序贯激光治疗早期增生性烧伤瘢痕的临床效果  

Clinical effects of sequential laser treatments on early stage hypertrophic burn scars

作　　者：谢卫国[1] 雷芳[1] 王娟[1] 徐娟[1] 阮晶晶[1] 李泽[1] Xie Weiguo;Lei Fang;Wang Juan;Xu Juan;Ruan Jingjing;Li Ze(Institute of Burns,Tongren Hospital of Wuhan Universi-ty ＆ Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学附属同仁医院暨武汉市第三医院烧伤研究所,430060

出　　处：《中华烧伤杂志》2018年第9期615-623,共9页Chinese Journal of Burns

基　　金：国家自然科学基金面上项目（81772097）;湖北省自然科学基金（2016CFB473）

摘　　要：目的观察脉冲染料激光（PDL）＋剥脱性点阵二氧化碳激光序贯治疗对早期增生性烧伤瘢痕的临床效果。方法2016年1月-2017年12月，到笔者单位就诊的221例烧伤患者创面愈合6个月以内全身各部位增生性瘢痕228个符合人选标准纳入本前瞻性研究，先采用PDL治疗，每个月治疗1次，至瘢痕充血程度评分降至2分以下时，改行剥脱性点阵二氧化碳激光治疗，每3个月治疗1次。记录治疗开始时间、次数及随访时间。首次治疗开始前（以下称治疗前）、末次随访（以下称治疗后），采用自制瘢痕评定量表评定瘢痕充血程度、厚度及柔韧度，对观察时间为创面愈合后6～18个月的患者，按年龄、瘢痕部位、治疗开始时间及治疗次数分组比较瘢痕评分；采用激光散斑血流成像仪测定瘢痕血流值；以瘙痒语言评分量表评估瘢痕瘙痒情况。治疗后调查医患双方疗效满意度参照李克特量表评分，记录治疗全程的治疗反应或不良反应。对数据行配对t检验、Mann-Whit-neyU检验、Wilcoxon符号秩和检验、Kruskal-WallisH检验及Spearman秩相关分析。结果（1）本组患者于创面愈合后（64±36）d开始治疗，行PDL治疗（2．5±1．3）次，行剥脱性点阵二氧化碳激光治疗（2．2±1．2）次，随访时间（331±189）d。（2）本组患者治疗后瘢痕的充血程度、厚度、柔韧度及总分分别为（1．4±0．9）、（2．0±0．8）、（1．7±0．8）、（5．0±2．1）分，明显低于治疗前的（4．1±0．7）、（3．1±0．8）、（3．0±0．9）、（10．2±2．0）分（t=43．332、24．968、28．063、46．394，P〈0．01）。（3）本组患者中观察时间为创面愈合后6～18个月的有120例共123个瘢痕。治疗后，不同年龄段患者瘢痕充血程度、厚度、柔韧度评分及总分总体比较差异均无统计学意义（X2=d．339、1．826、1．375、2．879，P〉0．05）；不同部�Objective To observe the clinical effects of sequential treatments of pulsed dye laser （PDL） and ablative fractional carbon dioxide laser on early stage hypertrophic burn scars. Methods From January 2016 to December 2017, 221 patients with 228 hypertrophic scars in all parts of body within 6 months post healing, conforming to the study criteria and treated in our department, were included in this prospective study. They were first treated by PDL, repeated at an interval of one month until the vascularity score of scar fell below 2 points, and then treated by ablative fractional carbon dioxide laser, repeated at an interval of 3 months. Their start time and numbers of treatment and follow-up time were recorded. Before the first treatment （hereinafter referred to as before treatment） and at the last follow-up （hereinafter referred to as after treatment） , the vascularity, thickness, and pliability of scars were scored by a self-made scar rating scale. The scores of patients with the observation time between 6 to18 months post healing were compared a- mong scars of patients grouped by age, body site of scar, starting time of treatment and numbers of treat- ment. The laser speckle contrast imaging technique was used to measure the blood flow value of scars. The itching symptom of the scars was evaluated by the Verbal Rating Scale. The satisfaction to the final effects of the doctors and patients was investigated and scored separately by Likert scale after treatment. The therapeu- tic or adverse reactions were recorded during the treatment. Data were processed with paired t test, Mann- Whitney U test, Wilcoxon signed rank sum test, Kruskal-Wallis H test, and Spearman rank correlation analy- sis. Results （ 1 ） The patients were treated on （64±36） d post healing, by PDL for （2.5±1.3 ） times and by ablative fractional carbon dioxide laser for （2.2±1.2） times. The follow-up time was （331±189） d. （2） The vascularity, thickness, pliability scores and total scores of scars were （ 1.4

关 键 词：烧伤 瘢痕 激光疗法 脉冲染料激光 二氧化碳激光 

分 类 号：R644[医药卫生—外科学]