类人胶原蛋白敷料联合超脉冲CO<sub>2</sub>点阵激光治疗凹陷性痤疮瘢痕的疗效和安全性

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摘要目的评价类人胶原蛋白敷料联合超脉冲CO₂点阵激光治疗面部凹陷性痤疮瘢痕的疗效和安全性。方法选择2015-05至2016-12就诊的面部痤疮凹陷性瘢痕患者76例,随机分为对照组和治疗组,各38例。对照组采用超脉冲CO₂点阵激光,间隔3个月治疗1次,共4次。治疗组在点阵激光术后给予类人胶原蛋白敷料外用。采用ECCA评估法评价皮损,对比两组患者的瘢痕评分、急性炎性反应红斑和疼痛持续时间、结痂时间、痂皮完全脱落时间、误工期、不良反应等。结果两组患者治疗后ECCA评分均比治疗前明显下降,治疗组比对照组下降更明显(P<0.05);治疗组术后红斑持续时间(1.25±0.62)d,疼痛持续时间(1.46±0.77)d,均明显短于对照组,差异有统计学意义(t=-2.483,P=0.015;t=-3.219,P=0.002);两组术后结痂时间对比,差异无统计学意义(t=-0.439,P=0.066),但治疗组痂皮完全脱落时间、误工期均短于对照组,差异有统计学意义(t=-3.049,P=0.003;t=-2.197,P=0.031);治疗组患者主观感受和舒适程度评价优于对照组,差异有统计学意义(Z=-2.197,P=0.028),治疗组患者满意率(68.42%)高于对照组(44.74%),差异有统计学意义(χ²=4.338,P=0.037);治疗组色素沉着发生率5.26%,低于对照组的21.05%,差异有统计学意义(χ²=4.145,P=0.042),两组患者均未出现水泡、感染和增生性瘢痕等不良反应。结论联合外用类人胶原蛋白敷料可明显提高超脉冲CO₂点阵激光术后痤疮凹陷性瘢痕患者的治疗效果,缩短急性期红斑持续时间和疼痛持续时间,促进愈合,缩短误工期,减少不良反应,改善患者术后不良感受,提高生活质量。

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关键词 ：二氧化碳点阵激光, 凹陷性瘢痕, 痤疮, 类人胶原蛋白敷料

Abstract： Objective To evaluate the effects and safety of human-like collagen dressings combined with ultra pulsed fractional CO₂ laser in the treatment of facial atrophic acne scars.Methods Seventy-six cases of facial atrophic acne scars treated between May 2015 and December 2016 in our hospital were randomly divided into the control group and the treatment group, with 38 cases in each. The control group was treated with ultra pulsed fractional CO₂ laser four times, once every 3 months, while the treatment group was given a human-like collagen dressing for external use after laser stroke. Skin lesions were evaluated with ECCA. The scar score, duration of acute inflammatory erythema, duration of pain, time it took for a scab to form, the time taken by a scab to drop off, duration of delayed work and adverse reactions were compared between the two groups.Results After treatment, the ECCA scores of the two groups of patients with atrophic acne scars were significantly lower, especially in the treatment group (P<0.05). The duration of erythema was (1.25±0.62) days and that of pain was (1.46±0.77) days in the treatment group, which were significantly shorter than those of the control group, so the difference was statistically significant(t=-2.483,P=0.015;t=-3.219,P=0.002). There was no statistically significant difference between the two groups in the time it took to form a scab(t=-0.439,P=0.066). However, the time taken by a scab to drop off and duration of delayed work were shorter in the treatment group than in the control group, and the difference was statistically significant (t=-3.049,P=0.003;t=-2.197,P=0.031). The subjective feeling and comfort level of the treatment group were better than those of the control group, and the difference was statistically significant(Z=-2.197,P=0.028). The satisfaction rate of the patients in the treatment group was 68.42%, higher than that of the control group (44.74%), and the difference was statistically significant(χ²=4.338,P=0.037). The incidence of pigmentation in the treatment group was 5.26%, which was lower than that of the control group(21.05%), and the difference was statistically significant(χ²=4.145,P=0.042). There were no adverse reactions, such as blisters, infection or hypertrophic scars, in either group.Conclusions Combination with human-like collagen dressing can significantly improve the therapeutic effect of ultra pulsed fractional CO₂ laser in patients with atrophic acne scars, shorten the duration of acute erythema and duration of pain, promote healing, shorten the duration of delayed work, reduce adverse reactions, alleviate patients’ postoperative discomfort and improve their quality of life.

Key words： fractional carbon dioxide laser atrophic scar acne human-like collagen dressing

收稿日期: 2018-03-20

ZTFLH:

R619.6

通讯作者: 白晓东,E-mail:baixiaotmu@126.com

作者简介: 王怀湘,本科学历,副主任医师。

引用本文:

王怀湘,李建明,郑金光,白晓东. 类人胶原蛋白敷料联合超脉冲CO₂点阵激光治疗凹陷性痤疮瘢痕的疗效和安全性[J]. 武警医学, 2018, 29(7): 680-679. WANG Huaixiang, LI Jianming, ZHENG Jinguang, and BAI Xiaodong. Effects and safety of human-like collagen dressing combined with ultra pulsed fractional CO₂ laser in treatment of atrophic acne scars. Med. J. Chin. Peop. Armed Poli. Forc., 2018, 29(7): 680-679.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2018/V29/I7/680

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