[1]王晓蕾,孙溦,黄小勇,等.内眼手术前生理盐水结膜囊冲洗临床效果评估[J].第三军医大学学报,2019,41(07):712-718.
 WANG Xiaolei,SUN Wei,HUANG Xiaoyong,et al.Clinical efficacy of conjunctival sac irrigation with normal saline before intraocular surgery[J].J Third Mil Med Univ,2019,41(07):712-718.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第07期
页码:
712-718
栏目:
临床医学
出版日期:
2019-04-15

文章信息/Info

Title:
Clinical efficacy of conjunctival sac irrigation with normal saline before intraocular surgery
作者:
王晓蕾孙溦黄小勇王贞李小梅
陆军军医大学(第三军医大学)第一附属医院:眼科,急救部
Author(s):
WANG Xiaolei SUN Wei HUANG Xiaoyong WANG Zhen LI Xiaomei  

Department of Ophthalmology, Department of Emergency, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
结膜囊冲洗冲洗量冲洗时间生理盐水感染内眼手术
Keywords:
conjunctival sac washing irrigation volume irrigation time normal saline infection surgery of internal eye
分类号:
R619; R779.6; R988.1
文献标志码:
A
摘要:

目的 比较生理盐水不同剂量、冲洗次数与间隔时间结膜囊冲洗效果,为急诊内眼手术前的准备方式提供循证依据。方法 选取2016年9月至2017年5月陆军军医大学第一附属医院眼科收治的126例患者进行不同剂量研究,按随机数字表法分为3组,每组42例,术前分别给予5、15、30 mL生理盐水冲洗1次,观察结膜囊冲洗后细菌培养阳性率、结膜充血、角膜受损及术后2周有无感染性眼内炎发生;采用上述剂量组结果,招募126名志愿者进行不同间隔时间研究,按随机数字表法分为3组,每组42例,并分别给予间隔0.5、1.0、1.5 h生理盐水冲洗3次,观察结膜囊冲洗后细菌培养阳性率及泪膜破裂时间变化。结果 不同剂量组冲洗前后细菌阳性率比较,差异有统计学意义(P<0.05);3组结膜充血阳性率比较,差异具有统计学意义(P<0.05),其中30 mL组结膜充血率(30.95%)显著高于5 mL组(9.52%,P<0.01);3组均无感染性眼内炎发生。不同间隔时间组冲洗3次后其细菌阳性率明显减少(P<0.05);第1次冲洗后,3组间细菌培养阳性率差异具有统计学意义(P<0.05),其中0.5 h、1.0 h组阳性率低于1.5 h组(P<0.05);经3次冲洗后,0.5 h组泪膜破裂时间短于其余2组(P<0.05),1.0 h、1.5 h组比较差异不明显。结论 5~30 mL生理盐水冲洗结膜囊均可以减少细菌阳性率,降低潜在感染率,5 mL低剂量冲洗时可明显减少结膜刺激;术前间隔1.0 h 3次以上的低剂量(5 mL)结膜囊冲洗可最大程度减少结膜囊细菌和泪膜损伤,为急诊内眼手术提供安全的结膜囊微环境。

Abstract:

Objective To compare the effects of different doses of normal saline, irrigation durations and intervals of conjunctival sac irrigation before intraocular surgery in order to provide evidence for preparation of emergency intraocular surgery. Methods A total of 126 patients admitted to our ophthalmology department from September 2016 to May 2017 were recruited in this study. The patients were randomly divided into 3 groups, with 42 cases in each group, and were given conjunctival sac irrigation once with 5, 15, and 30 mL normal saline before the operation. The positive rate of bacterial culture, conjunctival congestion, corneal damage, and incidence of infectious endophthalmitis in 2 weeks after the operation were observed. Then based on the above dose results, 126 volunteers were subjected as study groups for different intervals. These participants were randomly assigned into 3 groups (n=42) cases, and were given conjunctival sac irrigation with normal saline for 3 times at intervals of 0.5, 1.0 and 1.5 h, respectively. The positive rate of bacterial culture and tear film rupture time after irrigation were observed. ResultsIn different dose groups, there were no significant differences in the positive rate of bacteria and conjunctival congestion rate (P<0.05). The 30 mL group had obviously higher conjunctival congestion rate than the 5 mL group (30.95% vs 9.52%, P<0.05). No infectious endophthalmitis occurred in the 3 groups. The positive rate of bacteria was significantly reduced in different irrigation times and intervals after 3 rinses (P<0.05). After irrigation for the first time, the positive rate was remarkably lower in the 0.5 and 1.0 h interval groups than the 1.5 h group (P<0.05). After 3 times of irrigation, the tear film rupture time was statistically shorter in the 0.5 h group than the other 2 groups (P<0.05), and no difference was seen between the latter 2 groups. Conclusion Conjunctival sac irrigation with 5 to 30 mL normal saline reduces the bacterial positive rate, and potential infection. The conjunctival irritation can be significantly reduced by as low as 5 mL normal saline. Irrigation for over 3 times, with low dose (5 mL) in 1.0 h before operation can obviously reduce the bacteria of conjunctival sac and tear film injury, and provide a safe microenvironment of conjunctival sac for emergency intraocular surgery.

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更新日期/Last Update: 2019-04-05