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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2021, Vol. 16 ›› Issue (06) : 495 -502. doi: 10.3877/cma.j.issn.1673-9450.2021.06.007

论著

CO2点阵激光联合酷蓝长脉宽1 064 nm Nd: YAG激光及富血小板血浆序贯疗法治疗烧伤瘢痕的疗效观察
黄瑞娟1, 王宏宇1, 巴特1,†(), 闫增强1, 周彪1, 德奇2, 杨瑞2   
  1. 1. 014010　包头，内蒙古包钢医院烧伤科　内蒙古烧伤研究所
    2. 014010　包头，内蒙古包钢医院烧伤科　内蒙古烧伤研究所；010059　呼和浩特，内蒙古医科大学研究生院
  • 收稿日期:2021-09-16 出版日期:2021-12-01
  • 通信作者: 巴特
  • 基金资助:
    重大疾病防治科技行动计划(2018-ZX-01S-001); 内蒙古自治区自然科学基金项目(2020MS08022); 内蒙古自治区自然科学基金项目(2020MS08181)

Efficacy of ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser and platelet-rich plasma sequential therapy on burn scar

Ruijuan Huang1, Hongyu Wang1, Te Ba1,†(), Zengqiang Yan1, Biao Zhou1, Qi De2, Rui Yang2   

  1. 1. Department of Burns, Inner Mongolia Burn Research Institute, Inner Mongolia Baogang Hospital, Baotou 014010, China
    2. Department of Burns, Inner Mongolia Burn Research Institute, Inner Mongolia Baogang Hospital, Baotou 014010, China; Graduate School of Inner Mongolia Medical University, Huhhot 010059, China
  • Received:2021-09-16 Published:2021-12-01
  • Corresponding author: Te Ba
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引用本文：

黄瑞娟, 王宏宇, 巴特, 闫增强, 周彪, 德奇, 杨瑞. CO2点阵激光联合酷蓝长脉宽1 064 nm Nd: YAG激光及富血小板血浆序贯疗法治疗烧伤瘢痕的疗效观察[J]. 中华损伤与修复杂志(电子版), 2021, 16(06): 495-502.

Ruijuan Huang, Hongyu Wang, Te Ba, Zengqiang Yan, Biao Zhou, Qi De, Rui Yang. Efficacy of ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser and platelet-rich plasma sequential therapy on burn scar[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2021, 16(06): 495-502.

目的

探讨CO2点阵激光联合酷蓝长脉宽1 064 nm Nd：YAG激光及富血小板血浆(PRP)序贯疗法治疗烧伤瘢痕的临床疗效及安全性。

方法

选取内蒙古包钢医院烧伤科内蒙古烧伤研究所2018年1月至2019年8月收治的90例烧伤后瘢痕增生患者作为研究对象。按随机数字表法分为CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组及序贯组，每组各30例。CO2点阵激光治疗组治疗间隔时间为2个月，共行3次CO2点阵激光治疗；CO2点阵激光+酷蓝激光组在CO2点阵激光治疗组基础上，分别于第1、2次CO2点阵激光治疗结束1个月后，每2周行1次酷蓝激光治疗，共行3次CO2点阵激光治疗及4次酷蓝激光治疗；序贯组在CO2点阵激光+酷蓝激光组基础上于每次CO2点阵激光治疗结束后即刻创面局部涂抹PRP。观察并比较3组患者的临床疗效、视觉模拟评分法(VAS)评分、温哥华瘢痕量表(VSS)评分、患者满意度、不良反应及复发情况。数据行χ2检验、Fisher确切概率法、LSD-t检验、Kruskal-Wallis检验，Mann-Whitney检验。

结果

第3次CO2点阵激光治疗后2个月，CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组、序贯组的总有效率分别为22例(73.33%)、28例(93.33%)、29例(96.67%)，3组间整体比较，差异无统计学意义(χ2＝9.63，P＝0.14)。3组患者治疗前VAS评分比较，差异无统计学意义(F＝0.07，P＝0.932)。第1、2次CO2点阵激光治疗后2个月，3组间整体比较差异有统计学意义(F＝12.04、9.02，P<0.05)；第3次CO2点阵激光治疗后2个月，CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组、序贯组的VAS评分分别为(3.76±0.77)、(1.35±0.43)、(1.28±0.39)分，3组间整体比较差异有统计学意义(F＝59.09，P<0.05)，CO2点阵激光治疗组分别与CO2点阵激光+酷蓝激光组、序贯组比较，差异均有统计学意义(t＝6.61、6.65，P<0.05)；CO2点阵激光+酷蓝激光组与序贯组比较，差异有统计学意义(t＝0.52，P<0.05)。3组患者治疗前VSS评分比较，差异无统计学意义(F＝0.10，P＝0.90)。第1、2次CO2点阵激光治疗后2个月，3组间整体比较差异有统计学意义(F＝7.43、17.29，P<0.05)；第3次CO2点阵激光治疗后2个月，CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组、序贯组VSS评分分别为(5.43±1.06)、(4.32±0.95)、(1.80±0.64)分，3组间整体比较差异有统计学意义(F＝127.68，P<0.05)，序贯组分别与CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组比较，差异均有统计学意义(t＝15.60、10.80，P<0.05)；CO2点阵激光+酷蓝激光组与CO2点阵激光治疗组比较，差异有统计学意义(t＝4.80，P<0.05)。第3次CO2点阵激光治疗后2个月，CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组、序贯组的患者满意度分别为16例(53.33%)、30例(100.00%)、24例(80.00%)，3组间整体比较差异有统计学意义(P<0.05)。CO2点阵激光治疗组有3例(10.00%)患者激光治疗后皮肤出现红斑，2个月后自行消退，序贯组和CO2点阵激光+酷蓝激光组治疗过程中均未出现不良反应。随访1年，CO2点阵激光治疗组、CO2点阵激光+酷蓝激光组、序贯组复发率分别为8例(26.67%)、1例(3.34%)、0(0)，3组间整体比较差异有统计学意义(P<0.05)；CO2点阵激光治疗组分别与CO2点阵激光+酷蓝激光组、序贯组比较差异均有统计学意义(χ2＝4.71、7.07，P＝0.030、0.008)。

结论

CO2点阵激光联合酷蓝激光及PRP序贯疗法治疗烧伤瘢痕修复效果可靠，可明显改善瘢痕形态、色泽及柔软度，提高美观度，优于单一治疗，值得临床推广应用。

关键词: 烧伤, 瘢痕, 激光疗法, 富血小板血浆
Objective

To investigate the clinical efficacy and safety of ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser and platelet-rich plasma(PRP) sequential therapy in the treatment of burn scar.

Methods

A total of 90 patients with postburn scar hyperplasia admitted Department of Burns, to Inner Mongolia Burn Research Institute, Inner Mongolia Baogang Hospital from January 2018 to August 2019 were selected as the research object. According to random number table method, the patients were divided into ultra pulse CO2 lattice laser treatment group, ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and sequential group, with 30 cases in each group. In the ultra pulse CO2 lattice laser treatment group, the treatment interval was two months, and a total of three ultra pulse CO2 lattice laser treatments were performed. On the basis of ultra pulse CO2 lattice laser treatment group, ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser treatment group was treated with long pulse width 1 064 nm Nd: YAG laser treatment once every two weeks at once month after the end of the first and second ultra pulse CO2 lattice laser treatment, a total three ultra pulse CO2 lattice laser treatments and four long pulse width 1 064 nm Nd: YAG laser treatment. In the sequential group, PRP was applied locally to the wound immediately after each ultra pulse CO2 lattice laser treatment on the basis of ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group. Clinical efficacy, visual analogue scale (VAS) score, vancouver scar scale (VSS) score, patient satisfaction, adverse reactions and recurrence were observed and compared among the three groups. Data were processed with chi-square test, Fisher′s exact probability test, LSD-t test, Kruskal-Wallis test, and Mann-Whitney test.

Results

Two months after the third ultra pulse CO2 lattice laser treatment, the total effective rate of the ultra pulse CO2 lattice laser treatment group, the ultra pulse CO2 lattice laser combined with long pulse with 1 064 nm Nd: YAG laser group and the sequential group were 22 patients (73.33%), 28 patients (93.33%) and 29 patients (96.67%), respectively. There was no statistically significant differences among the three groups (χ2=9.63, P=0.14). There was no significant difference in VAS score among the three groups before treatment (F=0.07, P=0.932). Two months after the first and second ultra pulse CO2 lattice laser treatment, the overall differences among the three groups were statistically significant (F=12.04, 9.02; P<0.05). Two months after the third ultra pulse CO2 lattice laser treatment, the VAS scores of the ultra pulse CO2 lattice laser treatment group, the ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and the sequential group were (3.76±0.77), (1.35±0.43) and (1.28±0.39) points, respectively, and the overall difference among the three groups was statistically significant (F=59.09, P < 0.05). Compared with the ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and sequential group, the differences were statistically significant (t=6.61, 6.65; P<0.05). Compared with the sequential group, there was statistically significant difference in ultra pulse CO2 lattice laser combined with long pulse width 1 064 nmNd: YAG laser group (t=0.52, P<0.05). There was no statistically significant difference in VSS scores among three groups before treatment (F=0.10, P=0.90). Two months after the first and second ultra pulse CO2 lattice laser treatment, the overall differences among the three groups were statistically significant (F=7.43, 17.29; P<0.05). Two months after the third ultra pulse CO2 lattice laser treatment, the VSS scores of the ultra pulse CO2 lattice laser treatment group, the ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and the sequential group were (5.43±1.06), (4.32±0.95) and (1.80±0.64) points, respectively, and the overall difference among the three groups was statistically significant (F=127.68, P < 0.05). The sequential group was compared with ultra pulse CO2 lattice laser treatment group and ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group, respectively, and the differences were statistically significant (t=15.60, 10.80; P<0.05). The difference between ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and ultra pulse CO2 lattice laser treatment group was statistically significant (t=4.80, P<0.05). Two months after the third ultra pulse CO2 lattice laser treatment, the satisfaction of patients in ultra pulse CO2 lattice laser treatment group, ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and sequential group were 16 patients (53.33%), 30 patients (100.00%) and 24 patients (80.00%), respectively. The overall difference among the three groups was statistically significant (P < 0.05). In the ultra pulse CO2 lattice laser treatment group, 3 patients (10.00%) showed skin erythema after laser treatment, which disappeared spontaneously 2 months later. No adverse reactions occurred in the ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and sequential group. Follow-up for one year after laser treatment, the recurrence rates of ultra pulse CO2 lattice laser treatment group, ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and sequential group were 8 patients (26.67%), 1 patient (3.34%) and 0(0), the overall difference among the three groups was statistically significant (P < 0.05). There were statistically significant differences between the ultra pulse CO2 lattice laser treatment group and the ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser group and the sequential group (χ2=4.71, 7.07; P=0.030, 0.008).

Conclusions

Ultra pulse CO2 lattice laser combined with long pulse width 1 064 nm Nd: YAG laser and PRP sequential therapy has reliable healing effect on burn scar, which can significantly improve scar morphology, color and softness, and improve aesthetic degree. It is superior to single therapy and worthy of clinical application.

Key words: Burns, Cicatrix, Laser therapy, Platelet-rich plasma
表1 3组烧伤后瘢痕增生患者一般资料比较
组别 例数 性别(例) 平均年龄(岁，±s) 平均病程(个月，±s) 瘢痕位置(例)
男 女 面部 上肢 下肢 躯干
CO2点阵激光治疗组 30 15 15 32.7±5.7 6.1±2.3 9 10 5 6
CO2点阵激光+酷蓝激光组 30 12 18 31.0±4.6 5.9±2.4 8 10 5 7
序贯组 30 17 13 31.5±5.8 6.8±2.1 6 12 7 5
χ2值   1.69     1.70
F值     0.70 1.30  
P值   0.43 0.50 0.30 0.95
表2 3组烧伤后瘢痕增生患者瘢痕修复临床疗效比较
组别 例数 痊愈(例) 显效(例) 有效(例) 无效(例) 总有效率[例(%)]
CO2点阵激光治疗组 30 12 6 4 8 22(73.33)
CO2点阵激光+酷蓝激光组 30 15 7 6 2 28(93.33)
序贯组 30 13 9 7 1 29(96.67)
χ2值           9.63
P值           0.14
表3 3组烧伤后瘢痕增生患者治疗前后VAS评分比较(分，±s)
组别 例数 治疗前 第1次CO2点阵激光治疗后2个月 第2次CO2点阵激光治疗后2个月 第3次CO2点阵激光治疗后2个月
CO2点阵激光治疗组 30 6.42±1.33 5.32±1.17 4.29±0.99 3.76±0.77
CO2点阵激光+酷蓝激光组 30 6.41±1.58 4.13±1.32 3.80±0.88 1.35±0.43
序贯组 30 6.54±1.71 3.88±1.13 3.31±0.81 1.28±0.39
F值   0.07 12.04 9.02 59.09
P值   0.932 <0.05 <0.05 <0.05
t1值   0.02 3.81 2.12 6.61
P1值   0.99 <0.05 0.04 <0.05
t2值   0.33 0.78 2.13 0.52
P2值   0.74 0.44 0.04 <0.05
t3值   0.32 4.58 4.25 6.65
P3值   0.75 <0.05 <0.05 <0.05
表4 3组烧伤后瘢痕增生患者治疗前后VSS比较(分，±s)
组别 例数 治疗前 第1次CO2点阵激光治疗后2个月 第2次CO2点阵激光治疗后2个月 第3次CO2点阵激光治疗后2个月
CO2点阵激光治疗组 30 9.66±2.09 8.90±1.67 7.37±1.23 5.43±1.06
CO2点阵激光+酷蓝激光组 30 9.85±2.49 8.18±1.60 6.19±1.32 4.32±0.95
序贯组 30 9.58±2.32 7.34±1.42 5.53±1.13 1.80±0.64
F值   0.10 7.43 17.29 127.68
P值   0.90 0.001 <0.05 <0.05
t1值   0.31 1.79 3.72 4.80
P1值   0.76 0.08 <0.05 <0.05
t2值   0.45 2.06 2.09 10.80
P2值   0.66 0.04 0.04 <0.05
t3值   0.13 3.85 5.80 15.60
P3值   0.90 <0.05 <0.05 <0.05
表5 3组烧伤后瘢痕增生患者第3次CO2点阵激光治疗后2个月满意度比较
组别 例数 十分满意(例) 满意(例) 一般(例) 不满意(例) 十分不满意(例) 满意度[例(%)]
CO2点阵激光治疗组 30 8 8 6 5 3 16(53.33)
CO2点阵激光+酷蓝激光组 30 17 13 0 0 0 30(100.00)
序贯组 30 11 13 3 2 1 24(80.00)
P值             <0.05
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