Clinical efficacy of pressure therapy combined with narrow-band intense pulsed light for hypertrophic scars
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摘要:
目的 探讨采用压力疗法联合窄谱强脉冲光（NB-IPL）治疗增生性瘢痕的临床效果。 方法 该研究为回顾性队列研究。2023年1月—2025年1月,上海交通大学医学院附属第九人民医院收治73例符合入选标准的增生性瘢痕患者。根据患者采用的治疗方式,将其分为仅接受压力疗法的对照组[35例,男14例、女21例,年龄（32±9）岁]和在压力疗法基础上联合应用NB-IPL的观察组[38例,男18例、女20例,年龄（32±10）岁]。2组患者的压力疗法均在体表压强监测下进行,以确保瘢痕区域获得有效压力。联合治疗中,NB-IPL治疗每月1次,连续进行6次。治疗前和治疗9个月后,采用温哥华瘢痕量表（VSS）评估瘢痕外观,采用视觉模拟评分法（VAS）评估瘢痕瘙痒程度和疼痛程度。治疗9个月后,采用利克特量表评价患者对瘢痕改善效果的满意度。在治疗过程中及治疗9个月后,观察并记录患者不良反应,包括皮肤接触性皮炎、压力性水疱等的发生情况,并比较2组患者不良反应发生率。 结果 治疗9个月后,对照组和观察组患者瘢痕外观VSS评分分别为（7.4±1.4）、（6.1±1.7）分,均显著低于治疗前的（11.5±1.8）、（11.2±1.9）分（t值分别为-5.149、-5.396,P<0.05）；观察组患者瘢痕外观VSS评分显著低于对照组[均数差值（95%CI）为-1.2（-1.8~-0.6）分,t=-3.458,P<0.05]。治疗9个月后,对照组和观察组患者的瘢痕瘙痒程度均较治疗前显著改善（Z值分别为-4.815、-5.407,P<0.05）,观察组患者的瘢痕瘙痒程度较对照组显著改善（Z=-3.690,P<0.05）。治疗9个月后,对照组和观察组患者的瘢痕疼痛程度均较治疗前显著改善（Z值分别为-4.864、-5.303,P<0.05）,观察组患者的瘢痕疼痛程度较对照组显著改善（Z=-1.994,P<0.05）。治疗9个月后,观察组患者对瘢痕改善效果的满意度评分显著高于对照组（t=-2.964,P<0.05）。在治疗过程中及治疗9个月后,对照组仅有2例患者出现不良反应,观察组患者未发生明显不良反应,2组患者不良反应发生率比较,差异无统计学意义（P>0.05）。 结论 在压力疗法基础上联合应用NB-IPL对增生性瘢痕的外观、瘙痒与疼痛程度均有显著改善,且未增加治疗风险,可提升患者满意度,是一种安全有效的非手术联合治疗方案。 Abstract:Objective To investigate the clinical efficacy of pressure therapy combined with narrow-band intense pulsed light (NB-IPL) for hypertrophic scars. Methods This study was a retrospective cohort study. From January 2023 to January 2025, 73 patients with hypertrophic scars who met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine. According to whether they underwent laser treatment, patients were divided into control group that received pressure therapy alone (35 cases, 14 males and 21 females, aged (32±9) years), and observation group that received NB-IPL in addition to pressure therapy (38 cases, 18 males and 20 females, aged (32±10) years). In the two groups of patients, pressure therapy was performed under body surface pressure monitoring to ensure effective pressure on the scar area. In combination therapy, NB-IPL treatment was administered once a month for 6 consecutive sessions. Before treatment and 9 months after treatment, the Vancouver scar scale (VSS) was used to evaluate scar appearance, and the visual analogue scale (VAS) was used to assess the pruritus severity and pain levels of scars. Nine months after treatment, patients' satisfaction with the scar improvement effect was evaluated using the Likert scale. During the treatment and 9 months after treatment, adverse reactions in patients, including skin contact dermatitis and pressure blisters, were observed and recorded, and the incidence of adverse reactions was compared between the two groups of patients. Results Nine months after treatment, the VSS scores of scar appearance of patients in control group and observation group were 7.4±1.4 and 6.1±1.7, respectively, which were significantly lower than the pretreatment scores of 11.5±1.8 and 11.2±1.9, respectively (with t values of -5.149 and -5.396, respectively, P<0.05); the VSS score of scar appearance of patients in observation group was significantly lower than that in control group (with mean difference (95% CI) of -1.2 (-1.8 to -0.6), t=-3.458, P<0.05). Nine months after treatment, the pruritus severity of scar in both control group and observation group of patients was significantly improved compared with that before treatment (with Z values of -4.815 and -5.407, respectively, P<0.05); the pruritus severity of scar in observation group of patients was significantly improved compared with that in control group (Z=-3.690, P<0.05). Nine months after treatment, the scar pain levels in both control group and observation group of patients were significantly improved compared with that before treatment (with Z values of -4.864 and -5.303, respectively, P<0.05); the scar pain level in observation group of patients was significantly improved compared with that in control group (Z=-1.994, P<0.05). Nine months after treatment, the score of patients' satisfaction with the scar improvement in observation group was significantly higher than that in control group (t=-2.964, P<0.05). During the treatment and 9 months after treatment, only 2 patients in control group experienced adverse reactions, while no obvious adverse reactions were observed in observation group of patients. There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (P>0.05). Conclusions The application of NB-IPL combined with pressure therapy significantly improves the appearance, pruritus severity and pain levels of hypertrophic scars without increasing treatment risks, and can enhance patient satisfaction. It is a safe and effective non-surgical combination treatment approach. -
Key words:
- Cicatrix /
- Laser therapy /
- Narrow-band intense pulsed light /
- Pressure therapy /
- Scar assessment
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参考文献
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Table 1. 2组增生性瘢痕患者一般资料比较
组别 例数 性别（例） 年龄（岁, 病程（月, 瘢痕形状（例） 瘢痕部位（例） 致伤因素（例） 男 女 片状 线状 四肢 躯干 头面部 烧伤 手术 其他 对照组 35 14 21 32±9 6.3±2.9 22 13 23 7 5 16 12 7 观察组 38 18 20 32±10 6.0±2.7 27 11 21 9 8 20 10 8 统计量值 χ2=0.402 t=0.140 t=0.372 χ2=0.555 χ2=0.911 χ2=0.571 P值 0.526 0.611 0.584 0.456 0.634 0.752 注：对照组患者仅接受压力疗法,观察组患者在压力疗法基础上联合应用窄谱强脉冲光 
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Table 2. 2组患者治疗前及治疗9个月后增生性瘢痕瘙痒程度比较[例（%）]
组别 例数 治疗前 治疗9个月后 Z2值 P2值 无 轻度 中度 重度 无 轻度 中度 重度 对照组 35 0 2（5.7） 22（62.9） 11（31.4） 0 17（48.6） 17（48.6） 1（2.9） -4.815 <0.001 观察组 38 0 3（7.9） 24（63.2） 11（28.9） 0 31（81.6） 7（18.4） 0 -5.407 <0.001 Z1值 -0.742 -3.690 P1值 0.458 <0.001 注：对照组患者仅接受压力疗法,观察组患者在压力疗法基础上联合应用窄谱强脉冲光
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Table 3. 2组患者治疗前及治疗9个月后增生性瘢痕疼痛程度比较[例（%）]
组别 例数 治疗前 治疗9个月后 Z2值 P2值 无 轻度 中度 重度 无 轻度 中度 重度 对照组 35 0 13（37.1） 20（57.1） 2（5.7） 0 31（88.6） 4（11.4） 0 -4.864 <0.001 观察组 38 0 13（34.2） 23（60.5） 2（5.3） 0 37（97.4） 1（2.6） 0 -5.303 <0.001 Z1值 -0.454 -1.994 P1值 0.650 0.046 注：对照组患者仅接受压力疗法,观察组患者在压力疗法基础上联合应用窄谱强脉冲光
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