中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2012年
6期
588-592
,共5页
张远霞%姚毅%黄一飞%魏世辉%王志军
張遠霞%姚毅%黃一飛%魏世輝%王誌軍
장원하%요의%황일비%위세휘%왕지군
眼内炎/分类%微生物敏感性试验%预后
眼內炎/分類%微生物敏感性試驗%預後
안내염/분류%미생물민감성시험%예후
Endophthalmitis/classification%Microbial sensitivity%Prognosis
目的 分析2000年至2009年10年眼内炎的病因变化趋势、病原学特征及治疗效果.方法 2000年1月至2009年12月临床诊断为眼内炎并住院治疗的165例患者172只眼纳入研究.患者中,男性122例,女性43例；平均年龄(39.0±23.7)岁.视力光感者16只眼；光感～0.05者135只眼；＞0.05者12只眼.9例儿童患儿无视力记录.外源性眼内炎141例,占85.45％.其中,外伤89例；内眼手术后43例；其他9例.内源性眼内炎24例,占14.55％.玻璃体腔注射10mg/ml的万古霉素0.1m1113只眼.有房水或房水加玻璃体标本病原微生物培养记录152只眼,培养结果阳性者行药物敏感性试验.分析病原微生物培养、药物敏感性试验结果及药物治疗效果和2000年至2004年和2005年至2009年前后5年间不同类型眼内炎患者的构成比；采用SPSS统计软件对数据进行统计学分析处理.结果 行病原微生物培养的152只眼中,培养结果阳性42只眼,占27.63％.其中,细菌阳性28只眼；真菌阳性12只眼；丝状真菌和凝固酶阴性葡萄球菌混合生长2只眼.内源性眼内炎病原微生物培养结果阳性比例高于外源性眼内炎,差异有统计学意义(x2=4.721 9,P=0.029 8).药物敏感性试验结果显示,G+菌对青霉素类、头孢菌素类和除左氧氟沙星外的氟喹诺酮类普遍耐药；对万古霉素、复方新诺明及利福平敏感.干预治疗效果以外源性眼内炎中内眼手术所致者最好,外伤者次之,内源性眼内炎治疗效果最差.三者比较,差异有统计学意义(x2=38.941 3,P=0.000 0).治疗后BCVA＞0.05者23只眼,与治疗前比较,差异有统计学意义(x2=3.867 3,P=0.049 2).前后5年,内源性眼内炎由7.89％上升至20.23％,差异有统计学意义(x2=5.014 0,P=0.025 1).外源性眼内炎中,内眼手术后、外伤所致者分别由27.63％、60.53％下降为24.72％、48.31％；而其它原因所致者则由3.95％上升至6.74％.结论 2000年至2009年10年内源性眼内炎发生呈增长趋势.病原微生物培养阳性率低,但内源性眼内炎病原微生物培养结果阳性率相对较高.治疗效果以内眼手术所致眼内炎最好；内源性眼内炎最差.整体视力预后较差.
目的 分析2000年至2009年10年眼內炎的病因變化趨勢、病原學特徵及治療效果.方法 2000年1月至2009年12月臨床診斷為眼內炎併住院治療的165例患者172隻眼納入研究.患者中,男性122例,女性43例；平均年齡(39.0±23.7)歲.視力光感者16隻眼；光感～0.05者135隻眼；＞0.05者12隻眼.9例兒童患兒無視力記錄.外源性眼內炎141例,佔85.45％.其中,外傷89例；內眼手術後43例；其他9例.內源性眼內炎24例,佔14.55％.玻璃體腔註射10mg/ml的萬古黴素0.1m1113隻眼.有房水或房水加玻璃體標本病原微生物培養記錄152隻眼,培養結果暘性者行藥物敏感性試驗.分析病原微生物培養、藥物敏感性試驗結果及藥物治療效果和2000年至2004年和2005年至2009年前後5年間不同類型眼內炎患者的構成比；採用SPSS統計軟件對數據進行統計學分析處理.結果 行病原微生物培養的152隻眼中,培養結果暘性42隻眼,佔27.63％.其中,細菌暘性28隻眼；真菌暘性12隻眼；絲狀真菌和凝固酶陰性葡萄毬菌混閤生長2隻眼.內源性眼內炎病原微生物培養結果暘性比例高于外源性眼內炎,差異有統計學意義(x2=4.721 9,P=0.029 8).藥物敏感性試驗結果顯示,G+菌對青黴素類、頭孢菌素類和除左氧氟沙星外的氟喹諾酮類普遍耐藥；對萬古黴素、複方新諾明及利福平敏感.榦預治療效果以外源性眼內炎中內眼手術所緻者最好,外傷者次之,內源性眼內炎治療效果最差.三者比較,差異有統計學意義(x2=38.941 3,P=0.000 0).治療後BCVA＞0.05者23隻眼,與治療前比較,差異有統計學意義(x2=3.867 3,P=0.049 2).前後5年,內源性眼內炎由7.89％上升至20.23％,差異有統計學意義(x2=5.014 0,P=0.025 1).外源性眼內炎中,內眼手術後、外傷所緻者分彆由27.63％、60.53％下降為24.72％、48.31％；而其它原因所緻者則由3.95％上升至6.74％.結論 2000年至2009年10年內源性眼內炎髮生呈增長趨勢.病原微生物培養暘性率低,但內源性眼內炎病原微生物培養結果暘性率相對較高.治療效果以內眼手術所緻眼內炎最好；內源性眼內炎最差.整體視力預後較差.
목적 분석2000년지2009년10년안내염적병인변화추세、병원학특정급치료효과.방법 2000년1월지2009년12월림상진단위안내염병주원치료적165례환자172지안납입연구.환자중,남성122례,녀성43례；평균년령(39.0±23.7)세.시력광감자16지안；광감～0.05자135지안；＞0.05자12지안.9례인동환인무시력기록.외원성안내염141례,점85.45％.기중,외상89례；내안수술후43례；기타9례.내원성안내염24례,점14.55％.파리체강주사10mg/ml적만고매소0.1m1113지안.유방수혹방수가파리체표본병원미생물배양기록152지안,배양결과양성자행약물민감성시험.분석병원미생물배양、약물민감성시험결과급약물치료효과화2000년지2004년화2005년지2009년전후5년간불동류형안내염환자적구성비；채용SPSS통계연건대수거진행통계학분석처리.결과 행병원미생물배양적152지안중,배양결과양성42지안,점27.63％.기중,세균양성28지안；진균양성12지안；사상진균화응고매음성포도구균혼합생장2지안.내원성안내염병원미생물배양결과양성비례고우외원성안내염,차이유통계학의의(x2=4.721 9,P=0.029 8).약물민감성시험결과현시,G+균대청매소류、두포균소류화제좌양불사성외적불규낙동류보편내약；대만고매소、복방신낙명급리복평민감.간예치료효과이외원성안내염중내안수술소치자최호,외상자차지,내원성안내염치료효과최차.삼자비교,차이유통계학의의(x2=38.941 3,P=0.000 0).치료후BCVA＞0.05자23지안,여치료전비교,차이유통계학의의(x2=3.867 3,P=0.049 2).전후5년,내원성안내염유7.89％상승지20.23％,차이유통계학의의(x2=5.014 0,P=0.025 1).외원성안내염중,내안수술후、외상소치자분별유27.63％、60.53％하강위24.72％、48.31％；이기타원인소치자칙유3.95％상승지6.74％.결론 2000년지2009년10년내원성안내염발생정증장추세.병원미생물배양양성솔저,단내원성안내염병원미생물배양결과양성솔상대교고.치료효과이내안수술소치안내염최호；내원성안내염최차.정체시력예후교차.
Objective To analyze the etiology trends,etiological characteristics treatment effects of endophthalmitis in 10 years which from 2000 to 2009 in our hospital.Methods 165 patients (172 eyes) of endophthalmitis in hospital from January 2000 to December 2009 were enrolled in this study.The patients included 122 males and 43 females.The median age was (39.0 ± 23.7) years.The best visual acuity (BCVA) was non light perception in 16 eyes,light perception 0.05 in 135 eyes,＞0.05 in 12 eyes.Nine children did not have visual acuity records.There were 141 patients (85.45％) with exogenous endophthalmitis which including 89 patients of trauma,43 patients after intraocular surgery and nine others;24 patients (14.55％) with endogenous endophthalmitis.113 eyes were received intravitreal injection with vancomycin 0.1 ml (10 mg/ml).152 eyes had pathogenic microorganisms culture records of aqueous humor or aqueous humor and vitreous.The positive records were given drug sensitivity test.The types of endophthalmitis,pathogenic microbial culture and drug sensitivity test results and treatment effects were analyzed.Software of SPSS was used for the clinical data statistical analysis in this study.Results Of 152 eyes with a record of aqueous/vitreous samples pathogenic bacteria culture,42 eyes (27.63％) had a positive result.In which,28 eyes showed positive in bacteria culture,12 eyes was positive in fungus culture and two eyes had a positive in culture of fungus and bacteria growing.The culture positive rate was higher in exogenous endophthalmitis than that in endogenous endophthalmitis (x2 =4.721 9,P=0.029 8).Most of the G+ positive bacteria were resistance to cephalosporin and quinolones except levofloxacin; but sensitive to vancomycin,rifampin and sulfamethoxazole.The intervention effect was more available for postoperative endophthalmitis than that for traumatic endophthalmitis and endogenous endophthalmitis,the difference was statistically significant(x2 =38.941 3,P=0.000 0).The BCVA of 23 cases was ＞0.05 after the treatment,compared with before the treatment,the difference was statistically significant (x2 =3.867 3,P=0.049 2).Compared the ratio of past five years' to that of recent five years,endogenous endophthalmitis was increased from 7.89％ to 20.23％ (x2 =5.014 0,P =0.025 1); postoperative endophthalmitis decreased from27.63％ to 24.72％,and traumatic endophthalmitis decreased from 60.53％ to 48.31％,other causes linked endophthalmitis raised from 3.95 ％ to 6.74％.Conclusions In recent 10 years (from 2000 to 2009),the patients with endogenous endophthalmitis are growing.The positive rate of pathogenic agent culture is low,but the culture positive rate of the specimens from endogenous endophthalmitis is higher than that from exogenous endophthalmitis.The treatment was more available for postoperative endophthalmitis than that for other two types of endophthalmitis.The general visual prognosis is poor.
