庆大霉素和聚维酮碘对结膜囊细菌清除率的比较研究

摘要

目的 探讨庆大霉素、0.5%聚维酮碘及5.0%聚维酮碘清除结膜囊细菌的效果及其副作用.方法 采用比较性研究,选择2006年3月至5月在武汉爱尔眼科医院行眼前节手术的300例患者(300只眼),采用随机数字法分为3组.手术前1 d,用0.3%氧氟沙星眼液滴患眼6次.表面麻醉后术前约5 min依照不同分组分别用0.8%庆大霉素注射液、0.5%聚维酮碘及5.0%聚维酮碘冲洗结膜囊.在下列时间采集患者结膜囊标本做细菌培养和药物敏感性试验:入院时未用任何药物之前的基准培养;使用0.3%氧氟沙星滴眼液1 d后;未用药物冲洗结膜囊前;手术刚开始时;冲洗结膜囊约5 min后;手术结束时.在手术开始时,采集前房水标本做细菌培养.各组间培养阳性率的比较,采用Pearson卡方检验.结果 未用药前,0.8%庆大霉素注射液组、0.5%聚维酮碘组及5.0%聚维酮碘组结膜囊培养阳性率分别为79.7%、76.6%及77.8%,差异无统计学意义(X2=0.28,P=0.86);手术完成后,3组结膜囊培养阳性率分别为11.7%、8.3%及6.3%,差异也无统计学意义(X2=1.74,P=0.41).前房水培养平均阳性率为4.9%,3组之间比较差异无统计学意义(X2=1.21,P=0.54).患者未出现对聚维酮碘有明显的不良反应.结论 表面麻醉后术眼结膜囊内使用0.5%国产聚维酮碘和5.0%进口聚维酮碘均较安全;术前用0.8%庆大霉素注射液、0.5%聚维酮碘及5.0%聚维酮碘冲洗结膜囊清除眼表细菌的效果相似.%Objective To study the efficacy of gentamycin,0.5% povidone-iodine and 5.0% povidone-iodine in eliminating rate of positive conjunctival bacteria cultures and aqueous humor contamination,and to observe their adverse effects.Methods It was a comparative study.Three hundred patients(300 eyes)were randomized to three groups:gentamycin group,0.5% povidone-iodine group and 5.0% povidone-iodine group.All patients received 1-day(6 times)topical application of 0.3% ofloxacin before surgery.Approximately 5 minutes before surgery,the conjunctival sac was irrigated with 5-8 ml gentamycin,0.5% povidone-iodine or 5.0% povidone-iodine,correspondingly.Conjunctival cultures were obtained at the following time points:before receiving any topical medications;after application of 1-day topical 0.3% ofloxacin,before irrigating the conjunctival sac;immediately before surgery approximately 5 minutes after conjunctival sac irrigation and at the end of the surgery.Anterior chamber aspirates were obtained at the beginning of the surgery.Bacteria isolated were identified and antibiotic susceptibility was determined.The rate of positive conjunctival cultures among each group was compared and significance of the difference was tested with the Pearson chi-square test.Results Rate of positive conjunctival cultures before the conjnnctival irrigation was 79.7%,76.6% and 77.8% in the gentamycin group,0.5% povidone-iodine group and 5.0% povidone-iodine group,respectively.The difference between these three groups was not statistically significant(X2=0.28,P=0.86).At the end of surgery,the rate of positive conjunctival cultures in these three groups was 11.7%,8.3% and 6.3%,respectively.The difference between these three groups was also not statistically significant(X2=1.74,P=0.41).The average rate of anterior aqueous contamination was 4.9% and there was no significant difference among these three groups(P>0.05).Conclusions Both 0.5% povidone-iodine and 5.0% povidone-iodine using for irrigating conjunctival sac are safe.Gentamycin,0.5% povidone-iodine and 5.0% povidane-iodine have similar effects on the reduction of the bacteria in conjunctival sac.