目的：评价不同浓度聚维酮碘二次冲洗法对白内障手术结膜囊消毒的效果。

方法：选取我院眼科2016-08/2017-10接受白内障超声乳化联合人工晶状体植入术治疗的白内障患者600例600眼，术前、开睑后两次采用聚维酮碘冲洗法对结膜囊消毒，根据聚维酮碘二次冲洗所使用浓度不同将患者分为Ⅰ组320例、Ⅱ组280例，浓度分别为0.025%、0.05%。两组一次、二次冲洗后获取结膜囊拭子标本进行细菌鉴定，二次冲洗时评定患者的主观舒适度及球结膜充血、角膜上皮损伤情况，并统计术后眼内炎发生情况。

结果：Ⅰ组、Ⅱ组聚维酮碘一次、二次冲洗后细菌培养阳性率比较均无差异(P>0.05)。Ⅰ组结膜囊二次冲洗时异物感、痒感、畏光、眼红等主观感觉发生率明显低于Ⅱ组(P<0.05)。Ⅰ组结膜囊二次冲洗后球结膜充血、角膜上皮损伤程度较Ⅱ组显著低(P<0.05)。Ⅰ组、Ⅱ组术后分别有2眼(0.6%)、1眼(0.4%)发生眼内炎(P>0.05)。

结论：0.025%聚维酮碘已有高效的消毒作用，与0.05%聚维酮碘相比，其对于改善患者主观舒适度及减轻球结膜充血、角膜上皮损伤更有优势，更适用于白内障手术患者。

METHODS: A total of 600 cataract patients(600 eyes)who underwent phacoemulsification and intraocular lens implantation in Ophthalmology Department of the hospital during the period from August 2016 to October 2017 were enrolled in the study. Their conjunctival sacs were disinfected for twice with povidone-iodine irrigation before surgery and after opening eyelid. According to different concentrations of povidone-iodine applied in secondary irrigation, the patients were divided into group Ⅰ(320 cases)and group Ⅱ(280 cases), with concentrations of 0.025% and 0.05%, respectively. The conjunctival sac swab specimens were obtained from the two groups after the first and second irrigation to conduct bacterial identification. The subjective comfort and conditions of conjunctival hyperemia and corneal epithelial damage were assessed during second irrigation. The occurrence of endophthalmitis after surgery was statistically analyzed.

RESULTS: There was no significant difference in positive rate of bacterial culture between group Ⅰ and group Ⅱ after the first and second irrigation with povidone-iodine(P>0.05). The incidence rates of subjective feelings such as foreign body sensation, itching sense, photophobia and red eye in group Ⅰ were significantly lower than those in group Ⅱ when second irrigation for conjunctival sac(P<0.05). After second irrigation for conjunctival sac, degree of conjunctival hyperemia and corneal epithelial damage in group Ⅰ was significantly lower than that in group Ⅱ(P<0.05). There were 2 eyes(0.6%)and 1 eye(0.4%)with endophthalmitisin in group Ⅰ and group Ⅱ, respectively(P>0.05).

CONCLUSION: There is high-efficiency disinfection effect of 0.025% povidone-iodine. Compared with 0.05% povidone-iodine, there are more advantages in improving subjective comfort, reducing conjunctival hyperemia and corneal epithelial damage, which is more suitable for patients undergoing cataract surgery.