窄谱中波紫外线与红光和低功率He-Ne激光联合治疗烧伤后湿疹的临床疗效观察

Clinical efficacy observation on combination of narrow-spectrum medium-wave ultraviolet,red light, and low power He-Ne laser in treating post-burn eczema

目的探讨联合运用窄谱中波紫外线、红光、低功率He-Ne激光治疗烧伤后湿疹的临床效果。方法2014年7月-2017年7月笔者单位烧伤康复中心收治80例符合研究入选标准的烧伤后湿疹患者,对其临床资料进行回顾性分析。将患者按照治疗方法分为紫外线治疗组、红光治疗组、激光治疗组和联合治疗组,每组20例。紫外线治疗组患者湿疹采用窄谱中波紫外线治疗,隔日1次,每次10rain;红光治疗组、激光治疗组患者湿疹分别采用红光、激光治疗,均每日1次,每次10min;联合治疗组患者湿疹采用前述3种方法治疗,无先后顺序及间隔时间,各种疗法治疗时间、间歇时间等同前。4组患者均从接诊时开始持续治疗4周。每次治疗后,采用湿疹面积及严重度指数(EASI)评分法对靶组织瘙痒程度、受累体表面积、角化程度、皲裂程度进行评分,根据总分计算湿疹改善率判定疗效,记录治疗显效时间,根据首次治疗前及治疗4周后EASI总分计算治疗有效率;另观察记录患者不良反应。对数据行X^2检验、Kruskal-Wallis秩和检验、Wilcoxon符号秩和检验、单因素方差分析、LSD-t检验、Bonferroni校正。结果紫外线治疗组、红光治疗组、激光治疗组患者湿疹治疗显效时间相近,分别为(13.7±1.3)、(16.4±1.6)、(15.1±1.7)d(t=0.32、0.58、0.74,P>0.05);联合治疗组患者湿疹治疗显效时间为(6.3±0.9)d,明显短于紫外线治疗组、红光治疗组、激光治疗组(t=5.62、4.72、4.61,P<0.05或P<0.01)。治疗4周后,紫外线治疗组、红光治疗组、激光治疗组、联合治疗组患者湿疹EASI瘙痒程度、受累体表面积、角化程度、皲裂程度评分及总分均较首次治疗前明显改善(Z=5.372、4.392、4.284、3.998、4.092,3.904、4.042、4.216、3.684、3.890,5.081、4.794、4.094、3.493、3.995,5.084、4.903、4.384、3.995、4.063,P<0.05或P<0.01),前3组患者湿疹EASI各项评分及总分均相近(P>0.05),联合治疗组患者湿疹EASI各项评分及总分均明显优于紫外线治疗组、红光治疗组、激光治疗组(H=2.482、2.491、3.583、3.462、6.025,2.492、3.693、3.085、3.482、6.042,5.831、5.83I、4.893、4.092、6.931,P<0.05)。紫外线治疗组、红光治疗组、激光治疗组患者湿疹治疗有效率相近,分别为60%、60%、55%(X^2=1.46、1.63、0.97,P>0.05);联合治疗组患者湿疹治疗有效率为90%,明显高于紫外线治疗组、红光治疗组、激光治疗组(X^2=3.43、4.15、2.97,P<0.05或P<0.01)。4组患者治疗后均未出现严重不良事件;紫外线治疗组3例患者出现局部皮肤红斑,对症处理后得以缓解。结论窄谱中波紫外线与红光和低功率He-Ne激光联合治疗烧伤后湿疹的临床显效时间及疗效均优于单一疗法,且无明显不良反应,值得推广。

Objective To investigate the clinical effects of combined utilization of narrow-spectrum medium-wave uhravioiet,red light,and low power He-Ne laser on treatment of post-burn eczema. Methods From July 2014to July 2017,80patients with post-burn eczema who met the study inclusion criteria were treated in our burn rehabilitation center,and their ciinical data were analyzed retrospectively.Pa-tients were divided into ultraviolet treatment group,red light treatment group,laser treatment group,and combination treatment group according to the utilized treatment methods,with 20cases in each group.Pa- tients in ultraviolet treatment group were treated with narrow-spectrum medium-wave ultraviolet once every other day for 10minutes each time.Patients in red light treatment group and laser treatment group were trea- ted with red-light and low power He-Ne laser respectively once a day for 10minutes each time.Patients in combination treatment group were treated with combination of the above three methods without sequence or interval time,and the treatment time and interval time were the same as the previously described.All patients were treated for four weeks since the time of admission.The itching degree,surface area of the affect- ed body,degree of keratosis,and degree of cracking of target tissue were evaluated using Eczema Area and Severity Index (EASI)scoring method after each treatment.Eczema improvement rate was calculated ac- cording to the total score of EASI to determine the curative effect.The therapeutic effective time was recor-ded.The therapeutic effective rate was calculated according to the total scores of EASI before treatment for the first time and 4weeks after treatment.Besides,the adverse reactions of patients were also observed and recorded.Data were analyzed by Chi-square test,Kruskal-Wallis rank sum test,Wilcoxon signed rank sum test,one-way analysis of variance,Least Significant Difference-t test,and Bonferroni correction.Results Therapeutic effective times of eczema of patients in ultraviolet treatment group,red light treatment group, and laser treatment group were similar,respectively (13.7±1.3),(16.4±1.6),and (15.1±1.7)d (t =0.32,0.58,0.74,P >0.05).The therapeutic effective time of combination treatment group was (6.3±0.9)d,significantly shorter than that of ultraviolet treatment group,red light treatment group,or laser treatment group (t =5.62,4.72,4.61,P <0.05 or P <0.01).Compared with those before treatment for the first time,eczema itching degree,surface area of affected body,degree of keratosis,degree of cracking,and total score of EASI of patients in ultraviolet treatment group,red light treatment group,laser treatment group,and combination treatment group showed obvious improvement in 4weeks after treatment (Z= 5.372,4.392,4.284,3.998,4.092,3.904,4.042,4.216,3.684,3.890,5.081,4.794,4.094, 3.493,3.995,5.084,4.903,4.384,3.995,4.063,P <0.05 or P<0.01).Each item score and total score of EASI of eczema of patients in the first three groups were close (P >0.05),while each item score and total score of EASI of eczema of patients in combination treatment group was significantly better than those of ultraviolet treatment group,red light treatment group,and laser treatment group (H =2.482, 2.491,3.583,3.462,6.025,2.492,3.693,3.085,3.482,6.042,5.831,5.831,4.893,4.092, 6.931,P <0.05).Therapeutic effective rates of eczema of patients in ultraviolet treatment group,fed light treatment group,and laser treatment group were close,respectively 60%,60%,and 55%(X 2=1.46, 1.63,0.97,P >0.05).The therapeutic effective rate of eczema of patients in combination treatment group was 90%,significantly higher than that of ultraviolet treatment group,red light treatment group,or laser treatment group (X^2=3.43,4.15,2.97,P <0.05or P <0.01).There were no serious adverse reactions appeared in patients of all the four groups after treatment.Three patients in ultraviolet treatment group had local skin erythema,which was alleviated after symptomatic treatment.Conclusions Combination of narrow-spectrum medium-wave ultraviolet,red light,and low power He-Ne laser in treating post-burn eczema is superior to single therapy in terms of clinical effective time and efficacy,which has no obvious adverse reaction and is worthy of promotion.