壳聚糖创伤敷料用于调Q激光术后创面修复的分析

Analysis of Chitosan Wound Dressing in the Wound Repair after Q-switched Laser

目的探讨壳聚糖(医用敷料)在调Q激光术后皮肤创面修复的有效性和安全性。方法 2016年9月—2017年2月,中冶医院皮肤科纳入面部色素性疾病患者54例,将患者用随机数字表法分为实验组27例,对照组27例,在调Q开关脉冲激光治疗后,实验组患者即刻使用壳聚糖创伤敷料,之后连续5日每日敷创伤敷料,然后每隔1 d敷创伤敷料,敷料使用时间每次均为20 min/次(从治疗首日至最后观察日共28 d,创伤敷料共使用16次)。对照组患者不使用敷料,每日正常清洁面部使其自然恢复,两组患者分别于激光术后首日,第5、12、28天对受试部位红肿、灼热、色沉、凝血等炎性反应进行半定量判定,同时比较两组患者对5、12、28 d的评分和平均结痂脱痂时间以及患者敷料使用后的主观评分(包括洁净度、水润度、光滑度、舒适度、色沉度季整体满意度)。结果两组患者的激光术后创面临床疗效评价在术后第5、12、28天差异有统计学意义(P<0.05),实验组患者12天后评分等级为0分的有12例,28 d后评分等级为0分的有22例。对照组患者12天后评分等级为0分的有1例,28天后评分等级为0分的有5例。实验组优于对照组。壳聚糖创伤敷料对于改善激光术后皮肤红肿、灼热、色沉、凝血愈合等炎性症状明显优于未使用患者(P<0.05),激光术后患者创面的洁净度、水润度、光滑度、舒适度及总体满意度,使用壳聚糖创伤敷料的患者明显优于未使用患者(P<0.05)。实验组患者使用敷料的洁净度表现为优的有21例,水润度表现为优的有25例,光滑度表现为优的有23例,舒适度表现为优的有21例,色沉度表现为优的有20例,整体满意度表现为优的有22例。对照组患者使用敷料的洁净度表现为优的有15例,水润度表现为优的有10例,光滑度表现为优的有8例,舒适度表现为优的有14例,色沉度表现为优的有12例,整体满意度表现为优的有11例。两组患者的平均结痂时间[(2.13±0.45),(2.21±0.39)d],第一块痂皮脱落时间[(6.57±0.74),(8.24±0.67)d]及最后一块痂皮脱落时间[(7.65±0.32),(9.63±0.41)d],差异无统计学意义(P<0.05)。结论壳聚糖创伤敷料用于调Q激光术后创面护理可快速修复热损伤,促进伤口愈合,抑制细菌活性,改善炎性急性反应,提高创面的洁净度、水润度、光滑度、舒适度及色沉度。

Objective To study the effectiveness and safety of chitosan wound dressing in the wound repair after Q-switched laser. Meth-ods 54 cases of patients with facial pigmentation diseases in our hospital from September 2016 to February 2017 were selected and randomly divided into two groups with 27 eases in each, the experimental group used the chitosan wound dressing immediately and were given the wound dressing for the consecutive five days, and the dressing time was 20 rain every time （ 28 days in total from the first day of treatment to the last observation day, and the wound dressing was used for 16 times）, and the control group did not use the dressing, and the face was normally cleaned every day and was made naturally recover, and the inflammatory reactions of redness, heat, pigmentation, blood coagulation of the subjected sites at the 1, 5, 12 28 d were given the semiquantitative determination, and the scores at 5, 12 and 28 d, average scabbing and scab exfoliating time and subjective scores （including cleanliness, moisture, smooth- ness, comfort, color retention and overall satisfaction degree ） were compared between the two groups. Results The differences in the wound clinical curative effect evaluation after the laser surgery at 5, 12 and 28 d between the two groups were statistically significant （P〈0.05）, and in the experimental group, the ranking of 12 cases was 0 after 12 days, the ranking of 22 cases was 0 after 28 days, in the control group, the ranking of 1 case after 12 days was 0, and the ranking of 5 cases after 28 days was 0, and the ranking in the experimental group was better than that in the control group （P〈0.05）, the cleanliness, moisture, smoothness, comfort, color retention and overall satisfaction degree of patients using the chitosan wound dressing was obviously better than that of patients without using the chitosan wound dressing （P〈0.05）, in the experimental group, the cleanliness of 21 eases was excellent, the moisture of 25 eases was excellent, the smoothness of 23 cases was excellent, and comfort of 21 cases was excellent, and color retention of 20 cases was excellent and the overall satisfactory degree of 22 eases was excellent, in the control group, the cleanliness of 15 eases was excellent, the moisture of 10 cases was excellent, the smoothness of 8 cases was excellent, the comfort of 14 cases was excellent and the color retention of 12 cases was excellent and the overall satisfactory degree of 11 cases was excellent, and the t test analysis showed that the differences in the average scabbing time, first decrustation time and last decrustation time between the two groups were not statis- tically significant[（2.13±0.45）d vs （2.21±0.39）d, （6.57±0.74）d vs （8.24±0.67）d, （7.65±0.32）d vs （9.63±0.41）d]（P〈0.05）. Conclu- sion The chitosan wound dressing in the wound repair after Q-switched laser can rapidly repair the heat injury, promote the wound healing, suppress the bacterial activity, improve the inflammatory acute reaction and improve the wound cleanliness, moisture, smooth- ness, conlfort, color retention.