Clinical observation of the effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine on the treatment of hyperplastic scar
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摘要: 目的 探讨超脉冲二氧化碳点阵激光结合中药复春散治疗烧伤后增生性瘢痕的临床效果。 方法 2012年2月—2014年6月,选择笔者单位收治的63例烧伤后增生性瘢痕患者,采用超脉冲二氧化碳点阵激光结合中药复春散治疗。根据瘢痕形成时间,将患者分为早期组、中期组、晚期组。早期组为瘢痕形成3周~3个月患者,共35例;中期组为瘢痕形成时间大于3个月且小于或等于6个月患者,共25例;晚期组为3~15年陈旧性瘢痕患者,共3例。统计各组患者的激光治疗次数;数字评价量表(NRS)评定3组患者治疗前及治疗1、2、3次后的瘢痕疼痛强度;温哥华瘢痕评定量表评定瘢痕情况,比较早期组、中期组患者在治疗前及治疗1、3、5次后的分值,晚期组患者只观察、不评分;治疗前及治疗3、5次后,拍摄3组患者治疗区域瘢痕照片评价疗效。对数据行
t 检验。 结果 早期组患者治疗(4.8±1.1)次;中期组(7.7±2.1)次;晚期组中2例患者治疗5次后终止治疗,1例治疗12次。治疗1次后,早期组和中期组患者疼痛减轻明显,NRS评分1~4分者由5例增至38例;治疗2、3次后,1~4分者增加幅度不大。治疗前和治疗1次后,早期组、中期组患者瘢痕情况评分相近(t 值分别为0.641、0.082、P 值均大于0.05);治疗3、5次后,早期组患者的瘢痕情况评分分别为(9.2±0.8)、(7.0±1.1)分,明显低于中期组的(9.7±1.0)、(8.2±1.0)分(t 值分别为–1.993、–4.433,P <0.05或P <0.01)。治疗3次后,早期组、中期组患者总有效率分别为88.6%(31/35)、72.0%(18/25);治疗5次后,早期组、中期组患者总有效率分别为100.0%(35/35)、96.0%(24/25);治疗5次后晚期组3例患者效果不明显。 结论 烧伤后增生性瘢痕早期应用超脉冲二氧化碳点阵激光结合中药复春散治疗,效果明确。Abstract: Objective To explore the clinical effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan) on the treatment of postburn hyperplastic scar. Methods Sixty–three patients with hyperplastic scar after burn injury hospitalized from February 2012 to June 2014 in our department were treated with lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan). Patients were divided into early stage group (E,n =35), middle stage group (M,n =25), and late stage group (L,n =3) according to the formation time of scar, which was respectively 3 weeks to 3 months, longer than 3 months and less than or equal to 6 months, and 3 to 15 years in groups E, M, and L. The number of times of laser treatment of patients in each group was recorded. The degree of scar pain in patients of the three groups was assessed by the Numerical Rating Scale (NRS) before treatment and after treatment for 1, 2, and 3 times. The scar condition of patients in groups E and M was assessed by the Vancouver Scar Scale (VSS) before treatment and after treatment for 1, 3, and 5 times. Patients in group L did not receive VSS assessment but were evaluated by clinical observation only. Photos of scar in treating area were taken before treatment and after treatment for 3 and 5 times to evaluate the clinical effect. Data were processed witht test. Results Patients in groups E and M were treated with laser for (4.8±1.1) and (7.7±2.1) times respectively. In group L, the treatment was stopped in 2 patients after laser treatment for 5 times, and 1 patient received laser treatment for 12 times. The degree of pain in patients of groups E and M was alleviated significantly after treatment for one time, and the number of patients scoring 1–4 point (s) in NRS increased from 5 cases to 38 cases. After treatment for 2 and 3 times, the increase in the number of patients scoring 1–4 point (s) in NRS was on a small scale. Before treatment and after treatment for 1 time, VSS scores of patients in groups E and M were similar (witht values respectively 0.641 and 0.082,P values above 0.05). After treatment for 3 and 5 times, VSS scores of patients in group E were respectively (9.2±0.8) and (7.0±1.1) points, which were significantly lower than those in group M [(9.7±1.0) and (8.2±1.0) points, witht values respectively –1.993 and –4.433,P <0.05 orP <0.01]. After treatment for 3 times, the rate of improvement in appearance was respectively 88.6% (31/35) and 72.0% (18/25) in groups E and M, and it was respectively 100.0% (35/35) and 96.0% (24/25) after treatment for 5 times. No significant effect in appearance was found in the 3 patients in group L. Conclusions Early application of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan) for the treatment of postburn hyperplastic scar is effective.-
Key words:
- Burns /
- Cicatrix /
- Laser therapy /
- Drugs, Chinese herbal
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