脉冲染料激光用于烧伤后增生性瘢痕的最佳治疗间隔的前瞻性随机对照临床研究

A prospective randomized controlled clinical study on the optimal treatment interval of pulsed dye laser in treating hypertrophic scar after burn

目的观察不同治疗间隔脉冲染料激光(PDL)对烧伤患者增生性瘢痕的影响,探讨最佳治疗间隔。方法2018年5月—2019年3月,就诊于空军军医大学第一附属医院的20例烧伤后增生性瘢痕患者符合入选标准纳入本前瞻性随机对照研究。将患者按随机数字表法分为1周组[4例患者,男2例、女2例,年龄27(4,67)岁,19个瘢痕]、2周组[5例患者,男2例、女3例,年龄为9(3,55)岁,15个瘢痕]、3周组[5例患者,男4例、女1例,年龄为26(19,45)岁,15个瘢痕]、4周组[6例患者,男4例、女2例,年龄31(14,48)岁,13个瘢痕],分别按照1周1次、2周1次、3周1次及4周1次行共3个月的PDL治疗。首次治疗前及首次治疗后3个月,行温哥华瘢痕量表(VSS)评分,并计算VSS评分下降值;采用激光多普勒血流灌注成像仪测定瘢痕内血流灌注量,并计算血流灌注量变化比例。对数据行Kruskal-Wallis检验、Wilcoxon秩和检验、Wilcoxon符号秩和检验、Bonferroni校正、Fisher确切概率法检验。结果1周组、2周组、3周组、4周组患者首次治疗后3个月VSS评分均明显低于首次治疗前(Z=-3.74、-3.47、-2.69、-3.25,P<0.01);4组患者首次治疗后3个月VSS评分下降值组间总体比较,差异无统计学意义(H=2.35,P>0.05)。2周组、3周组患者首次治疗后3个月瘢痕血流灌注量明显低于首次治疗前(Z=-2.95、-2.50,P<0.05或P<0.01)。1周组、2周组、3周组、4周组患者瘢痕血流灌注量变化比例分别为-0.02(-1.05,0.69)、-0.29(-0.75,0.18)、-0.11(-0.55,0.23)、0.05(-0.61,0.75),组间总体比较差异明显(H=9.39,P<0.05);2周组患者瘢痕血流灌注量变化比例明显高于1周组(Z=2.76,P<0.01)。结论PDL治疗可降低VSS评分及瘢痕血流灌注量,2周1次及3周1次治疗对瘢痕血流灌注的改善更明显,可推荐为PDL治疗烧伤后增生性瘢痕的适宜治疗间隔。

Objective To observe the influence of different treatment intervals of pulsed dye laser(PDL)in treating hypertrophic scar after burn,and to explore the optimal treatment interval.Methods From May 2018 to March 2019,20 burn patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University were included in this prospective randomized controlled study.Patients were divided into 1 week group(4 patients,2 males and 2 females,aged 27(4,67)years,19 scars),2 weeks group(5 patients,2 males and 3 females,aged 9(3,55)years,15 scars),3 weeks group(5 patients,4 males and 1 female,aged 26(19,45)years,15 scars),and 4 weeks group(6 patients,4 males and 2 females,aged 31(14,48)years,13 scars),according to the random number table,and treated with PDL with the treatment intervals of 1 week,2 weeks,3 weeks,and 4 weeks,respectively,with total treatment cycle of 3 months.Before the first treatment and three months after the first treatment,the Vancouver Scar Scale(VSS)was conducted and the decreased value of VSS score was calculated;the laser Doppler blood flow meter was used to measure scar blood perfusion and the proportion of change in blood perfusion volume was calculated.Data were statistically analyzed with Kruskal-Wallis test,Wilcoxon rank sum test,Wilcoxon symbolic rank sum test,Bonferroni correction,and Fisher′s exact probability test.Results The VSS scores of patients in 1 week group,2 weeks group,3 weeks group,and 4 weeks group in three months after the first treatment were significantly lower than those before the first treatment(Z=-3.74,-3.47,-2.69,-3.25,P<0.01).There were no statistically significant differences in the decreased values of VSS scores in three months after the first treatment among the patients in 4 groups(H=2.35,P>0.05).Three months after the first treatment,the blood perfusion volumes of patients in 2 weeks group and 3 weeks group were significantly lower than those before the first treatment(Z=-2.95,-2.50,P<0.05 or P<0.01).The proportions of changes in blood perfusion volume of patients in 1 week group,2 weeks group,3 weeks group,and 4 weeks group were respectively-0.02(-1.05,0.69),-0.29(-0.75,0.18),-0.11(-0.55,0.23),0.05(-0.61,0.75).There were statistically significant differences among the 4 groups(H=9.39,P<0.05).The proportions of changes in blood perfusion volume of patients in 2 weeks group was statistically higher than that of 1 week group(Z=2.76,P<0.01).Conclusions PDL treatment can reduce the VSS score and blood perfusion volume of scar.One treatment every two weeks or three weeks improve the scar blood perfusion volume more significantly,and can be recommended as the appropriate treatment interval of PDL for hypertrophic scar after burn.