剥脱性点阵CO_(2)激光联合^(32)P同位素敷贴修复烧伤后增生性瘢痕的效果

Effect of exfoliating dot matrix CO_(2) laser combined with ^(32)P isotope application in repairing hypertrophic scar after burn

目的 研究剥脱性点阵CO_(2)激光联合^(32)P同位素敷贴修复烧伤后增生性瘢痕的效果。方法 将126例烧伤后增生性瘢痕患者按照随机数字表法分为对照组(n=63)和观察组(n=63)。对照组患者均予以剥脱性点阵CO_(2)激光治疗,观察组在接受激光治疗后给予^(32)P同位素敷贴。对比两组的总有效率、瘙痒视觉模拟评分(VAS)、温哥华瘢痕量表(VSS)评分、中文版精简烧伤后健康量表(BSHS-B)评分,监测瘢痕瘙痒及血清中P物质、肿瘤坏死因子-α(TNF-α)、转化生长因子-β_(1)(TGF-β_(1))水平,统计不良反应。结果 观察组的总有效率高达93.33%,明显高于对照组的总有效率(79.67%),差异有统计学意义(P<0.05)。创面愈合后随着时间的延长,观察组、对照组患者的VAS评分、VSS评分均低于治疗前(P<0.05),创面愈合后1个月、3个月时观察组VAS、VSS评分均低于对照组(P<0.05)。治疗结束创面愈合后3个月,两组患者的BSHS-B评分明显高于治疗前(P<0.05),血清中P物质、TNF-α、TGF-β_(1)均低于治疗前(P<0.05);且观察组的BSHS-B评分明显高于对照组(P<0.05),观察组的P物质、TNF-α、TGF-β_(1)水平明显低于对照组(P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(χ^(2)=1.559,P=0.212)。结论 剥脱性点阵CO_(2)激光联合^(32)P同位素敷贴对烧伤后增生性瘢痕有确切的修复效果,利于缓解瘙痒,改善瘢痕柔软度、色泽、形态,提高生活质量,其作用可能与抑制血清中P物质、TNF-α、TGF-β_(1)等表达有关,安全性高,值得推广。

Objective To study the effect of exfoliating dot matrix CO_(2)laser combined with^(32)P isotope application in repairing hypertrophic scar after burn.Methods One hundred and twenty-six patients with hypertrophic scar after burn were divided into the control group(n=63)and observation group(n=63)according to the random number table method.The control group was treated with the exfoliated dot matrix CO_(2)laser,and the observation group was treated with^(32)P isotope application after laser treatment.The total effective rate,visual analog scale(VAS)score,vancouver scar scale(VSS)score and Chinese Simplified Post-burn Health Scale(BSHS-B)score were compared between the two groups.The levels of scar itching and serum substance P,tumor necrosis factor-α(TNF-α),transforming growth factor-β_(1)(TGF-β_(1))were monitored,and the adverse reactions were counted.Results The total effective rate in the observation group was 93.33%,which was significantly higher than 79.67%in the control group,and the difference was statistically significant(P<0.05).After wound healing,with the time extension,the VAS and VSS scores in the observation group and control group were lower than those before treatment(P<0.05),and the VAS and VSS scores in 1 and 3 months after wound healing in the observation group were lower than those in the control group(P<0.05).The BSHS-B score in 3 months after wound healing after treatment in the two groups was significantly higher than that before treatment(P<0.05),the serum substance P,TNF-αand TGF-β_(1)levels were lower than those before treatment(P<0.05),moreover the BSHS-B score in the observation group was significantly higher than that in the control group.The levels of substance P,TNF-αand TGF-β_(1)in the observation group were significantly lower than those in the control group(P<0.05).There was no statistically significant difference in the adverse reactions rate between the two groups(χ^(2)=1.559,P=0.212).Conclusion The exfoliating dot matrix CO_(2)laser combined with^(32)P isotope application has definite repair effect in the patients with hypertrophic scar after burn,which is beneficial to relieve itching,improve the softness,color and shape of scar,and increase the quality of life.Its effects may be related to inhibit the expression of substance P,TNF-αand TGF-β_(1)in serum.It has high safety and is worthy of promotion.