摘要：
目的 探讨5％聚维酮碘不同作用时间清除结膜囊细菌的效果及不良反应.方法 前瞻性随机对照研究.收集2017年12月至2018年6月在陆军军医大学大坪医院眼科行白内障摘除手术的420例患者,选用非手术眼(420只眼)作为研究对象,随机数字表法分为4组:30 s组、1.0 min组、2.0 min组、3.5 min组,手术当天使用国产5％聚维酮碘冲洗结膜囊,分别作用30 s、1.0 min、2.0 min、3.5 min.在冲洗前及冲洗后分别采集结膜囊标本行细菌培养和细菌鉴定.比较各组细菌培养阳性率及细菌生长情况.术后1h和术后1d观察眼表,记录角膜上皮损伤发生情况.各组间细菌培养阳性率及角膜损伤阳性率的比较均采用χ2检验.结果 排除标本污染的20例患者后,纳入400例(400只非手术眼)患者,男性191例,女性209例,平均年龄66.8岁.30 s组96例,1.0 min组90例,2.0 min组109例,3.5 min组105例.冲洗结膜囊前,30 s组、1.0 min组、2.0 min组及3.5 min组结膜囊细菌培养阳性率分别为44.8％(43/96)、43.3％(39/90)、43.1％(47/109)及43.8％(46/105),差异无统计学意义(χ2=0.066,P=0.996);冲洗后,4组结膜囊细菌培养阳性率分别为29.2％(28/96)、31.1％(28/90)、13.8％(15/109)及13.3％(14/105),两两比较显示2.0 min组与30 s组(χ2=7.308,P=0.007)、2.0 min组与1.0 min组(χ2=8.760,P=0.003)、3.5 min组与30 s组(χ2=7.606,P=0.006)、3.5 min组与1.0 min组(χ2=9.063,P=0.003)差异有统计学意义.30 s组、1.0 min组、2.0 min组及3.5 min组术后1 h均有角膜上皮轻度损伤,发生率分别为16.7％(16/96)、18.9％(17/90)、20.2％(22/109)、34.3％(36/105),两两比较显示3.5 min组与30 s组(χ2=8.118,P=0.004)、1.0 min组(χ2=5.804,P=0.016)、2.0 min组(χ2=5.383,P=0.020)差异有统计学意义;术后1 d各组角膜上皮损伤发生与术后1 h比较均明显减少,无新发生的角膜上皮损伤,角膜轻度损伤发生率分别为3.1％(3/96)、5.6％(5/90)、9.2％(10/109)、15.2％(16/105),两两比较显示3.5 min组与30 s组(χ2=8.597,P=0.003)、1.0 min组(χ2=4.728,P=0.030)差异有统计学意义.术后1d存在的角膜上皮损伤在术后1周复查时全部愈合.结论 白内障摘除手术前国产5％聚维酮碘冲洗结膜囊2.0 min或3.5 min较冲洗30 s或1.0 min能更有效减少术前结膜囊细菌负荷,术前冲洗2.0 min术后1 h的角膜上皮损伤情况优于冲洗3.5 min,5％聚维酮碘作用结膜囊2.0 min既有效又安全,是一个可参考选用的预防感染措施.%Objective To investigate the efficacy and adverse reactions of 5％ povidone-iodine in removing bacteria from the conjunctival sac with different durations. Methods Randomized controlled study. A total of 420 patients who underwent cataract surgery in Daping Hospital, Army Medical University from December 2017 to June 2018 were selected. Non-surgical eyes (420 eyes) were selected as the study subjects and divided into 4 groups randomly: 30-second group, 1.0-min group, 2.0-min group and 3.5-min group. On the day of surgery, domestic 5％ povidone-iodine was used to flush the conjunctival sac for 30 seconds, 1.0 min, 2.0 min and 3.5 min, respectively. The conjunctival sac specimens were collected for bacterial culture and bacterial identification before and after flushing the conjunctival sac with povidone-iodine. The positive rates of bacterial culture and bacterial growth were compared. The patients′ocular surface was observed and the incidence of corneal epithelial injury was recorded at 1 hour and 1 day after surgery. The positive rates of bacterial culture and corneal epithelial injury between groups were compared by Pearson chi-square test. Results After excluding 20 patients with suspected specimens contamination, 400 patients (400 non-surgical eyes) were enrolled, including 191 males and 209 females, with an average age of 66.8 years. Before flushing the conjunctival sac, the positive rates of bacterial culture in the 30-second group, 1.0-min group, 2.0-min group and 3.5-min group were 44.8％(43/96), 43.3％(39/90), 43.1％(47/109) and 43.8％(46/105), respectively, with no statistically significant difference (χ2=0.066, P=0.996). After flushing, the positive rates of conjunctival sac bacterial culture in the 4 groups were 29.2％(28/96), 31.1％ (28/90), 13.8％ (15/109) and 13.3％ (14/105), respectively. The differences between the 30-second group and 2.0-min group (χ2=7.308, P=0.007), between the 1.0-min group and 2.0-min group (χ2=8.760, P=0.003), between the 30-second group and 3.5-min group (χ2=7.606, P=0.006), and between the 1.0-min group and 3.5-min group (χ2=9.063, P=0.003) were statistically significant. At 1 hour after surgery, mild corneal epithelial injury occurred in each group, with a rate of 16.7％(16/96), 18.9％(17/90), 20.2％(22/109) and 34.3％(36/105), respectively. The differences between the 30-second group and 3.5-min group (χ2=8.118, P=0.004), between the 1.0-min group and 3.5-min group (χ2=5.804, P=0.016), and between the 2.0-min group and 3.5-min group (χ2=5.383, P=0.020) were statistically significant. At 1 day after surgery, there was no occurrence of new injury, and the incidence of mild corneal injury in each group was 3.1％(3/96), 5.6％ (5/90), 9.2％ (10/109) and 15.2％ (16/105), respectively. There was statistically significant difference between the 30-second group and 3.5-min group (χ2=8.597, P=0.003), and between the 1.0-min group and 3.5-min group (χ2=4.728, P=0.030). The corneal epithelial injury healed completely at 1 week after surgery. Conclusions The preoperative bacterial load of the conjunctival sac is more effectively reduced with 5％ povidone-iodine in the 2.0-min and 3.5-min than in the 30-second and 1.0-min, and the 2-min is superior to the 3.5-min in the occurrence of corneal epithelial injury at 1 hour after surgery. Irrigation of the conjunctival sac with 5％povidone-iodine for 2 min is effective and safe, which can be an alternative measure.
