超脉冲CO2点阵激光对烧伤后增生性瘢痕的治疗效果研究

Therapeutic effect of ultra pulse carbon dioxide fractional laser on treating hypertrophic scar after burn

目的 研究超脉冲CO2点阵激光对烧伤后增生性瘢痕的治疗效果.方法 选取45例烧伤后增生性瘢痕患者.每次激光治疗包括1次超脉冲模式扫描照射与1次Scaar FX模式扫描照射,每月治疗1次,共治疗4～6次.超脉冲照射参数为：能量150～175 mJ,频率40 Hz,孔距约4～～5 mm,每孔照射时间2～3 s;Scaar FX模式照射参数为：能量60～150 mJ,频率250 Hz,密度1％～3％.在首次治疗前和全部治疗结束后6个月,采用温哥华瘢痕量表（VSS）对瘢痕的形态进行评分,用视觉模拟评分法（VAS）对瘢痕疼痛、瘙 痒情况进行评分,采用效果显著、有效和无效来评价治疗效果,记录治疗过程中发生的不良反应.结果 全部治疗后6个月患者的VSS评分、疼痛评分、瘙痒评分分别为4.16±1.72、1.58±0.62和1.24±0.74,而治疗前数值分别为10.17±1.96、2.98±0.89、2.31±0.97,其差异均具有统计学意义（均P＜0.01）.治疗对所有患者均有效,其中效果显著35例,有效10例,且治疗后6个月内未出现复发现象.3例患者在首次治疗后瘢痕上出现水疱,水疱破溃形成创面,经换药治疗7～10d后愈合.结论 超脉冲CO2点阵激光治疗烧伤后增生性瘢痕效果确切、不良反应轻、无复发,值得临床推广.

Objective To study the therapeutic effect of ultra pulsed carbon dioxide fractional laser on treating hypertrophic scar after burn.Methods Forty-five patients with hypertrophic scar after burn were selected.Each laser treatment included an ultra-pulse mode and a Scaar FX mode scan irradiation,and the treatment wasconducted once a month for 4 to 6 times.In the ultra-pulse irradiation,the energy was 150～175 mJ,frequency was40 Hz,hole spacing was about 4～5 mm,and irradiation time per hole was 2～3 s,and in Scaar FX mode energy was60～150 mJ,frequency 250 Hz,and density 1% to 3%.Before the first treatment and 6 months after the end of thetreatment,the Vancouver scar scale （VSS） was used to score the scar morphology,and the visual analog scale （VAS）was used to score the scar pain and itching.The effect of the treatment was classified as significant,effective andinvalid.In addition,adverse reactions occurred during the treatment were recorded.Results After six months of thetreatments,the VSS score,VAS pain score,and VAS pruritus score of the patients were 4.16±1.72,1.58±0.62,and1.24±0.74,respectively,while the pre-treatment values were 10.17±1.96,2.98±0.89,and 2.31±0.97,respectively.The differences were statistically significant （all P〈0.01）.The treatment was effective in all patients,and the effectwas significant in 35 cases,effective in 10 cases,and no recurrence occurred within 6 months after treatment.In 3patients,blisters appeared on the scar after the first treatment,and the blister collapsed to form a wound.After thedressing change,the blisters healed after 7 to 10 days.Conclusion Ultra pulsed carbon dioxide fractional laser iseffective in treating hypertrophic scar after burn,with mild adverse reactions and no relapse,which is worthy ofclinical promotion.