摘要：
Objective To compare the efficacy and safety of pulsed dye laser with different parameters in the treatment of hypertrophic scar after burn.Methods From January 2016 to June 2016,122 patients with hypertrophic scar after burn were treated in our unit.The data were analyzed retrospectively.According to the pulse width and energy of pulsed dye laser treatment,there were 31 cases with 0.45 ms-low energy,28 cases with 0.45 ms-high energy,37 cases with 1.5 ms-low energy and 26 cases with 1.5 ms-high energy,which were treated once every 3-4 weeks.The Vancouver Scar Scale (VSS) was used to evaluate the scar condition before and after treatment,and the pain of patients was scored by VAS before and after treatment.The blood flow of scar site was monitored before and 12 months after treatment,and the blood perfusion was recorded.The patients'satisfaction was recorded 3 to 6 months after treatment,and the satisfaction rate was calculated.Results (1) The VSS scores of 0.45 ms-low energy,0.45 ms-high energy,1.5 ms-low energy and 1.5 ms-high energy groups after treatment were significantly lower than those before treatment in each group (t =11.3,9.0,14.1,12.7,P ＜ 0.05).After treatment,the VSS scores of each group decreased by (5.8 ± 1.1),(5.2 ± 1.4),(4.1 ±0.8) and (4.0 ±0.9),respectively,with significant differences among the four groups (F =4.2,P ＜ 0.05).Except for 1.5 ms pulse width,there was no significant difference in the effect of low-energy and high-energy treatment (P ＞ 0.05),but there was significant difference in the effect of other treatment groups(t =7.29,4.81,6.91,5.11,4.74,P ＜0.05).(2)The VAS scores of the 4 groups after treatment were significantly lower than those before treatment in each group (t =7.1,5.2,4.1,6.6,P ＜ 0.05);the VAS scores of each group after treatment decreased by 3.9 ± 1.3,5.1 ± 0.9,3.5 ± 0.6,4.9 ± 0.9,respectively,with significant statistical differences among the four groups (F =8.8,P ＜ 0.05).Regardless of the pulse width of 0.45 ms or 1.5 ms,the pain degree of scar improved more in the high energy group than in the low energy group (t =6.4,2.2,3.4,4.74,P ＜0.05).(3) Four groups of scar blood perfusion decreased.(4) The satisfaction of the four groups were 82.3％,79.1％,84.5％,77.7％,respectively.There was no significant difference in satisfaction evaluation among the four groups (P ＞ 0.05).Conclusions The therapeutic effect of pulsed dye laser on hypertrophic scar is very exact,and the treatment parameters of 0.45 ms pulse width and low energy 4-6 J/cm2 are recommended,which provide clinical basis for the prevention and treatment of scar and the application of pulsed dye laser.It is worthy of clinical application.%目的 比较脉冲染料激光不同参数治疗烧伤后增生性瘢痕的疗效及安全性.方法 回顾性分析2016年1月至2016年6月本院收治122例烧伤后增生性瘢痕患者的临床资料.根据脉冲染料激光治疗脉宽与能量不同,分为0.45 ms-低能量组31例,0.45 ms-高能量组28例,1.5 ms-低能量组37例,1.5 ms-高能量组26例,间隔3～4周治疗1次,治疗前及治疗结束后采用温哥华瘢痕量表(VSS)对瘢痕情况进行评分,采用VAS法对患者疼痛进行评分;治疗前及治疗12个月监测瘢痕部位血流,记录血流灌注量;记录治疗结束后3～6个月患者满意度,并计算满意率.结果 (1)0.45 ms-低能量、0.45 ms-高能量、1.5 ms-低能量、1.5 ms-高能量四组治疗后VSS的评分明显低于各组治疗前(t=11.3、9.0、14.1、12.7,P＜0.05),各组治疗后评分依次分别下降(5.8±1.1)分、(5.2±1.4)分,(4.1±0.8)分、(4.0±0.9)分,四组比较差异有统计学意义(F=4.2,P＜0.05).除1.5 ms脉宽下,低能量与高能量治疗效果差异无统计学意义(P＞0.05),其他治疗组两两比较治疗效果差异均有统计学意义(t=7.29,4.81,6.91,5.11,4.74,P＜0.05).(2)0.45 ms-低能量、0.45 ms-高能量、1.5 ms-低能量、1.5 ms-高能量四组治疗后VAS评分明显低于各组治疗前(t=7.1、5.2、4.1、6.6,P＜0.05);各组治疗后评分依次分别下降(3.9±1.3)分、(5.1±0.9)分,(3.5±0.6)分、(4.9±0.9)分,四组间比较差异有统计学意义(F=8.8,P＜0.05).不论是0.45 ms或1.5 ms脉宽下,高能量组瘢痕疼痛程度改善较低能量组更多(t=6.4,2.2,3.4,4.74,P＜0.05).(3)0.45 ms脉宽组瘢痕血流灌注明显下降.(4)四组患者满意度分别达82.3％,79.1％,84.5％,77.7％,四者间满意度评价差异无统计学意义(P＞0.05).结论 脉冲染料激光对增生性瘢痕的疗效非常确切,且推荐0.45 ms脉宽、低能量4 ～6 J/cm2的治疗参数,为瘢痕的防治、脉冲染料激光的应用提供了临床依据.
