| Objective: To evaluate the diagnostic efficacy of fungal corneal ulcer in different degree of fungal corneal ulcer and compare the different kinds of drugs.To explore the diagnosis and treatment of fungal corneal ulcer(FCU),and compare and analyze the clinical curative effect of different drugs in different degrees of FCU.Materials and Methods: Collect the base data of 115 eyes of 115 patients which were admitted by the Bethune First Hospital of Jilin Univers ity from January 2014 to November 2016.After a c lear diagnosis,according to the classification of patients with corneal ulceration,The patients were divided into natamycin alone,voriconazole alone and natamyc in combined with voriconazole for drug therapy.The clinical efficacy of the drug on different degrees of mycotic corneal ulcer was analyzed,so as to summarize the c linical experience,to safer and more effective Drugs to treat fungal corneal ulcers.A total of 115 eyes of 115 patients with FCU were selected from the First Hospital of Jilin University from January 1,2014 to November 1,2016.After a clear diagnosis,patients were divided into three groups of local drug therapy according to the degree of FCU: natamyc in group,voriconazole group and natamyc in combined with voriconazole group.To compare and analyze the c linical curative effect of different drugs in different degrees of FCU.Result: Diagnosis and examination results: In this study,115 patients were detected by fungal culture and confocal microscopy.Fungal culture results showed positive in 44 cases,71 cases were negative,positive rate was 38.26%,negative detection rate was 61.74%;confocal microscopy results were positive in 101 cases,14 cases of negative,positive detection rate was 87.83% The negative detection rate was 12.17%.The results showed that the positive detection rate of confocal microscopy was higher than that of fungal culture,the difference was statistically significant(x2 = 60.630,p <0.001).The therapeutic effect of natamyc in was statistically significant(H = 5.061,P <0.05).(2)The effect of drug treatment: the effect of the same drug treatment in different degree of disease classification,the effect of natamycin treatment was not statistically significant(H =(P = 0.061).There was no significant difference in the total effective rate between the two groups(p = 0.061,p = 0.061),and the difference was not statistically significant(p = 0.054),the total effective rate of mild patients and moderate patients were higher than the total effective rate of severe patients,the difference was statistically s ignificant(p = 0.038);drug for natamycin combined with voriconazole drug treatment There was no statistically significant difference(P = 0.641)in the total effective rate between the two groups(P = 0.999,p = 0.607).In the mild fungal corneal ulcer in 17 cases,the total effective rate of drug treatment was 100%;moderate fungal corneal ulcer in 29 cases,the total effective rate of drug treatment was 93.10%;severe fungal corneal ulcer in 69 cases,drug treatment The efficiency is 78.26%.There were no significant differences in the therapeutic effects of mild and moderate fungal corneal ulcers compared with different drugs(mild: H = 0.813,p = 0.666;middle: H = 0.023,p = 0.498);severe fungal corneal ulcer The total effective rate of natamyc in plus voriconazole alone was significantly higher than that of natamyc in alone or voriconazole alone(p = 0.037).In summary,the conclusion is that fungal corneal ulcer disease severity of the more light,the better the effect of drug treatment,the severity of the more severe the worse the effect of drug treatment;for different drug treatment results for patients with mild and moderate single drug and Combined with drug efficacy was no significant statistical difference,so the clinical recommendation of a single drug is better,because of drug toxic ity is low,patients bear less economic pressure,no significant statistical difference in the treatment effect;severe combination therapy than s ingle drug efficacy,The total effective rate,there are statistical differences,the clinical recommendations on early joint use.For patients with drug treatment failure,feasible amniotic membrane transplantation,conjunctival flap covering and penetrating keratoplasty.1)Diagnosis and examination results: In this study,115 patients were detected by fungal culture and confocal microscopy.Fungal culture results showed that 81 cases(70.43%)were positive and 34 cases(29.57%)were negative;confocal microscopy results showed that 101 cases(87.83%)were positive and 14 cases(12.17%)were negative.The results showed that the positive detection rate of confocal microscopy was higher than that of fungal culture,the difference was statistically significant(?2= 10.531,p=0.001).2)Comparison of therapeutic effects: The effect of the same drug treatment in different degree of disease classification,the effect of natamycin treatment was not statistically significant(H=5.061,p=0.061).And there was no significant differences in effective rate(p=0.177).The effect of voriconazole treatment was not statistically significant(H=5.840,p=0.054).However,the total effective rate of mild and moderate FCU was significantly higher than that of severe FCU,with statistical significance(p=0.038).The effect of natamycin combined with voriconazole treatment was not statistically significant(H=1.116,p=0.558).And there was no significant differences in total effective rate(p=0.403).In this paper,17 patients with mild FCU,the total effective rate was 100%;29 patients with moderate FCU,the total effective rate was 100%;and 69 patients with severe FCU,the total effective rate was 78.26%.There were no significant differences in the therapeutic effects of mild and moderate FCU treated with different drugs(mild group: H=0.813,p=0.666;moderate group: H=0.011: p=0.995).The total effective rate of natamyc in combined with voriconazole was significantly higher than that of natamyc in alone or voriconazole alone in the treatment of severe FCU,and the difference was statistically significant(H=9.118,p=0.010).And there was a significant difference in total effective rate(p=0.037).Conclusion: 1)the degree of fungal corneal ulcer disease,the more light,the better the effect of drug treatment,the severity of the more severe,the effect of drug treatment worse;2)mild to moderate patients with single drug efficacy,drug toxicity is low,the economic burden of patients The pressure is small,and the effect of combination therapy was no significant difference,the clinical recommendations of a single medication.Severe patients with voriconazole alone is less effective,and natamycin severe and mild to moderate patients with no significant difference in efficacy,but the combination of effective than natamyc in alone,the difference was statistically significant,the clinical recommendations early combined with treatment;3)for drug therapy ineffective patients should be surgical treatment.1)The lighter the degree of FCU,the better the effect of drug treatment;the more serious the disease,the worse the effect drug treatment.2)Compared with combination of drugs,mild and moderate patients treated with single drug had better curative effect,lower toxicity and economic pressure,and there was no significant difference of treatment effect between the two groups.So,single drug was recommended in clinical treatment;Severe patients treated with voriconazole alone is less effective,and there was no significant difference in efficacy of different kinds of patients treated with natamyc in,but the combined rate is higher than the single use of natamyc in,and the difference was statistically significant.So,early combination of drugs was recommended in clinical treatment;3)For patients who are not effective in drug therapy,surgical treatment should be performed. |
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