脉冲染料激光与超脉冲点阵二氧化碳激光治疗烧伤后增生性瘢痕的临床对比研究

Clinical comparative study of pulsed dye laser and ultra-pulsed fractional carbon dioxide laser in the treatment of hypertrophic scars after burns

目的比较脉冲染料激光（PDL）与超脉冲点阵二氧化碳激光（UFCL）治疗烧伤后增生性瘢痕的疗效及安全性。方法2015年2月-2017年10月，笔者单位收治符合人选标准的烧伤后增生性瘢痕患者221例，对其资料进行回顾性分析。将患者按照治疗方法分为PDL组122例和UFCL组99例。PDL组患者采用PDL治疗，间隔3～4周治疗1次。UFCL组患者采用UFCL治疗，间隔6～12周治疗1次。2组患者均治疗持续至瘢痕形成12个月。治疗前及治疗后采用温哥华瘢痕量表（VSS）对瘢痕情况进行评分；治疗前及治疗后采用视觉模拟评分（VAS）法对患者疼痛进行评分；治疗前、治疗6个月及治疗12个月监测瘢痕部位血流，记录血流灌注量；记录治疗结束后3～6个月患者满意度，并计算满意率；记录患者不良反应情况，包括红斑／紫癜持续时间、治疗时VAS及误工时间。对数据行单因素方差分析、t检验、X2检验。结果（1）PDL组、UFCL组患者治疗后VSS评分均明显低于组内治疗前（t=11．34、12．77，P〈0．05）。PDL组与UFCL组患者治疗后VSS评分分别较治疗前下降（5．8±1．1）、（6．0±1．4）分，组间比较，差异无统计学意义（t=I．91，P〉0．05）。（2）PDL组、UFCL组患者治疗后VAS均明显低于组内治疗前（t=7．12、5．23，P〈0．05）。PDL组与UFCL组患者治疗后VAS分别较治疗前下降（4．0±0．6）、（3．24±1．3）分，组间比较，差异无统计学意义（t=1．93，P〉0．05）。（3）PDL组患者治疗6个月瘢痕血流灌注量较治疗前无明显变化（t=1．59，P〉0．05），治疗12个月瘢痕血流灌注量较治疗前及治疗6个月明显降低（t=3．17、6．96，P〈0．05）。UFCL组患者治疗6个月瘢痕血流灌注量较治疗前明显升高（t=6．01，P〈0．05）；治疗12个月瘢痕血流灌注量虽较治疗6个月明显下降（t=4．52，P〈0．05），但较治疗前无明显变化（t=0．92，P〉0．05）。（4）PDL组患者满意度为80．3％（98／122），与UFCL组的76．8％（76／99）比较，差异无统计学意义（X2=0．97，P〉0．05）。（5）PDL组患者红斑／紫癜持续时间为（5．24±O．7）d，明显短于UFCL组的（6．14±0．5）d（t=2．49，P〈0．05）。PDL组患者治疗时VAS为（1．94±0．9）分，明显低于UFCL组的（4．74±0．4）分（t=4．85，P〈0．05）。UFCL组患者误工时间为（9．174±0．72）d，明显长于PDL组的（3．96±0．23）d（t=3．17，P〈0．05）。结论PDL与UFCL对增生性瘢痕的疗效非常确切，而PDL的疼痛轻、损伤小、恢复时间快，尤其针对儿童及疼痛度耐受差的患者，是治疗早期增生性瘢痕安全有效的措施，值得临床推广应用。

Objective To compare the efficacy and safety of pulsed dye laser （PDL） and ultra- pulsed fractional carbon dioxide laser （UFCL） in treating hypertrophic scars after burns. Methods Two hundred and twenty one patients with hypertrophic scar after burns conforming to the study criteria were ad- mitted to our unit from February 2015 to October 2017, and their data were retrospectively analyzed. Patients were divided into group PDL （ n = 122） and group UFCL （ n =99） according to the treatment method. Pa- tients in group PDL were treated with PDL once every 3 - 4 weeks. Patients in group UFCL were treated with UFCL once every 6 - 12 weeks. Patients in both groups were treated until 12 months after having scar. Scars were scored by Vancouver Scar Scale （VSS） before and after treatment. Patients＇ pain was evaluated by Vis-ual Analogue Scale （VAS） method before and after treatment. Blood flow in scar was monitored and recor- ded before treatment and in treatment months 6 and 12. Satisfaction degree of patients was recorded 3 - 6 months after treatment, and the satisfaction rate was calculated. Adverse reactions including duration of ery- thema/purpura, VAS in treatment, and loss of working time were recorded. Data were processed with one- way analysis of variance, t test, and Chi-square test. Results （1） VSS scores of patients in groups PDL and UFCL after treatment were significantly lower than those before treatment in the same group （ t = 11.34, 12.77, P 〈 0.05）. The decreasing VSS scores of patients after treatment in groups PDL and UFCL were （5.8±1.1 ） and （6.0 ±1.4） points, respectively, and there was no statistically significant difference be- tween the two groups （ t = 1.91, P 〉 0.05）. （2） VAS of patients in groups PDL and UFCL after treatment were significantly lower than those before treatment in the same group （ t = 7.12, 5.23, P 〈 0.05 ）. The decreasing VAS of patients after treatment in groups PDL and UFCL were （4.0±0.6） and （3.2±1.3） points, respectively, and there was no statistically significant difference between the two groups （ t = 1.93, P 〉 0.05 ）. （3） Scar blood flow of patients in group PDL in treatment months 6 had no obvious change com- pared with that before treatment （ t = 1.59, P 〉 0.05） , while that in treatment months 12 significantly de- creased compared with that before treatment and that in treatment months 6 （ t = 3.17, 6.96, P 〈 0.05）. Scar blood flow of patients in group UFCL in treatment months 6 significantly increased compared with that before treatment （ t = 6.01, P 〈 0.05 ） , while that in treatment months 12 significantly decreased compared with that in treatment months 6 （ t = 4.52, P 〈 0.05 ） , but had no obvious change compared with that be- fore treatment （ t =0.92, P 〉0.05）. （4） The satisfaction degree of patients in group PDL was 80.3% （98/122） , which in group UFCL was 76.8% （76/99） , and there was no statistically significant difference between the two groups （ X 2 = 0.97, P 〉 0.05 ）. （5） The duration of erythema/purpura of patients in group PDLwas （5.2±0.7） d, significantly shorter than （6.1±0.5） dingroup UFCL （ t =2.49,P 〈0.05）. The VAS of patients in group PDL during treatment was （ 1.9 ~ 0.9 ） points, significantly lower than （4.7 ~ 0.4） points in group UFCL （ t =4.85, P 〈0.05）. Loss of working time of patients in group UFCL was （9.17±0.72） d, which was significantly longer than （3.96±0.23） d in group PDL （ t =3. 17, P 〈 O. 05）. Conclusions PDL and UFCL have definite effects on hypertrophic scar, while PDL with light pain, minor wound, and fast recovery time, is safe and effective for treatment of early hypertrophic scar and worthy of clinical promotion and application, especially for children and patients with poor pain tolerance.