点阵二氧化碳激光治疗儿童深度烧伤后早期增生性瘢痕的效果评价

刘继松; 邢福席; 付全有; 章祥洲; 李勇; 徐东卫

doi:10.16766/j.cnki.issn.1674-4152.002857

点阵二氧化碳激光治疗儿童深度烧伤后早期增生性瘢痕的效果评价

doi: 10.16766/j.cnki.issn.1674-4152.002857

蚌埠市第三人民医院烧伤整形科，安徽蚌埠 233000

基金项目:

安徽省卫生健康科研项目 AHW2021a042

蚌埠市政府基金资助项目蚌人才(2020)8号

详细信息

通讯作者:
刘继松，E-mail：13965288028@139.com

中图分类号: R644 R616.4
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出版历程
- 收稿日期: 2022-06-17
- 网络出版日期: 2023-04-20

Evaluation of fractional carbon dioxide laser in the treatment of early hypertrophic scars after deep burns in children

Department of Burn and Plastic Surgery, the Third People's Hospital of Bengbu, Bengbu, Anhui 233000, China

摘要

摘要: 目的深度烧伤后瘢痕增生常严重影响儿童的日常生活，本研究旨在探讨点阵二氧化碳激光治疗儿童深度烧伤后早期增生性瘢痕的疗效及安全性。方法选取2019年7月—2021年5月蚌埠市第三人民医院烧伤整形科收治的符合入选标准的深度烧伤患儿68例，其中男44例，女24例。按照随机数字法将患儿分为观察组(33例)与对照组(35例)，2组患儿均给予常规治疗(压力治疗和药物治疗), 观察组在常规治疗的基础上加用二氧化碳点阵激光治疗。采用温哥华瘢痕量表(VSS)和患儿与观察者瘢痕评估量表(POSAS)对患儿进行评分，并记录不良反应发生情况和患儿满意度。结果治疗后3个月，观察组患儿VSS[(5.54±1.41)分]、OSAS[(3.42±0.79)分]、PSAS[(4.00±0.79)分]总体评分较治疗前VSS[(8.24±1.73)分]、OSAS[(5.00±0.82)分]、PSAS[(5.48±0.97)分]明显改善，差异均有统计学意义(均P < 0.05)；对照组患儿VSS[(6.94±1.64)分]、OSAS[(4.28±0.75)分]、PSAS[(4.91±0.70)分]总体评分较治疗前改善，差异均有统计学意义(均P < 0.05)，观察组VSS、OSAS、PSAS总体评分均低于对照组(均P＜0.05)。治疗后观察组患儿的瘢痕改善程度较对照组更加明显(P < 0.05)。治疗过程中，观察组患儿出现红斑2例，色素沉着1例，糜烂1例，对照组患儿出现水疱3例，糜烂2例。结论对于增生性瘢痕，在常规抗瘢痕的基础上加用点阵二氧化碳激光治疗可以有效地改善瘢痕的厚度、血管分布等，减少瘢痕导致的瘙痒、疼痛，提高患儿的生活质量。
- 烧伤 /
- 点阵二氧化碳激光 /
- 瘢痕
Abstract: Objective This study aims to investigate the efficacy and safety of dot-matrix carbon dioxide laser in the treatment of early hypertrophic scar after deep burn in children. Methods A total of 68 children with deep burns who met the inclusion criteria and were admitted to the Department of Burn and Plastic Surgery, the Third People's Hospital of Bengbu from July 2019 to May 2021 were selected, including 44 males and 24 females. The patients were randomly divided into observation group (n=33) and control group (n=35). Both groups were given conventional treatment (pressure therapy and drug therapy), while the observation group was given carbon dioxide fractional laser on the basis of conventional treatment. The vancouver scar scale (VSS) and the patient and observer scar assessment scale (POSAS) were used to score patients, and adverse reactions and patient satisfaction were recorded. Results The overall scores of VSS [(5.54±1.41) points], OSAS [(3.42±0.79) points] and PSAS [(4.00±0.79) points] in the observation group were significantly improved at 3 months after treatment compared with those VSS [(8.24±1.73)], OSAS [(5.00±0.82)], and PSAS [(5.48±0.97)] before treatment, and the differences were all statistically significant (all P < 0.05). The overall scores of VSS [(6.94±1.64) points], OSAS [(4.28±0.75) points] and PSAS [(4.91±0.70) points] in the control group at 3 months after treatment were slightly improved compared with those before treatment, and the differences were statistically significant (all P < 0.05). The overall scores of VSS, OSAS and PSAS in the observation group were lower than those in the control group (all P < 0.05). After treatment, the degree of scar improvement in the observation group was more obvious than that in the control group. During the treatment, 2 patients in the observation group had erythema, 1 patient had pigmentation, and 1 patient had erosions. In the control group, 3 patients had blisters and 2 patients had erosions. Conclusion For hypertrophic scar, the addition of fractional carbon dioxide laser treatment on the basis of conventional anti-scar can effectively improve the thickness and blood vessel distribution of scar, reduce itching and pain caused by scar, and improve the patient's quality of life.
- Burn /
- Fractional carbon dioxide laser /
- Scar

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图 1 患儿治疗前和治疗后3个月的照片

注：A为治疗前可见瘢痕凸出体表，充血明显；B为经过点阵激光治疗后，可见瘢痕充血明显改善，疗效确切。

Figure 1. Photographs of the children before and 3 months after treatment

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表 1 2组深度烧伤患儿一般资料比较

Table 1. Comparison of general data between two groups of children with deep burn

组别	例数	性别		年龄 [M(P₂₅, P₇₅)，岁]	瘢痕面积 [M(P₂₅, P₇₅), %TBSA]
组别	例数	男	女	年龄 [M(P₂₅, P₇₅)，岁]	瘢痕面积 [M(P₂₅, P₇₅), %TBSA]
观察组	33	25	8	2(1, 3)	2(2, 4)
对照组	35	19	16	2(1, 3)	3(2, 4)
统计量		3.429^a		0.272^b	0.234^b
P值		0.064		0.787	0.816
注：^a为χ²值，^b为Z值。

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表 2 2组深度烧伤患儿VSS评分比较(x±s，分)

Table 2. Comparison of VSS scores in 2 groups of children with deep burn (x±s, points)

组别	例数	色泽		厚度		血管分布		柔软度		总评分
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
观察组	33	1.93±0.82	1.06±0.60^a	2.24±0.86	2.18±0.80	2.03±0.84	1.18±0.68^a	2.03±0.84	1.21±0.78^a	8.24±1.73	5.54±1.41^a
对照组	35	2.08±0.74	1.40±0.65^a	2.51±0.74	2.42±0.73	2.22±0.80	1.62±0.73^a	2.17±0.85	1.65±0.83^a	9.00±1.60	6.94±1.64^a
t值		0.769	2.221	1.391	1.315	0.988	2.601	0.682	2.262	1.870	3.745
P值		0.445	0.030	0.169	0.193	0.327	0.011	0.497	0.027	0.066	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组深度烧伤患儿观察者瘢痕评估量表评分比较(x±s，分)

Table 3. Comparison of observer scar assessment scale scores in 2 groups of children with deep burn (x±s, points)

组别	例数	血管分布		柔韧性		表面范围		瘢痕厚度
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
观察组	33	5.21±.073	4.57±0.70^a	5.24±0.79	4.30±0.68^a	5.06±0.70	4.30±0.58^a	4.93±0.93	4.87±0.89
对照组	35	5.02±0.82	4.43±0.75^a	5.14±0.80	4.08±0.65^a	4.85±1.14	4.14±1.03^a	4.85±1.00	4.82±1.04
t值		0.966	1.467	0.512	1.335	0.890	0.792	0.349	0.213
P值		0.388	0.147	0.610	0.187	0.377	0.432	0.728	0.832

组别	例数	色素沉着		瘢痕的凸凹程度		总体评价
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
观察组	33	5.06±0.82	4.72±0.71^a	5.36±0.74	5.36±0.74	5.00±0.82	3.42±0.79^a
对照组	35	5.00±0.93	4.94±0.96	4.85±1.00	4.77±0.94^a	5.37±0.87	4.28±0.75^a
t值		0.282	1.037	2.374	2.456	1.792	4.607
P值		0.779	0.303	0.021	0.017	0.078	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组深度烧伤患儿患者瘢痕评估量表评分比较(x±s，分)

Table 4. Comparison of scar assessment scale scores in 2 groups of children with deep burn (x±s, points)

组别	例数	疼痛		瘙痒程度		色素沉着		瘢痕硬度
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
观察组	33	4.90±0.76	4.30±0.72^a	5.09±0.91	4.60±0.78^a	4.90±0.91	4.12±0.78^a	5.21±0.85	4.21±0.85^a
对照组	35	5.22±0.84	4.45±0.70^a	5.14±0.77	5.08±0.74	5.11±0.83	4.22±0.64^a	5.11±0.90	4.20±0.83^a
t值		1.633	0.889	0.252	2.584	0.969	0.619	0.458	0.059
P值		0.107	0.377	0.802	0.012	0.336	0.538	0.648	0.953

组别	例数	瘢痕厚度		形状		总体评价
组别	例数	治疗前	治疗后3个月	治疗前	治疗后3个月	治疗前	治疗后3个月
观察组	33	5.27±0.91	5.21±0.81	5.15±0.87	4.48±0.87^a	5.48±0.97	4.00±0.79^a
对照组	35	6.02±0.95	5.94±0.96	5.20±0.79	4.57±0.77^a	5.91±0.91	4.91±0.70^a
t值		3.337	3.348	0.240	0.433	1.872	5.349
P值		0.001	0.001	0.811	0.666	0.066	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 5 2组深度烧伤患儿瘢痕的改善程度比较[M(P₂₅, P₇₅), 分]

Table 5. Comparison of improvement degrees of scar in twogroups of children with deep burn [M(P₂₅, P₇₅), points]

组别	例数	VSS总评分差值	OSAS总评分差值	PSAS总评分差值
观察组	33	3(2, 3)	1(1, 2)	1(1, 2)
对照组	35	2(1, 2)	1(1, 1)	1(0, 1)
Z值		2.302	3.091	2.515
P值		0.040	0.002	0.012

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