那他霉素联合氟康唑治疗外伤后真菌性角膜炎的疗效观察

目的探讨5%那他霉素滴眼液联合0.2%氟康唑滴眼液和氟康唑注射液治疗外伤后真菌性角膜炎的临床疗效及预后情况。方法选取2011年6月—2015年6月重庆市长寿区人民医院收治入院的外伤后真菌性角膜炎患者180例为研究对象,按随机数字表法将患者分为对照组和治疗组,每组各90例。对照组给予0.2%氟康唑滴眼液1~2滴/次,角膜病变轻度者1次/h,中度及重度者1次/0.5 h,同时给予氟康唑注射液1 m L结膜下注射,1次/d。治疗组在对照组的基础上加用5%那他霉素滴眼液交替点眼1~2滴/次,1次/1 h。两组均治疗2~3周。观察两组的临床疗效,同时比较治疗前后两组患者的角膜炎严重程度评分、视力以及随访90 d的预后情况。结果对照组、治疗组患者总有效率分别为73.3%、88.9%,两组总有效率比较差异具有统计学意义(P0.05)。治疗后7、14 d,两组患者角膜炎严重程度评分显著降低,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的降低程度优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后两组总体视力均明显改善,同组治疗前后差异具有统计学意义(P0.05);且治疗组总体视力改善情况优于对照组,两组比较差异有统计学意义(P0.05)。随访90 d,对照组、治疗组预后中等以上比率分别为85.5%、96.7%,两组预后中等以上比率比较差异具有统计学意义(P0.05)。结论 5%那他霉素滴眼液联合0.2%氟康唑滴眼液和氟康唑注射液治疗外伤后真菌性角膜炎具有较好的疗效,能够显著降低角膜炎严重程度评分,明显改善患者视力和预后水平,值得临床运用和推广。

Clinical observation of natamycin combined with fluconazole in treatment of posttraumatic fungal keratitis

Objective To observed the clinical efficacy and prognosis of Natamycin Eye Drops (5%) combined with Fluconazole Eye Drops (0.2%) and Fluconazole Injection in treatment of post-traumatic fungal keratitis. Methods Patients (180 cases) with post-traumatic fungal keratitis in People''s Hospital of Changshou Chongqing from June 2011 to June 2015 were enrolled in the study, and divided into control group (90 cases) and treatment group (90 cases) according to the random number table method. The patients in the control group were given 0.2 Fluconazole Eye Drops 1 or 2 drops/time, mild corneal lesions patients with 1 time/h, and moderate and severe patients with 1 time/0.5 h, at the same time were subconjunctival injection administered with Fluconazole Injection 1 mL, 1 time/d. The patients in treatment group were instiled alternating 5% Natamycin Eye Drops on the basis of the control group 1 or 2 drops/time, 1 time/1 h. Two groups were treated for 2-3 weeks. After treatment, the clinical efficacy was evaluated, and severity score of keratitis, visual acuity, and clinical prognosis followed up for 90 d in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 73.3% and 88.9%, respectively, and there was difference between two groups (P<0.05). After treatment 7 and 14 d, severity score of keratitis in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). After treatment, the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, visual acuity in two groups was significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After follow-up for 90 d, the ratio of medium and above clinical prognosis in the control and treatment groups were 85.5% and 96.7%, respectively, and there was difference between two groups (P<0.05). Conclusion Natamycin Eye Drops (5%) combined with Fluconazole Eye Drops (0.2%) and Fluconazole Injection has clinical curative effect in treatment of post-traumatic fungal keratitis, can significantly decrease severity score of keratitis, effectively improve visual acuity and prognosis level of post-traumatic fungal keratitis, which is worthy of clinical use.