臨床策略.方法 對青島眼科醫院1999年1月至2008年12月期間收治的真菌性角膜潰瘍導緻眼內炎患者的髮病原因、入院前治療經過、臨床特徵和實驗室檢查結果進行迴顧性分析.結果 47例眼內炎患者以農村居民(95.7%)為主.眼外傷是真菌性角膜潰瘍的最主要病因(66.0%).3例患者在髮病後曾應用激素藥物.在患者首診醫院中,一級醫院、二級醫院和三級醫院分彆佔68.1%、17.0%和14.9%.各級醫院相應真菌性角膜潰瘍正確診斷率分彆為31.3%、62.5%和71.4%.患者從髮病到入我院治療平均時間為(29±23)d.鐮刀菌屬是最常見的緻病菌屬(91.5%),其中前3位菌種分彆為茄病鐮刀菌(48.9%)、尖孢鐮刀菌(31.9%)和串珠鐮刀菌(8.5%).21例患者進行瞭抗真菌藥物敏感性試驗,前三位敏感藥物分彆為那他黴素(88.9%)、伏立康唑(78.6%)和兩性黴素(61.9%);前三位耐藥藥物分彆為咪康唑(90.5%)、氟康唑(66.7%)和伊麯康唑(61.9%).結論 基層醫院首診正確診斷率低、非敏感藥物使用和患者就診不及時是真菌性角膜潰瘍導緻眼內炎的主要原因.提高基層醫院診療水平,重視藥物敏感性檢測以及完善社會保障體繫和轉診製度是避免治療失敗的有效措施.
목적 탐토피면치료실패적림상책략.방법 대청도안과의원1999년1월지2008년12월기간수치적진균성각막궤양도치안내염환자적발병원인、입원전치료경과、림상특정화실험실검사결과진행회고성분석.결과 47례안내염환자이농촌거민(95.7%)위주.안외상시진균성각막궤양적최주요병인(66.0%).3례환자재발병후증응용격소약물.재환자수진의원중,일급의원、이급의원화삼급의원분별점68.1%、17.0%화14.9%.각급의원상응진균성각막궤양정학진단솔분별위31.3%、62.5%화71.4%.환자종발병도입아원치료평균시간위(29±23)d.렴도균속시최상견적치병균속(91.5%),기중전3위균충분별위가병렴도균(48.9%)、첨포렴도균(31.9%)화천주렴도균(8.5%).21례환자진행료항진균약물민감성시험,전삼위민감약물분별위나타매소(88.9%)、복립강서(78.6%)화량성매소(61.9%);전삼위내약약물분별위미강서(90.5%)、불강서(66.7%)화이곡강서(61.9%).결론 기층의원수진정학진단솔저、비민감약물사용화환자취진불급시시진균성각막궤양도치안내염적주요원인.제고기층의원진료수평,중시약물민감성검측이급완선사회보장체계화전진제도시피면치료실패적유효조시.
Objective To analyze causes of serious fungal corneal ulcer resulting in infectious endophthalmitis and explore clinical strategies of avoiding the failure of antifungal therapy. Methods Etiological factors, pre-hospital treatments, clinical features and laboratory findings of 47 inpatients with fungal corneal ulcer resulting in endophthalmitis from January 1999 to December 2008 in Qingdao eye hospital were retrospectively reviewed. Results Rural residents (95.7%) dominated in 47 cases with a mean age of (49. 8 ± 10.1 ) years. Ocular trauma was the leading cause of fungal corneal ulcer ( 66. 0% ) . Three patients were ever treated with hormone drugs after the fungal infection. Primary, secondary and tertiary hospital accounted for 68. 1%, 17.0% and 14.9% among first medical consultation sites. Diagnostic accuracies of fungal corneal ulcer in three grade hospitals were 31.3%, 62.5% and 71.4%respectively. The average interval from the onset of disease to the admission into our hospital was (29 ±23 )days. The dominating pathogen was genus Fusarium ( 91.5% ) with F. solani (48. 9% ), F. oxysporum (31.9%) and F. moniliforme (8. 5% ). Antifungal drug sensitivity tests were performed in 21 patients.The first three sensitive drugs were natamycin (88. 9% ), voriconazole (78. 6% ) and amphotericin B(61.9%). The first three drug-resistant ones were miconazole (90. 5%), fluconazole (66. 7% ) and itraconazole (61.9%). Conclusion Main causes of fungal corneal ulcer resulting in infectious endophthalmitis included lower diagnostic accuracies of first medical consultation in primary hospitals,abuses of non-sensitive drug and delayed treatment of patients. Improving clinical capabilities of doctors in primary hospitals, emphasizing antifungal drug susceptibility tests, and consummating the social security system and the referral system could be effective measures to avoid therapeutic failures.
