目的 探討5%那他霉素滴眼液聯(lián)合0.2%氟康唑滴眼液和氟康唑注射液治療外傷后真菌性角膜炎的臨床療效及預(yù)后情況。方法 選取2011年6月—2015年6月重慶市長壽區(qū)人民醫(yī)院收治入院的外傷后真菌性角膜炎患者180例為研究對象，按隨機數(shù)字表法將患者分為對照組和治療組，每組各90例。對照組給予0.2%氟康唑滴眼液1～2滴/次，角膜病變輕度者1次/h，中度及重度者1次/0.5 h，同時給予氟康唑注射液1 mL結(jié)膜下注射，1次/d。治療組在對照組的基礎(chǔ)上加用5%那他霉素滴眼液交替點眼1～2滴/次，1次/1 h。兩組均治療2～3周。觀察兩組的臨床療效，同時比較治療前后兩組患者的角膜炎嚴(yán)重程度評分、視力以及隨訪90 d的預(yù)后情況。結(jié)果 對照組、治療組患者總有效率分別為73.3%、88.9%，兩組總有效率比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后7、14 d，兩組患者角膜炎嚴(yán)重程度評分顯著降低，同組治療前后差異具有統(tǒng)計學(xué)意義（P<0.05）；且治療組這些觀察指標(biāo)的降低程度優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后兩組總體視力均明顯改善，同組治療前后差異具有統(tǒng)計學(xué)意義（P<0.05）；且治療組總體視力改善情況優(yōu)于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。隨訪90 d，對照組、治療組預(yù)后中等以上比率分別為85.5%、96.7%，兩組預(yù)后中等以上比率比較差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 5%那他霉素滴眼液聯(lián)合0.2%氟康唑滴眼液和氟康唑注射液治療外傷后真菌性角膜炎具有較好的療效，能夠顯著降低角膜炎嚴(yán)重程度評分，明顯改善患者視力和預(yù)后水平，值得臨床運用和推廣。

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.