摘要
目的分析2000年至2009年10年眼内炎的病因变化趋势、病原学特征及治疗效果。方法2000年1月至2009年12月临床诊断为眼内炎并住院治疗的165例患者172只眼纳入研究。患者中，男性122例，女性43例；平均年龄（39．0±23．7）岁。视力光感者16只眼；光感～0．05者135只眼；〉O．05者12只眼。9例儿童患儿无视力记录。外源性眼内炎141例，占85．45％。其中，外伤89例；内眼手术后43例；其他9例。内源性眼内炎24例，占14．55％。玻璃体腔注射10mg／ml的万古霉素0．1ml¨3只眼。有房水或房水加玻璃体标本病原微生物培养记录152只眼，培养结果阳性者行药物敏感性试验。分析病原微生物培养、药物敏感性试验结果及药物治疗效果和2000年至2004年和2005年至2009年前后5年间不同类型眼内炎患者的构成比；采用SPSS统计软件对数据进行统计学分析处理。结果行病原微生物培养的152只眼中，培养结果阳性42只眼，占27．63％。其中，细菌阳性28只眼；真菌阳性12只眼；丝状真菌和凝固酶阴性葡萄球菌混合生长2只眼。内源性眼内炎病原微生物培养结果阳性比例高于外源性眼内炎，差异有统计学意义（χ2=4．7219，P=0．0298）。药物敏感性试验结果显示，G＋菌对青霉素类、头孢菌素类和除左氧氟沙星外的氟喹诺酮类普遍耐药；对万古霉素、复方新诺明及利福平敏感。干预治疗效果以外源性眼内炎中内眼手术所致者最好，外伤者次之，内源性眼内炎治疗效果最差。三者比较，差异有统计学意义（χ2=38．9413，P=0．0000）。治疗后BCVA〉0．05者23只眼，与治疗前比较，差异有统计学意义（χ2=3．8673，P=0．0492）。前后5年，内源性眼内炎由7．89％上升至20．23％，差异有统计学意义（χ2=5．0140，P=0．0251）。外源性眼内炎中，内眼手术后、外伤所致者分别由27．63％、60．53％下降为24．72％、48．31％；而其它原因所致者则由3．95％上升至6．74％。结论2000年至2009年10年内源性眼内炎发生呈增长趋势。病原微生物培养阳性率低，但内源性眼内炎病原微生物培养结果阳性率相对较高。治疗效果以内眼手术所致眼内炎最好；内源性眼内炎最差。整体视力预后较差。
Objective To analyze the etiology trends, etiological characteristics treatment effects of endophthalmitis in 10 years which from 2000 to 2009 in our hospital. Methods 165 patients （172 eyes） of endophthalmitis in hospital from January 2000 to December 2009 were enrolled in this study. The patients included 122 males and 43 females. The median age was （39.0 ± 23.7） years. The best visual acuity （BCVA） was non light perception in 16 eyes, light perception - 0.05 in 135 eyes, 2〉0.05 in 12 eyes. Nine children did not have visual acuity records. There were 141 patients （85.45%） with exogenous endophthalmitis which including 89 patients of trauma, 43 patients after intraocular surgery and nine others; 24 patients （14.55%） with endogenous endophthalmitis. 113 eyes were received intravitreal injection with vancomycin 0.1 ml （10 mg/ml）. 152 eyes had pathogenic microorganisms culture records of aqueous humor or aqueous humor and vitreous. The positive records were given drug sensitivity test. The types of endophthalmitis, pathogenic microbial culture and drug sensitivity test results and treatment effects were analyzed. Software of SPSS was used for the clinical data statistical analysis in this study. Results Of 152 eyes with a record of aqueous/vitreous samples pathogenic bacteria culture, 42 eyes （27.63%） had apositive result. In which, 28 eyes showed positive in bacteria culture, 12 eyes was positive in fungus culture and two eyes had a positive in culture of fungus and bacteria growing. The culture positive rate was higher in t,xogenous endophthalmitis than that in endogenous endophthalmitis （χ2 = 4. 721 9, P= 0. 029 8）. Most of the G＋ positive bacteria were resistance to cephalosporin and quinolones except levofloxacin; but sensitive to vaneomycin, rifampin and sulfamethoxazole. The intervention effect was more available for postoperative endophthalmitis than that for traumatic endophthalmitis and endogenous endophthalmitis, the difference was statistically significant（χ2=38. 941 3 ,P=0. 000 0）. The BCVA of 23 cases was 〉0.05 after the treatment, compared with before the treatment, the difference was statistically significant （χ2 =3. 867 3, P=0. 049 2）. Compared the ratio of past five yearst to that of recent five years, endogenous endophthalmitis was increased from 7.89% to 20.23% （χ2 = 5. 014 0, P = 0. 025 1）;postoperative endophthalmitis decreased from 27.63% to 24.72%, and traumatic endophthalmitis decreased from 60.53% to 48.31%, other causes linked endophthalmitis raised from 3.95% to 6.74%. Conclusions In recent 10 years （from 2000 to 2009）, the patients with endogenous endophthalmitis are growing. The positive rate of pathogenic agent culture is low, but the culture positive rate of the specimens from endogenous endophthalmitis is higher than that from exogenous endophthalmitis. The treatment was more available for postoperative endophthalmitis than that for other two types of endophthalmitis. The general visual prognosis is poor.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2012年第6期588-592,共5页
Chinese Journal of Ocular Fundus Diseases
关键词
眼内炎
分类
微生物敏感性试验
预后
Endophthalmitis/classification
Microbial sensitivity
Prognosis
