强脉冲光联合长脉冲1064 nm Nd:YAG激光治疗早期增生性烧伤瘢痕的临床效果

Clinical effect of intense pulsed light combined with long-pulse 1064 nm Nd:YAG laser in the treatment of early hypertrophic burn scars

目的研究长脉冲1064 nm Nd:YAG激光联合强脉冲光(IPL)治疗早期增生性烧伤瘢痕的效果及安全性。方法前瞻性选取内蒙古包钢医院烧伤外科激光治疗中心2021年1月至2022年1月收治的90例烧伤瘢痕修复患者作为研究对象。按随机数字表法随机分为3组,每组30例。IPL治疗组患者采用IPL治疗3个月,治疗间隔时间为4周,共治疗3次。长脉冲激光治疗组患者采用长脉冲1064 nm Nd:YAG激光治疗3个月,治疗间隔时间为2周,共治疗6次。联合治疗组患者采用长脉冲1064 nm Nd:YAG激光联合IPL治疗,即首次为1064 nm Nd:YAG激光治疗,满2周进行IPL治疗,交替进行,每次治疗间隔为2周,共治疗6次。观察并比较3组患者的临床疗效、视觉模拟评分法(VAS)评分、温哥华瘢痕量表(VSS)评分、患者满意度、不良反应及复发情况。数据分析采用χ2检验、Fisher确切概率法、双因素重复测量方差分析、Lsd-t检验、Kruskal-Wallis检验和Mann-Whitney检验。结果联合治疗组患者临床总有效率为96.7%(29/30),高于IPL治疗组患者93.3%(28/30)和长脉冲激光治疗组患者73.3%(22/30)(P<0.05)。治疗1、2、3个月时,3组VAS评分比较,差异均有统计学意义(P<0.05),且均低于治疗前(P<0.05)。与治疗前比较,3组治疗1、2、3个月时VSS评分均下降(除长脉冲激光治疗组治疗1个月时,P<0.05),且3组比较,差异亦有统计学意义(P<0.05)。治疗后3组患者瘢痕色素、血供、柔韧度、厚度及总分均下降,且联合治疗组患者瘢痕色素、血供、柔韧度、厚度及总分低于其他两组(P<0.05)。治疗期间,联合治疗组和IPL治疗组患者不良反应发生率为0,低于长脉冲激光治疗组。联合治疗组患者复发率为0,低于IPL治疗组(3.3%)和长脉冲激光治疗组(26.7%),差异有统计学意义(P<0.05)。联合治疗组患者满意率为80.0%,高于长脉冲激光治疗组(53.3%),差异有统计学意义(P<0.05)。结论长脉冲1064 nm Nd:YAG激光联合IPL治疗早期烧伤瘢痕修复效果可靠,可明显改善瘢痕色泽及柔软度,提高美观度,优于单一治疗,值得临床推广应用。

Objective To investigate the efficacy and safety of long-pulse 1064 nm Nd:YAG laser combined with intense pulsed light(IPL)in the treatment of early hypertrophic burn scars.Methods A total of 90 patients with burn scar repair who were admitted to the Department of Burn Surgery,Baogang Hospital from January 2021 to January 2022 were enrolled as the prospective research subjects.According to the random number table,all patients were randomly divided into three groups,with 30 cases in each group.The patients in IPL group were treated with IPL for 3 months,with an interval of 4 weeks and a total of 3 treatments.The patients in long pulse laser group were treated with a long pulse width of 1064 nm Nd:YAG laser for 3 months,with a treatment interval of 2 weeks,and a total of 6 treatments.The patients in combination group were treated with a long pulse width of 1064 nm Nd:YAG laser and IPL treatment alternately,with an interval of 2 weeks between each treatment,and a total of 6 treatments.The clinical efficacy,visual analogue score(VAS),Vancouver scar scale(VSS),patient satisfaction,adverse reactions and recurrence were observed and compared among the three groups.The data were analyzed by the chi-square test,Fisher′s exact probability method,the two-way repeated measures ANOVA analysis,the Lsd-t test,the Kruskal-Wallis test and the Mann-Whitney test.Results The total clinical effective rate of combination group was 96.7%(29/30),which was higher than that of IPL group[93.3%(28/30)]and long pulse laser group[73.3%(22/30),P<0.05].There were statistically significant differences in VAS scores among the three groups at 1,2,3 months of treatment,and so as compared with VAS scores before the treatment.The VSS scores of the three groups were lower than those before treatment(P<0.05),and the differences were statistically significant among the three groups at 1,2,3 months after the treatment(P<0.05).After treatment,the scar pigment,blood supply,flexibility,thickness and total score of the three groups decreased,and those above indexes of patients in combination group were lower than the other two groups(P<0.05).During the treatment period,the incidence of adverse reactions in combination group and IPL group were 0,lower than that in long pulse laser group.The recurrence rate of combination group was 0,lower than that of IPL group(3.3%)and long pulse group(26.7%),and the difference was statistically significant(P<0.05).The satisfaction rate of combination group was 80.0%,which was higher than that of long pulse laser group(53.3%)and the difference was statistically significant(P<0.05).Conclusion The long pulse width of 1064 nm Nd:YAG laser combined with IPL has a reliable effect in the treatment of early burn scar repair,which can significantly improve the color and softness of the scar,and make it better for look,which is superior to the single therapy,and is worthy of clinical application.