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目的对某医院准分子激光手术室准分子激光原位角膜磨镶术(LASIK)后暴发弥漫性板层角膜炎(DLK)并发症进行现场流行病学调查,为DLK预防控制提供参考。方法采用现场流行病学研究方法,调查9月21日-10月21日在该医院准分子激光手术室行LASIK后并发DLK者,采用队列研究方法推断病因。结果共发现11例DLK病例,罹患率8.21%;不同负责清洗护士、月份、台序进行手术的两组人群DLK罹患率差异有统计学意义(P<0.05);患者多为一侧眼受累,临床处于Ⅰ、Ⅱ、Ⅲ期各有7眼(46.67%)、2眼(13.33%)、6眼(40.00%),潜伏期1、2、3d各有4例(36.36%)、2例(18.18%)、1例(9.10%),4例潜伏期不明确(36.36%);队列研究表明,C护士负责清洗、前5台及10月份术者是发生DLK的危险因素(P<0.05)。结论微型角膜刀头异体蛋白残留导致该次LASIK术后DLK并发症暴发;微型角膜刀头供需矛盾,清洗不彻底是暴发原因。
Objective To investigate the epidemiological investigation of the complications of diffuse lamellar keratitis (DLK) after excimer laser in situ keratomileusis (LASIK) in a hospital and provide a reference for the prevention and control of DLK. Methods A field epidemiological study was conducted to investigate the association between DLK and LASIK operating in the hospital from September 21 to October 21, and the cohort study was used to infer the etiology. Results A total of 11 DLK cases were found, with an attack rate of 8.21%. There was significant difference in the DLK attack rates between the two groups (P <0.05) There were 7 eyes (46.67%), 2 eyes (13.33%) and 6 eyes (40.00%) in clinical stage Ⅰ, Ⅱ and Ⅲ, 4 cases (36.36% %), 1 case (9.10%), and 4 cases with unclear incubation (36.36%). The cohort study showed that C nurses were responsible for cleaning, and the first 5 and October surgeries were the risk factors of DLK (P <0.05). Conclusion The residual corneal microalveolar protein residue leads to the DLK complications after LASIK. The contradiction between supply and demand of microkeratome and incomplete cleaning is the reason of the outbreak.