重组人表皮生长因子凝胶联合CO2点阵激光治疗增生性瘢痕的效果观察

目的观察重组人表皮生长因子凝胶联合CO₂点阵激光治疗烧伤及创伤后增生性瘢痕的临床效果。 方法选择2020年12月至2021年10月安徽医科大学第一附属医院烧伤与创面修复外科收治的20例增生性瘢痕患者，按照随机数字表法将患者分为联合治疗组及单纯激光治疗组，每组10例。术前均对2组患者术区进行拍照存像、消毒、擦干，局部均匀涂抹5%复方利多卡因乳膏后以无菌薄膜封闭保护60 min，擦去乳膏后再次消毒术区。术中使用CO₂点阵激光治疗仪对患者瘢痕部位进行扫描，根据患者增生性瘢痕厚度选定合适的机器参数，维持机器频率300 Hz及密度5%，在20～30 J调整能量参数的大小，时间间隔1 s，保证点阵矩形完全覆盖增生瘢痕，允许2次激光形成的热损伤矩阵之间存在25%面积的重叠。术后即刻冷敷创面60 min，冷敷结束至术后1周，单纯激光治疗组不外用任何药物，联合治疗组术区加用重组人表皮生长因子凝胶外用，3次/d。术后3 d治疗部位不碰水，若出现感染情况，可以加用抗生素软膏，点状损伤创面外痂皮未掉落完全时禁止擦洗创面，禁止直接剥除痂皮，禁止术区涂抹化妆品等，避免接受阳光直射。于第1次激光治疗后2个月进行第2次激光治疗，以2次CO₂点阵激光治疗为1个疗程，1个疗程治疗后间隔2个月待术区稳定后行疗效判断，计算2组患者治疗的总有效率；根据温哥华瘢痕量表(VSS)与患者与观察者瘢痕评估量表(POSAS)对患者治疗前、第1次激光治疗后2个月、第2次激光治疗后2个月瘢痕的各项指标进行评分。数据比较采用重复测量方差分析和χ²检验。 结果(1)治疗1个疗程后2个月，单纯激光治疗组与联合治疗组患者治疗的总有效率分别为80%(8/10)、90%(9/10)，2组间比较差异无统计学意义(χ²＝2.40，P＝0.49)。(2)对2组VSS评分的各项指标进行比较，其中疼痛、瘙痒、柔软度及厚度评分的组内及组间各时相点比较，差异均无统计学意义(P>0.05)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组VSS评分中色泽评分分别为(1.9±0.7)、(1.9±0.1)、(1.8±1.0)分，联合治疗组分别为(2.9±0.7)、(2.8±0.6)、(1.9±0.7)分，2组在不同时相点组内比较，差异有统计学意义(F＝ 26.143，P<0.05)；2组组间不同时相点比较，差异有统计学意义(F＝6.753，P＝0.018)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组VSS评分中血管分布评分分别为(1.8±1.0)、(1.7±0.7)、(1.5±1.0)分，联合治疗组分别为(2.6±0.5)、(2.5±0.5)、(1.7±0.8)分，2组在不同时相点组内比较，差异有统计学意义(F＝17.603，P<0.05)，2组组间不同时相点比较，差异无统计学意义(F＝ 2.538，P＝0.129)。(3)对2组POSAS评分的各项指标进行比较，其中厚度、粗糙度、柔软度和表面积评分的组内及组间各时相点比较，差异均无统计学意义(P>0.05)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组POSAS评分中色泽评分分别为(4.9±2.6)、(4.1±0.8)、(3.5±2.0)分，联合治疗组分别为(7.6±1.1)、(6.8±1.4)、(5.4±1.8)分，2组在不同时相点组内比较，差异有统计学意义(F＝ 26.509，P<0.05)，2组组间不同时相点比较，差异有统计学意义(F＝ 8.973，P＝0.008)。治疗前、第1次激光治疗后2个月及第2次激光治疗后2个月，单纯激光治疗组POSAS评分中血管分布评分分别为(4.4±2.1)、(3.9±0.9)、(3.5±1.6)分，联合治疗组分别为(6.3±1.1)、(5.7±2.0)、(4.5±1.6)分，2组在不同时相点组内比较，差异有统计学意义(F＝ 20.118，P<0.05)，2组组间不同时相点比较，差异有统计学意义(F＝ 5.744，P＝0.028)。 结论重组人表皮生长因子凝胶联合CO₂点阵激光及单独使用CO₂点阵激光治疗增生性瘢痕均效果明确，但联合使用重组人表皮生长因子凝胶能有效促进创面愈合、改善瘢痕组织血管分布和减少局部色素沉着。

Observation of the effect of recombinant human epidermal growth factor gel combined with CO2 fractional laser in the treatment of hypertrophic scars

ObjectiveTo evaluate the clinical efficacy of recombinant human epidermal growth factor gel combined with CO₂ fractional laser in the treatment of hypertrophic scars after burns and traumatic. MethodsTwenty patients with hypertrophic scar who were admitted to the Department of Burns and Wound Repair Surgery, First Affiliated Hospital of Anhui Medical University from December 2020 to October 2021 were selected and divided into the combined treatment group and the laser treatment group according to the random number table method, with 10 cases in each group. Before operation, the operation area of patients in both groups were taken photos, disinfected, wiped dry, and evenly applied 5% compound lidocaine cream locally, then a sterile film was sealed and protected for 60 min, and the cream was wiped off, the operation area was disinfected again. During the operation, the CO₂ fractional laser therapy device was used to scan the patients′ scar, and the appropriate machine parameters according to the thickness of the patients′ hypertrophic scar were selected. The machine frequency was maintained at 300 Hz and the density of 5%, adjusted the energy parameter at 20-30 J, the interval was 1 sec, and ensure that the hypertrophic scar was covered by the lattice rectangle completely, allowing a 25% area overlap between the thermal damage matrix formed by the two lasers. The wounds were cold compressed for 60 min after operation. Within 1 week after operation, the laser treatment group was not given any external medicine, and the combined treatment group was given external application of recombinant human epidermal growth factor gel 3 times a day in the operation area. For 3 days after the operation, the treated area should not touch water. If there was infection, antibiotic ointment should be added to the surgical area. If the scab outside the wound was not completely removed, the wound should not be scrubbed, the scab should not be directly peeled off, cosmetics should not be applied to the operation area, and avoided direct sunlight. The second laser treatment was performed 2 months after the first laser treatment, and two CO₂ fractional laser treatments were taken as a course of treatment. At 2 months after 1 course of treatment, the curative effect was judged when the operation area was stable, and the total effective rate of the two groups of patients was calculated. According to the Vancouver scar scale (VSS) and the patient and observer scar assessment scale (POSAS), the patients′ scars were scored before treatment, 2 months after the end of the first laser treatment, and 2 months after the end of the second laser treatment. Data were compared with repeated measures analysis of variance and chi-square test. Results(1) Two months after one course of treatment, the total effective rates of the patients in the laser treatment group and the combined treatment group were 80% (8/10) and 90% (9/10), there was no statistically significant difference between the two groups (χ²=2.40, P=0.49). (2) The indexes of VSS scores between the two groups were compared and there were no statistically significant differences in pain, itching, softness and thickness scores within and between groups at each time point (P>0.05). Before treatment, 2 months after the first laser treatment and 2 months after the second laser treatment, the color scores in the VSS score of the laser treatment group were (1.9±0.7), (1.9±0.1), (1.8±1.0) points, respectively, and were (2.9±0.7), (2.8±0.6), (1.9±0.7) points in the combined treatment group. The two groups were compared at different time points, and the difference was statistically significant (F=26.143, P<0.05); there was statistically significant difference between the two groups at different time points (F=6.753, P=0.018). Before treatment, 2 months after the first laser treatment and 2 months after the second laser treatment, the blood vessel distribution scores in the VSS score of the laser treatment group were (1.8±1.0), (1.7±0.7), (1.5±1.0) points, respectively, and were (2.6±0.5), (2.5±0.5), (1.7±0.8) points in the combined treatment group. The two groups were compared at different time points, and the difference was statistically significant (F=17.603, P<0.05), and the difference between the two groups at different time points was not statistically significant (F=2.538, P= 0.129). (3) The indexes of POSAS scores between the two groups were compared, and there were no statistically significant differences in the thickness, roughness, softness and surface area scores within and between groups at each time point (P>0.05). Before treatment, 2 months after the first laser treatment and 2 months after the second laser treatment, the color scores in the POSAS score of the laser treatment group were (4.9±2.6), (4.1±0.8), (3.5±2.0) points, respectively, the combined treatment group were (7.6±1.1), (6.8±1.4), (5.4±1.8) points, the two groups were compared at different time points, the difference was statistically significant (F=26.509, P<0.05 ), there was statistically significant difference between the two groups at different time points (F=8.973, P=0.008). Before treatment, 2 months after the first laser treatment and 2 months after the second laser treatment, the blood vessel distribution scores of the POSAS scores of the laser treatment group were (4.4±2.1), (3.9±0.9), (3.5±1.6) points, the combined treatment group were (6.3±1.1), (5.7±2.0), (4.5±1.6) points. There was statistically significant difference between the two groups at different time points (F= 20.118, P<0.05), and between the two groups at different time points, the difference was statistically significant (F= 5.744, P= 0.028). ConclusionRecombinant human epidermal growth factor gel combined with CO₂ fractional laser and CO₂ fractional laser alone have clear effects in the treatment of hypertrophic scars, but the combined use of recombinant human epidermal growth factor gel can effectively promote wound healing, improve vascular distribution of scar tissue and reduce local pigmentation.