| Objective To investigate the distribution of bacteria in conjunctival sac of two groups of cataract patients with different preoperative aseptic treatment,and compare the clinical effect of 0.5%povidone iodine disinfectant washing conjunctival sac combined with antibiotic eye drops and antibiotic eye drops alone on killing conjunctival sac bacteria.Methods 400 patients(400 eyes)who underwent cataract surgery in Inner Mongolia Baotou Steel Hospital from October 2019 to October 2020 were selected in a randomized controlled study.All patients received routine preoperative examination of cataract,and conjunctival sac samples were collected for culture at admission(before aseptic preparation).They were randomly divided into experimental group(group A)and control group(group B),100 cases in each group.Group A:the patients were given Gatifloxacin Eye Gel(3 times/day,1 drops/times)combined with Diclofenac Sodium Eye Drops(4 times/day,1 drops/times)before the operation,and the conjunctival sac specimens were collected by 2H before the operation.After that,0.5%povidone iodine solution was used to irrigate the conjunctival sac,then it was dripped into the conjunctival sac of the conjunctiva.After 3min,it was washed with 0.9%Sodium Chloride Injection,and the conjunctival sac was collected after washing.1D The conjunctival sac was washed with 0.5%povidone iodine disinfectant after operation,and the conjunctival sac samples were collected for bacterial culture after washing and after operation.Corneal epithelium was observed after each rinse.Group B:the patients were given Gatifloxacin Eye Gel(3 times/day,1 drops/times)combined with Diclofenac Sodium Eye Drops(4 times/day,1 drops/times)before the operation,and the conjunctival sac specimens were collected by 2H before operation.After 0.9%eyes were washed with Gatifloxacin Eye Gel,the conjunctival sac was washed,the specimens of conjunctival sac were collected after washing,and0.9%Sodium Chloride Injection was rinsed after the operation was disinfected.The group was treated with 1D.Conjunctival sac specimens was collected for bacterial culture after irrigation and after operation.The positive rate and distribution of bacteria were compared between the two groups.Results 400 patients(400 eyes)with cataract surgery in Inner Mongolia Baotou Steel Hospital were included,with an average age of 70.51±10.66 years old,including 214 females and 186 males.There were 186 patients with hypertension,85patients with coronary heart disease and 26 patients with cerebral infarction.The experimental group(group A)and the control group(group B),200 cases in each group.In mercaptoacetate culture tube,the positive rate of conjunctival sac bacterial culture before and after treatment with povidone iodine disinfectant combined with antibiotic eye drops and normal saline combined with antibiotic eye drops at different time points had statistical significance(X~2=11.498,P<0.022).The bacteria were cultured and identified in mercaptoacetate culture tube,and a variety of bacteria were cultured at different time points in the two groups.Conjunctival sac samples were collected at admission and 2 hours before operation.Group A and group B were cultured in mercaptoacetate culture tube,and there was no significant difference in the positive results of pathogens between the two groups(P=0.955;P=0.073);there was significant difference in the distribution of positive pathogens between group A and group B before and after disinfection(P<0.001);there was significant difference in the distribution of pathogens between the two groups after operation(P=0.005).For different strains,the results of the two groups were different at different time points.For Staphylococcus epidermidis,Corynebacterium,Enterococcus faecalis,Streptococcus and other Gram-positive bacteria,there was significant difference between the two groups at different time points(P<0.001);for Staphylococcus aureus,gram-positive cocci and Gram-negative bacteria,there was no significant difference between the two groups at different time points(P=0.113;P=0.224;P=0.146).Conjunctival sac samples were collected at admission and 2 hours before operation.Group A and group B were cultured in blood plate culture medium.There was no significant difference in the number of positive results and colonies between the two groups(X~2=1.322,P=0.516;X~2=2.032,P=0.362).Before entering the operating room,conjunctival sac samples were collected from patients in group A and group B for blood culture,and there was significant difference in the number of positive samples and colonies between the two groups(X~2=46.610,P<0.001);after operation disinfection,there was significant difference in the number of positive colonies in blood culture medium between group A and group B(X~2=4.126,P=0.042);after operation,there was significant difference in the number of colonies between the two groups(P<0.001).Conjunctival sac specimens were cultured in blood plate culture medium.There was no significant difference between the two groups with 0-10 and 101-1000 bacterial colonies at different time points(P=0.370and 0.071,respectively).When the bacterial colony number was 11-100,there was significant difference between the two groups at different time points(P<0.001).One day after operation,69 eyes(34.5%)of group A and 33 eyes(16.5%)of group B had corneal epithelial injury.The number of corneal epithelial punctate injury 3 days after operation was 30 eyes(15.0%)in group A and 6 eyes(3.0%)in group B.Only 1 case of mild corneal epithelium injury was observed in group 1W after operation.Only 2needle point stained spots were observed in corneal fluorescein staining,and 2 eyes were removed by protein deproteinized eye drops.After 3 days,the patients were cured.There was no significant difference in corneal epithelial injury between the two groups at different time points(X~2=4.133,P=0.127).Conclusion The combination of 0.5%povidone iodine disinfectant and antibiotic eye drops can effectively reduce the bacterial load of conjunctival sac before operation.At the same time,it is safe to wash conjunctival sac with 0.5%povidone iodine disinfectant before operation. |
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