超脉冲点阵CO_(2)激光联合外涂硅凝胶治疗面颈部深Ⅱ度烧伤后增生性瘢痕

Ultra-pulsed Fractional CO_(2) Laser Combined with Silicone Gel for the Treatment of Hypertrophic Scar after DeepⅡDegree Burns on Face and Neck

目的:观察超脉冲点阵CO_(2)激光联合硅凝胶对面颈部深Ⅱ度烧伤后增生性瘢痕(Hypertrophic scar,HS)的临床效果。方法:选择2020年5月-2023年2月笔者医院收治的118例面颈部深Ⅱ度烧伤后HS患者,采用随机数字表法分为对照组(给予硅凝胶治疗,59例)和联合组(给予超脉冲点阵CO_(2)激光联合硅凝胶治疗,59例)。对比两组患者临床疗效、视觉模拟疼痛量表(Visual analogue scale,VAS)评分、温哥华瘢痕量表(Vancouver scar scale,VSS)评分、瘢痕厚度、瘢痕回声密度、生长因子指标[转化生长因子-β_1(Transforming growth factor-β_1,TGF-β_1)、表皮生长因子(Epidermal growth factor,EGF)]及不良反应发生情况。结果:治疗3个月后,联合组总有效率为98.31%,高于对照组的84.75%(P<0.05);联合组VAS、VSS评分均低于对照组(P<0.05);联合组瘢痕厚度低于对照组(P<0.05),瘢痕回声密度则高于对照组(P<0.05);联合组TGF-β_1、EGF水平均低于对照组(P<0.05)。治疗期间,联合组和对照组不良反应发生率分别为11.86%和8.47%,但差异无统计学意义(P>0.05)。结论:超脉冲点阵CO_(2)激光联合硅凝胶治疗面颈部深Ⅱ度烧伤后HS患者可提高临床疗效,缓解疼痛症状,改善瘢痕情况,促进瘢痕消退,调节生长因子水平,且安全可靠。

Objective To observe the clinical effects of utrapulse fractional CO_(2) laser combined with silicone gel on hyperplastic scarring(HS)after DeepⅡdegree burns on the face and neck.Methods One hundred and eighteen patients with HS after DeepⅡdegree burns on the face and neck admitted to author's hospital from May 2020 to February 2023 were selected and divided into a control group(treated with silicone gel,59 patients)and a combined group(treated with utrapulse fractional CO_(2) laser combined with silicone gel,59 patients)using the random number table method.The clinical efficacy,visual analogue pain scale(VAS)score,Vancouver scar scale(VSS)score,scar thickness,scar echodensity,growth factor indexes[transforming growth factor-β_(1)(TGF-β_(1)),epidermal growth factor(EGF)]and the occurrence of adverse reactions were compared between the two groups.Results After 3 months of treatment,the total effective rate of the combined group was 98.31%,which was higher than 84.75%of the control group(P<0.05).The VAS score and VSS score after treatment in the combined group were lower than those in the control group(P<0.05).The scar thickness after treatment was lower in the combined group than in the control group(P<0.05),while the scar echogenic density was higher than in the control group(P<0.05).TGF-β_(1) and EGF were lower in the combined group than in the control group after treatment(P<0.05).During the treatment,the incidence of adverse reactions in the combined group and the control group was 11.86%and 8.47%,respectively,but the difference was not statistically significant(P>0.05).Conclusion Utrapulse fractional CO2 laser combined with silicone gel can improve clinical efficacy,relieve pain symptoms,improve scar condition,promote scar regression,and regulate growth factor levels in patients with HS after DeepⅡdegree burns on the face and neck,and it is safe and reliable.