影响二氧化碳激光即刻联合光动力治疗尖锐湿疣后疼痛的多因素分析

Influential factors of pain after treatment of condyloma acuminate with carbon dioxide laser combined with photodynamic therapy： analysis of 40 cases

目的探讨二氧化碳（CO2）激光即刻联合局部5-氨基酮戊酸光动力疗法（ALA-PDT）治疗尖锐湿疣后疼痛的发生率、强度及影响因素。方法40例尖锐湿疣患者，男24例，女16例；年龄19～54岁，平均（31．9±9，5）岁。CO2激光去除疣体后，20％溶液均匀敷于疣体及其周围1cm内的正常皮肤，塑料薄膜封包3-4h后，使用LED—IB．1140型光动力激光治疗仪，激光波长633nm，垂直照射20rain，输出功率为90mw／cm^2。每周1次ALA—PDT治疗，共3次。采用混合线性模型统计方法分析影响因素。结果78％、88％和90％的患者在第1、2、3次治疗后出现疼痛，平均分是2．2、3．4和4．2。3例诉疼痛难忍，予冷藏的胶原贴敷料治疗。2例出现局部感染，予以夫西地酸软膏治疗。混合线性模型统计分析发现：治疗次数多者疼痛发生率亦高。学历在本科以下、睡眠质量好者疼痛分值低。结论学历、睡眠质量是疼痛强度的影响因素。

Objective To explore the incidence, intensity and influential factors of pain after the treatment of condyloma acuminate （CA） with carbon dioxide （CO2） laser immediately combined with 5-aminolaevulinic acid-photodynamic therapy （ALA-PDT）. Methods Forty patients with CA, 24 males and 16 females, aged （31.9 ±9.5） （19±54）, first underwent CO2 laser abrasion to remove the visible warts, followed by occlusive application of 20% ALA on the wart（s） and normal skin around. Three hours later vertical irradiation by type LED-IB. 1140 photodynamic therapeutic instrument with the laser way e length of 633 nm and output power of 90 mw/cm^2 was administered for 20 min. Such regime was repeated every week twice （for a total of 3 times）. Numeric rating scale was used to assess the pain intensity. Mixed linear model was used to conduct single and multiple factor analyzes. Results The pain rates were 78%, 88%, and 90% after the first, second, and third treatment respectively with the average scores of pain intensity of 2.2, 3.4, and 4.2 respectively. 3 cases complained of unbearable pain and received cold storage of Collagen Dressings therapy. Tropical infaction occurred in 2 cases and Fusidic Acid Cream therapy was administered. The number of treatment, educational level and sleep quality influenced the pain intensity significantly. Conclusion Those with a low educational level （college degree or below） and those with good sleep often have low pain intensity.