CAJ | 학술논문

目的：研究高原地区老年白内障围手术期内用药与术后感染的相关性，以期为防治白内障术后眼内感染提供参考。方法选取2008年10月－2013年10月入院诊治的高原地区老年白内障手术患者1050例（眼），根据其围手术期用药情况分为A组（仅术前用药）、B组（围手术期单纯结膜囊用药）和C组（围手术期结膜囊用药联合全身给药），各350例，观察3组患者术后眼内感染情况。结果1050例患者中细菌培养阳性者133例，阳性率为12．67％，其中革兰阳性菌128株，占96．24％，均为凝固酶阴性葡萄球菌；对凝固酶阴性葡萄球菌敏感率较高的抗菌药物为呋喃妥因、青霉素、氨苄西林、阿米卡星、万古霉素、克林霉素等；1050例患者发生眼内感染52例，感染率为4．95％，A组感染45例，感染率为12．86％；B组感染5例，感染率为1．43％；C组感染2例，感染率为0．57％；A组与B、C两组比较，差异有统计学意义（ P＜0．05），B组与C组比较，差异无统计学意义。结论部分高原地区老年性白内障患者在术前结膜囊内即存在致病菌，通过在围手术期全程眼内应用敏感药物可避免感染的发生，没有必要全身使用抗菌药物。
목적：연구고원지구노년백내장위수술기내용약여술후감염적상관성，이기위방치백내장술후안내감염제공삼고。방법선취2008년10월－2013년10월입원진치적고원지구노년백내장수술환자1050례（안），근거기위수술기용약정황분위A조（부술전용약）、B조（위수술기단순결막낭용약）화C조（위수술기결막낭용약연합전신급약），각350례，관찰3조환자술후안내감염정황。결과1050례환자중세균배양양성자133례，양성솔위12．67％，기중혁란양성균128주，점96．24％，균위응고매음성포도구균；대응고매음성포도구균민감솔교고적항균약물위부남타인、청매소、안변서림、아미잡성、만고매소、극림매소등；1050례환자발생안내감염52례，감염솔위4．95％，A조감염45례，감염솔위12．86％；B조감염5례，감염솔위1．43％；C조감염2례，감염솔위0．57％；A조여B、C량조비교，차이유통계학의의（ P＜0．05），B조여C조비교，차이무통계학의의。결론부분고원지구노년성백내장환자재술전결막낭내즉존재치병균，통과재위수술기전정안내응용민감약물가피면감염적발생，몰유필요전신사용항균약물。
OBJECTIVE To study the correlation between the perioperative use of drugs and postoperative infections in the elderly patients with cataract in plateau area so as to provide guidance for prevention and treatment of the postoperative infections in the patients with cataract .METHODS A total of 1 050 elderly patients (eyes) with cata‐ract from the plateau area who were treated from Oct 2008 to Oct 2013 were enrolled in the study and divided into the group A (single preoperative medication) ,the group B (single perioperative conjunctival sac medication) ,and the group C (perioperative conjunctival sac medication combined with systemic medication) ,with 350 cases in each group;the incidence of the postoperative eye infections was observed and compared among the three groups . RESULTS Totally 133 of 1 050 patients were positive for the bacterial culture with the positive rate of 12 .67% ;there were 128 (96 .24% ) strains of gram‐positive bacteria ,all of which were coagulase‐negative Staphylococcus . The coagulase‐negative Staphylococcus strains were highly susceptible to nitrofurantoin ,penicillin ,ampicillin , amikacin ,vancomycin ,and clindamycin .The eye infections occurred in 52 of 1 050 patients with the infection rate of 4 .95% ;the infections occurred in 45 cases in the group A with the infection rate of 12 .86% ,5 cases in the group B with the infection rate of 1 .43% ,and 2 cases in the group C with the infection rate of 0 .57% ,there was significant difference among the group A ,group B ,and group C (P<0 .05) ,but there was no significant differ‐ence between the group B and the group C .CONCLUSION The pathogenic bacteria exist in the conjunctival sac of the elderly patients with cataract from some plateau areas before the surgery .The perioperative use of sensitive drugs in the eyes can contribute to the prevention of infections , and the systemic use of antibiotics is not necessary .