王薇白内障手术感染研究报告.ppt

对策：北京大学第三医院老年眼病组 手术当日： 常规散瞳 冲洗泪道 冲洗结膜囊 进入手术等待室：局部麻醉（球后2%利多卡因或表面麻醉-美多丽滴眼液） 碘伏眼表手术野消毒（护士） 75%酒精局部脱碘 手术贴膜 BSS冲洗结膜囊 随时总结，加强医护沟通，保障程序有效流动 对策：北京大学第三医院老年眼病组 全身准备： 无手术禁忌 皮肤无感染灶 控制血糖：空腹血糖 至少停用抗凝剂1周 眼部准备： 除外眼部感染性疾病，如急性结膜炎、慢性泪囊炎 处理严重的睑内、外翻 手术前3天，术眼用抗菌素/抗生素滴眼液3-4次/天 美国同学发来的美国医德/医训： 如有可能，尽全力治愈，尽管这只适用于少数病人； 尽医者所能缓解病情或肿瘤负荷； 再次为尽医者所能缓解症状； 无论任何时候，医者必须牢记 Do no harm! 谢谢大家！ Endophthalmitis following other types of intraocular surgery has a similar microbiological profile with the following exceptions: 其它内眼手术引发眼内炎的致病微生物类同，但以下情况例外： 滤过性手术：最常见致病菌为链球菌，嗜血流感菌、凝固酶阴性葡萄球菌In filtering bleb-associated cases, the most common offending species is Streptococcus, followed by Haemophilus influenzae and coagulase-negative staphylococci.11,19 迟发性眼内炎：革兰氏阳性杆菌或其它In chronic postoperative endophthalmitis, an important causative organism is Propionibacterium acnes, a slow-growing, gram-positive bacillus that is associated with a characteristic white, intracapsular plaque that develops weeks to months and years after cataract surgery.13,14 Coagulase-negative staphylococci, fungal species, and unusual gram-negative organisms also have been reported to cause chronic postoperative endophthalmitis.11 Mortality/Morbidity Fortunately, postsurgical endophthalmitis, unlike endogenous endophthalmitis, rarely causes any extraocular complications. Rarely, untreated cases can lead to late panophthalmitis and orbital cellulitis, prompting need for enucleation. Morbidity associated with postoperative endophthalmitis can be substantial and is related not only to the acute process but also to late sequelae. In general, the risk of severe visual loss in patients with acute endophthalmitis is higher in patients who develop infections from more virulent organisms and do not seek treatment promptly.1,10,11 Fortunately, 70-80% of patients with postoperative endophthalmitis have infections caused by coagulase-negative staphylococci, and the visual prognosis in these cases is usually good with rapid treatment. Race No r