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

雷颖; 谭军; 欧阳华伟; 刘小加; 喻亿玲

doi:10.3760/cma.j.cn501225-20220519-00192

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

doi: 10.3760/cma.j.cn501225-20220519-00192

湖南省人民医院（湖南师范大学附属第一医院）整形激光美容外科，长沙　　410005

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谭军，Email：doctortanjun@163.com

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- 收稿日期: 2022-05-19

Effects of composite laser technique combined with multipoint microinjection of triamcinolone acetonide in the treatment of hypertrophic scars in burn children

(1st Affiliated Hospital of Hunan Normal University), Changsha 410005, China

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Corresponding author: Tan Jun, Email: doctortanjun@163.com

摘要

摘要: 目的探讨脉冲染料激光（PDL）和超脉冲点阵二氧化碳激光（UFCL）联合多点微量注射曲安奈德治疗烧伤患儿早期红色增生性瘢痕的疗效。方法采用回顾性队列研究及自身前后对照方法。2019年2月—2020年12月，湖南省人民医院（湖南师范大学附属第一医院）收治67例符合入选标准的烧伤后早期红色增生性瘢痕患儿，其中男32例、女35例，年龄1~12岁。患儿均采用复合激光技术（PDL和UFCL）联合曲安奈德治疗（以下简称联合治疗），间隔2个月后，行第2次联合治疗。分别于首次联合治疗前和末次联合治疗后6个月，由医师和患儿家属采用患者与观察者瘢痕评估量表（POSAS）评估患儿瘢痕情况。于末次联合治疗后6个月，统计患儿家属对疗效的满意度并计算总体满意率。记录患儿治疗过程中的不良反应情况。对数据行配对样本t检验。结果末次联合治疗后6个月，医师对患儿瘢痕的厚度、血管分布、色泽、表面粗糙度、质地、范围及总体评价的POSAS评分以及患儿家属对患儿瘢痕的颜色、疼痛程度、瘙痒程度、硬度、厚度、形状大小及总体评价的POSAS评分均明显低于首次联合治疗前（t值分别为17.32、16.73、15.00、14.91、19.62、28.74、29.83，17.43、20.52、29.01、28.82、24.91、20.30、42.13，P<0.01）。末次联合治疗后6个月，分别有62（93%）、3（4%）、2（3%）名患儿家属对疗效表示非常满意、满意、较为满意，总体满意率为97%（65/67）。末次联合治疗后6个月，所有患儿创面均未出现瘢痕增厚、感染。结论复合激光技术联合多点微量注射曲安奈德治疗烧伤儿童早期红色增生性瘢痕可改善瘢痕的外观及质地，减轻患儿瘢痕疼痛和瘙痒，且不良反应少，患儿家属对疗效满意度较高。
- 烧伤 /
- 瘢痕 /
- 激光，染料 /
- 儿童 /
- 曲安奈德 /
- 超脉冲点阵二氧化碳激光
Abstract: Objective To explore the effects of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) combined with multipoint microinjection of triamcinolone acetonide in the treatment of red hypertrophic scar at early stage in burn children. Methods A retrospective cohort before-after control study in the same patients was conducted. From February 2019 to December 2020, a total of 67 burn children who met the inclusion criteria (32 males and 35 females, aged 1 to 12 years) with red hyperplastic scar at early stage, were treated in Hunan Provincial People's Hospital (1^st Affiliated Hospital of Hunan Normal University). All the children were treated with composite laser technique (PDL and UFCL) combined with triamcinolone acetonide (hereinafter referred to as combined treatment). After 2 months, they received the second combined treatment. Before the first combined treatment and 6 months after the last combined treatment, the scar of children was evaluated with the patient and observer scar assessment scale (POSAS) by physicians and family members. Six months after the last combined treatment, the satisfaction of the patients' family members with the efficacy was recorded and the overall satisfaction rate was calculated. Adverse reactions were recorded throughout the treatment process. Data were statistically analyzed with paired sample t test. Results Six months after the last combined treatment, the POSAS scores of children on the thickness, blood vessels distribution, color, surface roughness, texture, scope, and overall evaluation of scar evaluated by the physicians, and the POSAS scores of children on the color, degree of pain, degree of itching, hardness, thickness, shape and size, and overall evaluation of scar evaluated by the family members were significantly lower than those before the first combined treatment (with t values of 17.32, 16.73, 15.00, 14.91, 19.62, 28.74, 29.83, 17.43, 20.52, 29.01, 28.82, 24.91, 20.30, and 42.13, respectively, P<0.01). Six months after the last combined treatment, 62 (93%), 3 (4%), and 2 (3%) children's family members were very satisfied, satisfied, and relatively satisfied with the treatment effect, respectively, and the overall satisfaction rate was 97% (65/67). Six months after the last combined treatment, no scar thickening or infection occurred in all the wounds of children. Conclusions Composite laser technique combined with multipoint microinjection of triamcinolone acetonide in the treatment of red hypertrophic scar at early stage in burn children can improve the appearance and texture of scar, reduce scar pain and pruritus, with high satisfaction of children's family members to the treatment effect and less adverse reactions.
- Burns /
- Cicatrix /
- Lasers, dye /
- Child /
- Triamcinolone acetonide /
- Ultra-pulsed fractional carbon dioxide laser
雷颖：论文撰写、临床操作；谭军：研究指导、论文修改、临床操作；欧阳华伟：数据整理、统计学分析；刘小加、喻亿玲：图片处理、数据整理

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1 采用脉冲染料激光和超脉冲点阵二氧化碳激光联合多点微量注射曲安奈德治疗例1患儿颏、颈、前胸部沸水烫伤创面愈合后早期红色增生性瘢痕。1A.首次联合治疗前，瘢痕色红，凹凸不平伴颈部牵扯；1B.末次联合治疗后6个月，瘢痕平，颜色接近周围正常肤色，颈部牵扯明显好转

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2 采用脉冲染料激光和超脉冲点阵二氧化碳激光联合多点微量注射曲安奈德治疗例2患儿右耳前沸水烫伤后早期红色增生性瘢痕。2A.首次联合治疗前，瘢痕色红，增厚并凹凸不平；2B.末次联合治疗后6个月，瘢痕平，颜色接近周围正常肤色

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表1 医师针对67例烧伤后早期红色增生性瘢痕患儿采用复合激光技术联合曲安奈德治疗前后POSAS评分比较（分，x¯±s）

项目	首次联合治疗前	末次联合治疗后6个月	t值	P值
厚度	6.7±0.5	2.0±0.3	17.32	<0.001
血管分布	8.5±0.3	1.8±0.5	16.73	<0.001
色泽	3.2±0.7	1.8±0.6	15.00	<0.001
表面粗糙度	6.7±0.4	2.5±0.9	14.91	<0.001
质地	7.2±0.5	1.8±0.3	19.62	<0.001
范围	7.8±0.8	2.5±0.6	28.74	<0.001
总体评价	8.5±0.3	2.8±0.6	29.83	<0.001
注：复合激光技术为脉冲染料激光+超脉冲点阵二氧化碳激光；POSAS为患者与观察者瘢痕评估量表

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表2 患儿家属针对67例烧伤后早期红色增生性瘢痕患儿采用复合激光技术联合曲安奈德治疗前后POSAS评分比较（分，x¯±s）

项目	首次联合治疗前	末次联合治疗后6个月	t值	P值
颜色	8.7±0.6	1.5±0.3	17.43	<0.001
疼痛程度	7.5±0.8	1.8±0.6	20.52	<0.001
瘙痒程度	8.2±0.3	1.5±0.4	29.01	<0.001
硬度	7.7±0.4	2.0±0.9	28.82	<0.001
厚度	7.2±0.6	1.8±0.6	24.91	<0.001
形状大小	7.3±0.5	2.5±0.5	20.30	<0.001
总体评价	8.8±0.5	2.6±0.4	42.13	<0.001
注：复合激光技术为脉冲染料激光+超脉冲点阵二氧化碳激光；POSAS为患者与观察者瘢痕评估量表

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