Effect of pulsed dye laser in combination with ultra-pulsed fractional carbon dioxide laser in treating pediatric burn scars at early stage
-
摘要: 目的 探讨脉冲染料激光(PDL)联合超脉冲点阵二氧化碳激光(UFCL)治疗小儿早期烧伤瘢痕的效果。 方法 2016年1月—2019年12月,湖南省人民医院收治符合入选标准的120例早期烧伤瘢痕患儿,采用单组病例对照研究对其资料进行回顾性分析。患儿中男78例、女42例,年龄(4.2±0.8)岁,瘢痕面积(100.3±0.7)cm2。首次治疗采用PDL联合UFCL治疗,随后PDL每次治疗间隔1个月,UFCL每次治疗间隔3个月。总治疗周期为6个月,共行2次PDL单独治疗、2次联合治疗。首次联合治疗前、2次联合治疗后6个月,采用患者与观察者瘢痕评估量表(POSAS)对医师和患儿家属进行疗效评估。2次联合治疗后6个月,统计患儿家属疗效满意度并计算总体满意率。记录整个治疗过程中的不良反应情况。对数据行配对
t 检验。 结果 (1)2次联合治疗后6个月,患儿瘢痕血管分布、色素沉着、厚度、凹凸程度、柔软度、表面范围和总体评价,疼痛、瘙痒、颜色、硬度、厚度、形状和总体评价的POSAS医师和患儿家属评分均明显低于首次联合治疗前(t =16.6、16.0、16.9、14.9、20.8、29.3、30.7,20.4、29.3、18.1、27.9、25.8、20.8、45.3,P <0.01)。其中首次联合治疗前、2次联合治疗后6个月,医师总体评价分别为(8.1±0.8)、(2.7±0.6)分,患儿家属总体评价分别为(8.2±0.8)、(2.4±0.5)分。(2)2次联合治疗后6个月,110例(92%)患儿的家属对疗效非常满意,6例(5%)患儿的家属满意,4例(3%)患儿的家属较为满意,无不满意,总满意率为97%(116/120)。(3)5例患儿首次治疗后3~4 d创面出现瘙痒、红疹。3例患儿首次治疗后3周出现色素沉着。1例患儿3次治疗后1周创面可见小水疱,并伴瘙痒。所有创面均未出现瘢痕加重、感染等不良反应。 结论 PDL联合UFCL治疗小儿早期烧伤瘢痕,疗效较明显,治疗周期较短,可减轻症状并改善小儿生活质量,且不良反应少,临床可推广应用。-
关键词:
- 烧伤 /
- 瘢痕 /
- 儿童 /
- 激光,染料 /
- 超脉冲点阵二氧化碳激光
Abstract: Objective To explore the effect of combined application of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) in the treatment of pediatric large burn scars at early stage. Methods One hundred and twenty pediatric patients with large burn scars at early stage conforming to the study criteria were admitted to the People′s Hospital of Hunan Province from January 2016 to December 2019. Their data were retrospectively analyzed by the method of single case-control study. There were 78 males and 42 females with age of (4.2±0.8) years and scar area of (100.3±0.7) cm2. PDL combined with UFCL was used for the first time. The treatment interval of PDL was a month and the treatment interval of UFCL was 3 months. The total treatment cycle was 6 months, with 2 PDL treatments alone and two combined treatments. Before the first combined treatment and 6 months after two combined treatments, the curative effect was assessed using Patient and Observer Scar Assessment Scale (POSAS) by doctors and family members of pediatric patients. Satisfaction degrees of the family members of pediatric patients were recorded, and the overall satisfaction rate was calculated 6 months after two combined treatments. The adverse effects during the whole treatment course were recorded. Data were statistically analyzed with pairedt test. Results (1) Six months after two combined treatments, the scores of pediatric patients′ scar vascularity, pigment, thickness, relief, pliability, surface area, and overall valuation in POSAS by doctors and the scores of pain, itch, color, stiffness, thickness, irregularity, and overall valuation in POSAS by family members of pediatric patients were all significantly lower than those before the first combined treatment (t =16.6, 16.0, 16.9, 14.9, 20.8, 29.3, 30.7, 20.4, 29.3, 18.1, 27.9, 25.8, 20.8, 45.3,P <0.01). The overall evaluation scores by doctors were (8.1±0.8) and (2.7±0.6) points, and the overall evaluation scores by family members of pediatric patients were (8.2±0.8) and (2.4±0.5) points respectively before the first combined treatment and six months after two combined treatments. (2) Six months after two combined treatments, 110 (92%) family members of pediatric patients were very satisfied with the curative effect, 6 (5%) family members of pediatric patients were satisfied, and 4 (3%) family members of pediatric patients were relatively satisfied with no unsatisfied reported. The overall satisfaction rate was 97% (116/120). (3) During the treatment, pruritus and rash appeared in 5 pediatric patients 3 to 4 days after the first treatment; pigmentation appeared in 3 pediatric patients 3 weeks after the first treatment; pruritus and vesicle appeared in 1 patient 1 week after the third treatment. No adverse effects such as aggravated scar or infection were observed on the wounds. Conclusions In treating pediatric large burn scars at early stage, PDL combined with UFCL has demonstrated significant effect with short treatment cycle, few adverse effects. The combined treatment can alleviate symptoms and improve the quality of pediatric patients′ life, and is worthy to be popularized and applied in clinic.-
Key words:
- Burns /
- Cicatrix /
- Child /
- Lasers, dye /
- Ultra-pulsed fractional carbon dioxide laser
-
参考文献
(22) 期刊类型引用(25)
1. 徐培,张红玲,童欢,龙忠恒,张祥明. 皮肤软组织扩张术在儿童颈胸部增生性瘢痕修复中的应用. 中国美容整形外科杂志. 2024(03): 153-156 . 百度学术
2. 孟森,高迦南,李昂,金培生,李雪阳. 游离全厚皮片联合眼周美容手术治疗眼周肿物. 徐州医科大学学报. 2023(01): 44-47 . 百度学术
3. 陈耿明. 二氧化碳激光磨削术联合曲安奈德封闭治疗瘢痕疙瘩疗效和不良反应研究. 实用中西医结合临床. 2023(02): 35-38 . 百度学术
4. 杨松,余晴,陈丽娜,王琦. 超脉冲点阵CO_2激光及舒敏保湿特护霜联合小针刀皮下剥离术治疗痤疮凹陷性瘢痕. 中国美容医学. 2023(09): 100-103 . 百度学术
5. 马伟欢,习耀峰,张成锋,张晔,张秋霞,贾伟,陈荣. 加味“七白散”中药面膜粉外敷联合超脉冲二氧化碳点阵激光治疗烧伤后面部色素沉着的临床观察. 贵州医药. 2022(02): 281-282 . 百度学术
6. 周丽娜,汤勇,刘文军. 聚氨酯泡沫敷料在点阵激光治疗面颈部增生性瘢痕辅助治疗中的疗效观察. 中国医疗美容. 2022(02): 38-41 . 百度学术
7. 刘欣欣,刘选奎,宫泽琨,李钦峰. 儿童瘢痕的治疗进展. 中国现代医药杂志. 2022(07): 105-108 . 百度学术
8. 靳楷,张建海,罗馨岚,胡锦江,张刚. 早期瘢痕光电干预治疗临床应用进展. 中国医疗美容. 2022(08): 84-88 . 百度学术
9. 雷颖,谭军,欧阳华伟,刘小加,喻亿玲. 复合激光技术联合多点微量注射曲安奈德治疗烧伤患儿增生性瘢痕的效果. 中华烧伤与创面修复杂志. 2022(09): 810-815 . 本站查看
10. 杜敏. 脉冲染料激光在手部深度烧伤后增生性瘢痕中的应用效果. 中外医学研究. 2022(27): 124-127 . 百度学术
11. 谭军. 激光与光技术治疗瘢痕. 中国美容整形外科杂志. 2022(11): 641-645 . 百度学术
12. 郑慧敏,罗峰. CO_2点阵激光联合重组牛碱性成纤维细胞生长因子凝胶用于面部痤疮瘢痕治疗效果及安全性分析. 智慧健康. 2022(29): 70-73+77 . 百度学术
13. 杨丽,李娜,程静,韩军涛,胡大海. 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. 中华烧伤杂志. 2021(01): 57-63 . 百度学术
14. 黄振,陈烨,王朋,郑大伟,宗亚力,吕国忠. 二氧化碳点阵激光联合自体脂肪注射治疗烧伤后增生性瘢痕效果的前瞻性随机对照临床研究. 中华烧伤杂志. 2021(01): 49-56 . 百度学术
15. 谢春晖,高欣欣,孟祥龙,陈可欣,张修航,周鑫,于家傲. 应用序贯激光治疗烧伤患儿早期增生性瘢痕的效果分析. 中华烧伤杂志. 2021(04): 327-332 . 百度学术
16. 卢会秀,曹海育,李建英,孙静. Cynergy双波长脉冲染料激光联合局部封闭治疗病理性瘢痕疗效分析. 中国美容医学. 2021(06): 79-82 . 百度学术
17. 顾斌,施加加. 自制拇指伸展矫形器联合点阵激光治疗烧伤患者手部虎口瘢痕挛缩的效果观察. 按摩与康复医学. 2021(15): 32-34 . 百度学术
18. 雷颖,谭军,欧阳华伟,吴维子,朱轶,刘小加,喻亿玲. 瘢痕皮下改薄术联合复合激光技术治疗肥厚增生性瘢痕的临床疗效. 中国医疗美容. 2021(08): 10-15 . 百度学术
19. 谭军. 点阵CO_2激光辅助的增生性瘢痕的皮肤再生修复. 中国医疗美容. 2021(08): 1-9 . 百度学术
20. 雷颖,吴溯帆,李文志,董继英,杨斌,尹锐,谭军. 激光联合治疗增生性瘢痕新进展. 中国激光医学杂志. 2020(05): 285-290 . 百度学术
21. 刘悦,王连召. 瘢痕综合治疗的临床实践与思考. 中华整形外科杂志. 2020(10): 1069-1074 . 百度学术
22. 雷颖,彭诗绮,陈红阳,欧阳华伟,谭军. 点阵激光联合脉冲染料激光加多点微量注射曲安奈德对兔耳增生性瘢痕的影响. 中华整形外科杂志. 2020(10): 1128-1138 . 百度学术
23. 李亚军,施加加,王丽,陈智超,凌静,于冶. 二氧化碳点阵激光联合康复措施治疗烧伤后增生性瘢痕的临床观察. 中华损伤与修复杂志(电子版). 2020(06): 441-447 . 百度学术
24. 杨丽,李娜,程静,韩军涛,胡大海. 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. 中华烧伤杂志. 2020(01): E022-E022 . 百度学术
25. 黄振,陈烨,王朋,郑大伟,宗亚力,吕国忠. 二氧化碳点阵激光联合自体脂肪注射治疗烧伤后增生性瘢痕效果的前瞻性平行对照临床研究. 中华烧伤杂志. 2020(01): E021-E021 . 百度学术
其他类型引用(2)
-
计量
- 文章访问数: 2078
- HTML全文浏览量: 170
- PDF下载量: 60
- 被引次数: 27