CAJ | 학술논문

目的前瞻性研究白内障术前通过眼睑热敷、按摩及清洁睑缘等睑板腺的特殊处理对结膜囊微生物状态的影响,寻求更安全的内眼手术术前准备方法.方法将87例90只眼拟行白内障手术患者随机分为A(空白组:未做任何处理之前)、B(对照组:术前使用抗生素眼液滴眼、剪眼睫毛、生理盐水冲洗泪道及结膜囊等常规术前准备)、C(处理组:常规术前准备+睑板腺特殊处理)三组,分别为25例26只眼、29例29只眼、33例35只眼,A组于人院时,B、C两组于手术开始及术毕两个时间点分别采集结膜囊标本,送检行微生物培养.结果 (1)结膜囊微生物培养阳性率:A组为53.85％,B组与C组手术开始及术毕两个时间点的阳性率分别为10.34％、27.59％与2.86％、5.71％.C组结膜囊微生物培养阳性率明显降低,与A组、B组组间差异均有统计学意义(P＜0.05).(2)结膜囊微生物培养阳性率与术前抗生素眼液使用天数、术前睑板腺处理时间、手术持续时间长短差异均无统计学意义(P＞0.05).(3)结膜囊微生物培养菌种:共培养出阳性菌28株,5种菌属.未培养出真菌.结论 (1)正常人群中结膜囊存在一定细菌；术前使用抗生素眼液滴眼、剪眼睫毛、生理盐水冲洗泪道及结膜囊等常规术前准备可以减少结膜囊微生物培养阳性率；对睑板腺特殊处理后可以更进一步降低结膜囊微生物培养检出率.(2)白内障术前增加对睑板腺的特殊处理可以在减少局部使用抗生素眼液时间的情况下,同样达到有效清洁术野、减少结膜囊微生物的作用,从而起到降低术后眼内炎风险的作用.
목적 전첨성연구백내장술전통과안검열부、안마급청길검연등검판선적특수처리대결막낭미생물상태적영향,심구경안전적내안수술술전준비방법.방법 장87례90지안의행백내장수술환자수궤분위A(공백조:미주임하처리지전)、B(대조조:술전사용항생소안액적안、전안첩모、생리염수충세루도급결막낭등상규술전준비)、C(처리조:상규술전준비+검판선특수처리)삼조,분별위25례26지안、29례29지안、33례35지안,A조우인원시,B、C량조우수술개시급술필량개시간점분별채집결막낭표본,송검행미생물배양.결과 (1)결막낭미생물배양양성솔:A조위53.85％,B조여C조수술개시급술필량개시간점적양성솔분별위10.34％、27.59％여2.86％、5.71％.C조결막낭미생물배양양성솔명현강저,여A조、B조조간차이균유통계학의의(P＜0.05).(2)결막낭미생물배양양성솔여술전항생소안액사용천수、술전검판선처리시간、수술지속시간장단차이균무통계학의의(P＞0.05).(3)결막낭미생물배양균충:공배양출양성균28주,5충균속.미배양출진균.결론 (1)정상인군중결막낭존재일정세균；술전사용항생소안액적안、전안첩모、생리염수충세루도급결막낭등상규술전준비가이감소결막낭미생물배양양성솔；대검판선특수처리후가이경진일보강저결막낭미생물배양검출솔.(2)백내장술전증가대검판선적특수처리가이재감소국부사용항생소안액시간적정황하,동양체도유효청길술야、감소결막낭미생물적작용,종이기도강저술후안내염풍험적작용.
Objective To study the effect of the conjunctival sac's microbial condition after special treatment of meibomian gland including eye lid fomentation,massage and clean palpebral margin,to explore more and more safe preparation before ocular operation.Methods Eighty-seven cases of 90 eyes that needed the cataract surgery were divided into three groups randomly.A (blank group:without any treatments),B (control group:routine preparation preoperative including use of antibiotic eye drops + cut lashes + rinse tractus lacrimalis and conjunctival with isotonic Na chloride),C (treatment group:routine preparation preoperative + special treatment of meibomian gland).There were 25 cases of 26 eyes,29 cases of 29 eyes,33 cases of 35 eyes in each group respectively.Specimens of the conjunctival sac were collected at the admission (group A),at the start of the surgery and at the end of the surgery (group B and C),and sent to bacterial culture.Results Microbial culture positive rate of the conjunctival sac:in group A was 53.85％,at the start of the surgery and at the end of the surgery,the positive rates were 10.34％,27.59％ and 2.86％,5.71％ respectively in the group B and group C.Microbial culture positive rate of the conjunctival sac was decreased obviously in the group C (meibomian gland received the special treatment),there was statistical significance (P ＜0.05).There wasn't statistical significance between the microbial culture positive rate of the conjunctival sac and date of antibiotic eye drops used before surgery,time of the treatment of meibomian gland,duration of the surgery (P ＞0.05).The kinds of the microbial culture were 28 stocks and 5 genera totally,fungus was not detected.Conclusions There is a certain bacteria in the conjunctival sac of the normal population; routine preparation preoperative can reduce the microbial culture positive rate of the conjunctival sac,and reduce further after special treatment of the meibomian gland.On the condition of reduce the local use of antibiotic eye drops plus the special treatment of the meibomian gland before cataract surgery,also can gain the effect of clean operative field and reduce bacteria of conjunctival sac,thereby lower postoperative endophthalmitis rate.