Clinical effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus
-
摘要: 目的 观察临床上应用窄谱强脉冲光联合点阵二氧化碳激光治疗增生性瘢痕瘙痒的效果。 方法 2017年3—12月,笔者单位收治符合入选标准的增生性瘢痕患者90例,采用随机数字表法分为联合治疗组和对照组各45例,进行前瞻性随机对照研究。针对瘢痕瘙痒,对照组患者采用窄谱强脉冲光治疗2次,治疗间隔1个月;联合治疗组患者采用窄谱强脉冲光联合点阵二氧化碳激光治疗1次,1个月后再行窄谱强脉冲光治疗1次。治疗前及治疗后3个月,采用视觉模拟评分法和四项目瘙痒量表评定瘢痕瘙痒程度,拍照对比评定瘢痕改善度;治疗后3个月患者自评瘢痕瘙痒治疗满意度;记录治疗及随访期间不良反应。对数据行
χ 2检验、配对t 检验、Wilcoxon秩和检验、Fisher确切概率法检验。 结果 治疗前,2组患者瘢痕视觉模拟评分法评定的瘙痒严重程度和四项目瘙痒量表瘙痒部位、程度、频率及睡眠影响得分分布差异均无统计学意义(Z =-1.08、-0.91、-0.03、-0.69、-1.49,P >0.05)。治疗后3个月,对照组、联合治疗组患者瘢痕视觉模拟评分法评定的瘙痒严重程度均较组内治疗前明显减轻(Z =-1.98、-4.65,P <0.05或P <0.01),联合治疗组患者视觉模拟评分法评定的瘙痒严重程度明显轻于对照组(Z =-2.14,P <0.05);对照组患者瘢痕瘙痒程度、频率及联合治疗组患者瘢痕瘙痒部位、程度、频率与睡眠影响得分均较组内治疗前明显降低(Z =-2.33、-2.34、-3.53、-4.96、-3.32、-4.84,P <0.05或P <0.01),对照组患者瘢痕瘙痒部位和睡眠影响得分与组内治疗前相近(Z =-0.58、-1.34,P >0.05),联合治疗组患者瘢痕瘙痒部位、程度、频率与睡眠影响得分较对照组明显降低(Z =-2.09、-2.69、-1.99、-2.23,P <0.05或P <0.01)。联合治疗组患者瘢痕改善度明显优于对照组(Z =-4.00,P <0.01)。联合治疗组患者对瘢痕瘙痒治疗的满意度为0、1%~25%、26%~50%、51%~75%、76%~100%的百分比分别为0、2.2%(1/45)、17.8%(8/45)、48.9%(22/45)、31.1%(14/45),明显优于对照组的0、11.1%(5/45)、53.3%(24/45)、28.9%(13/45)、6.7%(3/45),Z =-4.42,P <0.01。对照组患者治疗及随访期间不良反应发生率为6.7%(3/45),与联合治疗组的2.2%(1/45)相近(P >0.05)。 结论 窄谱强脉冲光联合点阵二氧化碳激光治疗增生性瘢痕瘙痒优于单用窄谱强脉冲光,更能降低瘙痒程度,瘢痕治疗效果更好,患者满意度更高。 临床试验注册 中国临床试验注册中心,ChiCTR-ONH-17012350。Abstract: Objective To observe the effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus in clinic. Methods A prospective randomized controlled study was conducted. A total of 90 patients with hypertrophic scars conforming to the inclusion criteria who were hospitalized in our ward from March to December 2017 were divided into combination treatment group and control group according to the random number table, with 45 patients in each group. For scar pruritus, patients in control group were treated twice by narrow-spectrum intense pulsed light with a one-month interval, while patients in combination treatment group were firstly treated by narrow-spectrum intense pulsed light combined with fractional carbon dioxide laser once, and with narrow-spectrum intense pulsed light once one month later. Before and 3 months after treatment, scar pruritus was evaluated by the Visual Analogue Scale and the Four-item Itch Questionnaire, and the improvement of scar was assessed by photography. Three months after treatment, the treatment satisfaction of scar pruritus was self-rated by patients. Meanwhile, adverse effects were recorded during the procedures and follow-up periods. Data were processed with Chi-square test, pairedt test, Wilcoxon rank-sum test, and Fisher′s exact probability test. Results Before treatment, there was no statistically significant difference in scar pruritus degree evaluated by the Visual Analogue Scale and score distribution of scar pruritus location, extent, frequency, and sleep effect of the Four-item Itch Questionnaire between patients of two groups (Z =-1.08, -0.91, -0.03, -0.69, -1.49,P >0.05). Three months after treatment, there was reducing degree of scar pruritus of patients evaluated by the Visual Analogue Scale in control group or combination treatment group compared with before treatment within the same group (Z =-1.98, -4.65,P <0.05 orP <0.01), while the latter was more obvious than the former (Z =-2.14,P <0.05). There were reducing scores of scar pruritus extent and frequency of patients in control group, along with location, extent, frequency, and sleep effect of patients in combination treatment group compared with those before treatment within the same group (Z =-2.33, -2.34, -3.53, -4.96, -3.32, -4.84,P <0.05 orP <0.01). However, scores of scar pruritus location and sleep effect of patients in control group were similar to those before treatment within the same group (Z =-0.58, -1.34,P >0.05). The scores of scar pruritus location, extent, frequency, and sleep effect of patients were obviously lower in combination treatment group compared with control group (Z =-2.09, -2.69, -1.99, -2.23,P <0.05 orP <0.01). It was much better of scar improvement of patients in combination treatment group compared with control group (Z =-4.00,P <0.01). The percentages of treatment satisfaction of scar pruritus of patients with 0, 1%-25%, 26%-50%, 51%-75%, 76%-100% were 0, 2.2% (1/45), 17.8% (8/45), 48.9% (22/45), and 31.1% (14/45) respectively in combination treatment group, which were obviously better than 0, 11.1% (5/45), 53.3% (24/45), 28.9% (13/45), and 6.7% (3/45) in control group (Z =-4.42,P <0.01). During the treatment and follow-up periods, the adverse effect ratio of patients in control group was 6.7% (3/45), similar to 2.2% (1/45) of combination treatment group (P >0.05). Conclusions The combination of narrow-spectrum intense pulsed light and fractional carbon dioxide laser can greatly reduce pruritus, improve effect of scar treatment, and bring higher patient satisfaction compared with narrow-spectrum intense pulsed light alone in treating hypertrophic scar pruritus. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-ONH-17012350. -
参考文献
(17) 期刊类型引用(38)
1. 文强,王鹏,杨加保,金鑫. 消风散联合硅酮凝胶治疗侧胸壁取皮区瘢痕瘙痒临床观察. 四川中医. 2024(04): 190-193 . 百度学术
2. 石晨龙,易阳艳,丁颖,王朝慧,黎炜,禾瑶,童亚婷. 点阵激光联合皮下分离术治疗凹陷性痤疮瘢痕的临床效果. 中国现代医生. 2024(22): 9-12 . 百度学术
3. 王博,金莹. 超分子水杨酸联合窄谱强脉冲光治疗玫瑰痤疮患者的效果. 中国民康医学. 2023(04): 97-99+103 . 百度学术
4. 曹鹏,王运帷,姚明,李少珲,陈阳,张浩,官浩. 机械力对增生性瘢痕的影响及TGFβ1/Smad通路在其作用机制中的研究进展. 空军军医大学学报. 2023(05): 471-475 . 百度学术
5. 章一新,李洁. 瘢痕光电治疗之我见. 中华烧伤与创面修复杂志. 2023(06): 501-506 . 本站查看
6. 陈梦佳,张元文. 烧伤后瘙痒的机制和治疗研究进展. 中华烧伤与创面修复杂志. 2023(07): 690-694 . 本站查看
7. 刘琪,薛磊,杨伊帆,杜雅,高阳,张蕴珍,刘召明,张文显. 不同时机治疗儿童四肢先天性色素痣效果观察. 中国美容整形外科杂志. 2023(08): 477-479+511 . 百度学术
8. 赵光耀,章祥洲,吴军军. 优化脉冲光、点阵CO_2激光联合复方肝素钠尿囊素凝胶透皮给药治疗儿童烧伤后增生性瘢痕. 中国美容医学. 2023(08): 58-62 . 百度学术
9. 杨明,柯友辉. 刃针联合超脉冲CO_2点阵激光治疗面部痤疮凹陷性瘢痕的临床观察. 中国皮肤性病学杂志. 2023(10): 1138-1141+1150 . 百度学术
10. 杨帅,蒋小姣,马海燕. 超脉冲点阵CO_2激光联合窄谱强脉冲光治疗创伤后早期增生性瘢痕效果分析. 中国美容医学. 2022(02): 58-61 . 百度学术
11. 范林明,马飞,李晟,肖祥明,邓柳. 超脉冲点阵CO_2激光联合强脉冲光在皮肤年轻化治疗中的效果及安全性分析. 中国美容医学. 2022(03): 29-32 . 百度学术
12. 杜红霞,胡媛媛. 重组牛碱性成纤维细胞生长因子辅助治疗凹陷性痤疮瘢痕的临床观察. 中国医学科学院学报. 2022(02): 208-212 . 百度学术
13. 董继英,吴珊,王棽,严敏,米晶,林琥燕,曾颖,张逸秋,宋晨璐,裴庆,朱婕,温晓钰,陆文婷,姚敏. 光电治疗对皮肤创伤性瘢痕的疗效研究. 组织工程与重建外科. 2022(02): 133-137 . 百度学术
14. 唐密,孙跃华,张静,张晓东,尹璐. 窄谱强脉冲光联合重组牛碱性成纤维细胞生长因子凝胶治疗玫瑰痤疮的效果观察. 中国临床实用医学. 2022(02): 74-76 . 百度学术
15. 李波蓬,刘艳,蔡洁,丁锋,刘雪萍. 超脉冲CO_2激光联合曲安奈德注射治疗对耳廓瘢痕疙瘩VSS评分及复发情况的影响. 中国美容医学. 2022(10): 82-86 . 百度学术
16. 赵化波. 强脉冲光联合二氧化碳点阵激光治疗儿童外伤后瘢痕的疗效分析. 系统医学. 2022(18): 133-136 . 百度学术
17. 张见龙. 32P同位素敷贴治疗增生性瘢痕的效果. 临床医学. 2022(10): 44-45 . 百度学术
18. 杨德勇,董东,何小亮,石德顺,李文利,周忠玉. 窄谱强脉冲光+点阵CO_2激光治疗增生性瘢痕临床效果及预后分析. 中外医学研究. 2021(11): 73-75 . 百度学术
19. 邢福席,刘继松. 强脉冲光联合点阵CO_2激光治疗儿童下肢烧伤后增生性瘢痕的效果评价. 中国医疗美容. 2021(04): 61-65 . 百度学术
20. 曾颖,许佳,金蓉. 压力治疗联合点阵CO_2激光治疗增生性瘢痕的疗效观察. 组织工程与重建外科. 2021(02): 122-124 . 百度学术
21. 薛萍,宋保强,樊星,窦文婕. 精细毛囊单位提取移植术修复瘢痕性眉缺损的临床效果. 中华烧伤杂志. 2021(07): 661-665 . 百度学术
22. 何丽卡. 点阵CO_2激光联合皮下分离术治疗痤疮凹陷性瘢痕的疗效观察. 皮肤病与性病. 2021(05): 694-696 . 百度学术
23. 陈媛,刘建,李孝建. DPL在防治儿童烧伤后早期增生性瘢痕中应用的研究进展. 组织工程与重建外科. 2021(06): 497-502 . 百度学术
24. 于结,张咏梅,令狐玉双,吴敏,叶菁菁,李永义,谢文娅. 基于超声监测的水胶体敷料对胰岛素注射所致皮下硬结的干预效果研究. 遵义医科大学学报. 2021(06): 762-768 . 百度学术
25. 陈丽,刘军. 窄谱强脉冲光联合Nd:YAG激光治疗高原性毛细血管扩张症疗效分析. 中国美容医学. 2020(01): 19-22 . 百度学术
26. 卢锋. 强脉冲光联合压力疗法治疗烧伤患者瘢痕增生的临床研究. 心理月刊. 2020(04): 204 . 百度学术
27. 蔡杏仪,张方布. 窄谱强脉冲激光联合克痤隐酮凝胶治疗炎症性痤疮的临床效果. 中国当代医药. 2020(06): 57-59 . 百度学术
28. 冯雯隽. 精准脉冲光(DPL)治疗玫瑰痤疮的疗效及安全性分析. 中国美容医学. 2020(04): 38-40 . 百度学术
29. 郑建新,张亚军. 二氧化碳点阵激光联合曲安奈德注射治疗增生性瘢痕的疗效. 中国医疗美容. 2020(05): 84-88 . 百度学术
30. 江兰,张衍国,王小霞,王欢,刘涛. CO_2点阵激光联合注射醋酸泼尼松龙治疗增生性瘢痕临床观察. 海南医学. 2020(14): 1829-1832 . 百度学术
31. 雷岱锋,王朝霞,刘梅. 二氧化碳点阵激光联合醋酸曲安奈德局部注射对增生性瘢痕患者VSS评分及生活质量的影响. 中国医疗美容. 2020(07): 87-90 . 百度学术
32. 彭君强,罗斌,何国,刘春宏. 窄谱强脉冲光+点阵CO_2激光治疗增生性瘢痕患者的近期随访研究. 中国医疗美容. 2020(08): 64-68 . 百度学术
33. 于天培,姜春茹. 超声波加疤痕止痒软化膏治疗对烧伤瘢痕瘙痒患者康复的效果及预后的影响. 临床与病理杂志. 2020(10): 2642-2647 . 百度学术
34. 刘小加,罗明灿,喻亿玲,欧阳华伟,谭军. 医护一体化模式在红色增生性瘢痕激光治疗中的应用. 中国美容医学. 2020(10): 171-174 . 百度学术
35. 杨青,窦文婕,殷悦,马显杰,薛萍,李潼,樊星,宋保强. 激光序列治疗面部美容缝合术后早期瘢痕临床效果的回顾性研究. 中华整形外科杂志. 2020(10): 1075-1079 . 百度学术
36. 王维. 压力疗法联合强脉冲光治疗烧伤后增生型瘢痕的临床观察. 皮肤病与性病. 2019(04): 542-543 . 百度学术
37. 王佳,陈萧锋. 烧伤创面瘙痒的研究进展. 现代医药卫生. 2019(21): 3320-3323 . 百度学术
38. 陈琨,王伊宁,王燕妮,胡楠,李丹,齐鸿燕. 强脉冲光联合点阵铒激光治疗儿童外伤后瘢痕的临床研究. 组织工程与重建外科杂志. 2019(05): 335-337+348 . 百度学术
其他类型引用(4)
-
计量
- 文章访问数: 322
- HTML全文浏览量: 71
- PDF下载量: 22
- 被引次数: 42