本文選題：真菌性角膜潰瘍　切入點(diǎn)：診斷　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討真菌性角膜潰瘍?cè)\療方法,比較、分析不同藥物對(duì)真菌性角膜潰瘍不同程度病情的臨床療效。材料及方法:選取吉林大學(xué)第一醫(yī)院眼科2014年1月1日到2016年12月1日,共計(jì)115例真菌性角膜潰瘍患者115只患眼。經(jīng)檢查明確診斷,按患者的角膜潰瘍程度分類,分為單獨(dú)那他霉素、單獨(dú)伏立康唑及那他霉素聯(lián)合伏立康唑三組進(jìn)行局部藥物治療,比較、分析不同藥物對(duì)真菌性角膜潰瘍不同程度病情的臨床療效。結(jié)果:1)診斷及檢查結(jié)果情況:入組115名患者115只患眼分別通過(guò)真菌培養(yǎng)及共聚焦顯微鏡檢測(cè)。真菌培養(yǎng)結(jié)果顯示:陽(yáng)性81例(70.43%),陰性34例(29.57%);共聚焦顯微鏡檢測(cè)結(jié)果顯示:陽(yáng)性101例(87.83%),陰性14例(12.17%)。比較兩種檢測(cè)方法,結(jié)果顯示共聚焦顯微鏡陽(yáng)性檢出率優(yōu)于真菌培養(yǎng)檢出率,差異有統(tǒng)計(jì)學(xué)意義(χ~2=10.531,p=0.001)。2)藥物治療效果比較:不同病情程度分級(jí)時(shí)同種藥物治療效果比較,藥物為那他霉素治療時(shí)的效果,不同病情程度患者的治療效果無(wú)統(tǒng)計(jì)學(xué)意義(H=5.061,p=0.061),有效率差異也無(wú)統(tǒng)計(jì)學(xué)意義(p=0.177);藥物為伏立康唑治療時(shí)的治療效果,經(jīng)比較不同病情程度患者的治療效果差異無(wú)統(tǒng)計(jì)學(xué)意義(H=5.840,p=0.054),其中輕、中度的總有效率均高于重度,有統(tǒng)計(jì)學(xué)意義(p=0.038);藥物為那他霉素聯(lián)合伏立康唑用藥治療時(shí)的治療效果經(jīng)比較,不同病情程度患者的治療效果無(wú)統(tǒng)計(jì)學(xué)意義(H=1.116,p=0.558),總有效率也無(wú)意義(p=0.403)。本文輕度患者17例,總有效率為100%;中度患者29例中,總有效率為100%;重度患者69例,總有效率為78.26%。輕、中度患者經(jīng)比較不同藥物治療的效果差異無(wú)統(tǒng)計(jì)學(xué)意義(輕:H=0.813,p=0.666;中:H=0.011,p=0.995);重度真菌性角膜潰瘍?nèi)N治療方法的總有效率比較:那他霉素聯(lián)合伏立康唑的總有效率高于單獨(dú)應(yīng)用那他霉素或伏立康唑,差異有統(tǒng)計(jì)學(xué)意義(H=9.118,p=0.010),總有效率有意義(p=0.037)。結(jié)論:1)真菌性角膜潰瘍病情程度越輕,藥物治療效果越好,病情程度越重,藥物治療效果越差。2)真菌性角膜潰瘍患者早期檢測(cè)的陽(yáng)性檢出率,共聚焦顯微鏡檢測(cè)高于真菌培養(yǎng)。3)輕、中度患者單一用藥療效好,藥物毒性反應(yīng)低、患者承擔(dān)的經(jīng)濟(jì)壓力較小,與聯(lián)合用藥治療效果無(wú)顯著差異,臨床建議單一用藥。重度患者單獨(dú)應(yīng)用伏立康唑效果較差,而那他霉素治療重度與輕、中度患者效果無(wú)顯著差異,但聯(lián)合用藥有效率高于單獨(dú)使用那他霉素,差別有統(tǒng)計(jì)學(xué)意義,臨床上建議早期聯(lián)合用藥。4)對(duì)于藥物治療無(wú)效的患者,應(yīng)行手術(shù)治療。
[Abstract]:Objective: to explore the methods of diagnosis and treatment of fungal corneal ulcer. To analyze the clinical effect of different drugs on fungal corneal ulcer. Materials and methods: the first Hospital of Jilin University from January 1st 2014 to December 1st 2016. 115 eyes of 115 patients with fungal corneal ulcer were divided into three groups according to the degree of corneal ulcer. To compare, The clinical effect of different drugs on fungal corneal ulcer was analyzed. Results: 115 eyes of 115 patients with fungal corneal ulcer were examined by fungal culture and confocal microscope. The results showed that 81 cases were positive and 34 cases were negative. The results of confocal microscopy showed that 101 cases were positive in 87.83%, 14 cases were negative in 12.17%. The results showed that the positive rate of confocal microscope was better than that of fungal culture, and the difference was statistically significant (蠂 ~ 2 ~ 2 ~ (10.531) P ~ (0.001) 路2). The effect of drug treatment was compared with that of natamycin at different grade of illness, compared with that of natamycin, and the positive rate of confocal microscope was better than that of fungal culture (蠂 ~ (2 +)). There was no statistical significance in the treatment effect of patients with different degree of illness. There was no significant difference in the effective rate and the effective rate was 0.1770.The drug was the treatment effect of Vriconazole, and there was no significant difference in the effective rate between the patients and the patients with different degrees of illness, and there was no significant difference in the effective rate between the two groups. There was no significant difference in the therapeutic effect between patients with different degree of illness. The total effective rate of mild and moderate patients was higher than that of severe patients, and there was statistically significant difference between the two groups. There was no statistical significance in the treatment effect of patients with different degree of illness. The total effective rate was 0.558, and the total effective rate was neither significant nor significant. In this paper, 17 patients were mild, the total effective rate was 100; in 29 patients, the total effective rate was 100; in 69 patients with severe disease, the total effective rate was 78.26. There was no significant difference in the effect of different drug treatment in moderate patients (light: H0. 813 p0. 666; moderate: HU 0. 011 p0. 995; total effective rate of severe fungal corneal ulcer: the total effective rate of natamycin combined with voleconazole was higher than that of single) in moderate patients with severe fungal corneal ulcers: the total effective rate of natamycin combined with voleconazole was higher than that of single. Taking natamycin or voleconazole alone, The difference was statistically significant. The total effective rate was significant. Conclusion: the degree of fungal corneal ulcer is lighter, the better the therapeutic effect is, the more serious the disease is. The worse the drug treatment was, the lower the positive rate of early detection in fungal corneal ulcer patients was. Confocal microscopy was higher than fungal culture. 3) mild, moderate patients had good efficacy and low drug toxicity. The patients were under less economic pressure and had no significant difference with the combination therapy. The clinical recommendations were single use. The severe patients were poor in the effect of single use of voliconazole, while natamycin had no significant difference in the treatment of severe, mild and moderate patients, and no significant difference was found in the treatment of severe, mild and moderate patients. However, the effective rate of combined use of natamycin was higher than that of natamycin alone, the difference was statistically significant.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R772.21

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