目的:探讨1,5,25g/L三种不同浓度聚维酮碘清除结膜囊细菌的效果及其副作用。方法:采用随机对照性研究方法,选择2009-09/10在武汉爱尔眼科医院行白内障手术的患者205例205眼,用随机数字法分为3组。手术前1d,用3g/L氧氟沙星眼液滴患眼3次。术前约5～10min左右,表面麻醉后依照不同分组分别用1,5,25g/L三种不同浓度聚维酮碘冲洗结膜囊。在下列时间点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1d的3g/L氧氟沙星滴眼液后,未冲洗结膜囊前;聚维酮碘冲洗结膜囊约5～10min后,手术刚开始时;手术结束时。各组间培养阳性率的比较,采用Pearson卡方检验。并注意观察使用聚维酮碘后眼部的不良反应。结果:未用药前,1g/L聚维酮碘组、5g/L聚维酮碘组及25g/L聚维酮碘组结膜囊细菌培养阳性率分别为63.0%,61.4%及59.6%;手术完成后,3组结膜囊培养阳性率分别为12.3%,11.4%及12.9%,各组在用药前与手术结束时的阳性率差别均有显著的统计学意义(χ2值分别为54.88,57.61,40.47,P值均为0)。但是无论是用药前,还是在手术结束时,三组间培养阳性率的差别均无统计学意义(未用药前χ2=0.15,P=0.92;手术结束时χ2=0.06,P=0.96)。62例使用25g/L聚维酮碘患者有4例患者出现结膜充血和轻度角膜水肿,占6%,无其他不良反应,其他2组没有发现明显不良反应,三组间差别有显著的统计学意义(χ2=9.4,P=0.009)。结论:术前使用1g/L低浓度聚维酮碘冲洗结膜囊可以有效清除眼表细菌,和使用25g/L高浓度聚维酮碘的效果相似,而且更为安全。

AIM: To study the efficacy of 1,5,25g/L of three different concentrations of povidone-iodine in reducing the rate of positive conjunctival bacteria cultures,and to observe their adverse effects.METHODS: This was a comparative study.205 patients(205 eyes) who underwent cataract phacoemulsification cataract surgery were randomly divided into three groups.At preoperative 1 day,all patients received 3g/L ofloxacin eye drops 3 times.Approximately 5-10 minutes before surgery,the conjunctival sac was irrigated with 20-30mL 1,5,25g/L povidone-iodine,correspondingly.Conjunctival cultures were obtained at the following time points: before receiving any topical medications;after application of 1-day topical 3g/L ofloxacin,before irrigating the conjunctival sac;immediately before surgery,approximately 5-10 minutes after conjunctival sac irrigation and at the end of the surgery.The rate of positive conjunctival cultures among each group was compared and significance of the difference was tested with the Pearson Chi-square test.And adverse effects of the povidone-iodine were observed.RESULTS: The rate of positive conjunctival cultures before the conjunctival irrigation in the 1g/L povidone-iodine group,5g/L povidone-iodine group and 25g/L povidone-iodine group was 63.0%,61.4% and 59.6%,respectively;after surgery was 12.3%,11.4% and 12.9%.The differences of positive rates before the conjunctival irrigation and after the surgery in the corresponding group were statistically significant(χ2=54.88;57.61;40.47,all P=0).Both before the conjunctival irrigation and after surgery,the difference of positive rate among these three groups were not statistically significant(χ2=0.15,P=0.92;χ2=0.06,P=0.96).62 cases of the 25g/L povidone-iodine group had 4 cases with conjunctival congestion and mild corneal edema,accounting for 6%,no other adverse reactions,the other two groups were found no significant adverse reactions,the difference among the three groups was statistically significant(χ2=9.4,P=0.009).CONCLUSION: Three concentrations of povidone-iodine of 1,5,25g/L have similar effects on the reduction of the bacteria in conjunctival sac,but low concentrations of povidone-iodine of 1g/L and 5g/L are more secure.

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