超脉冲二氧化碳点阵激光治疗痤疮瘢痕的临床观察(1)
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[摘要]目的：探讨超脉冲二氧化碳点阵激光治疗皮肤痤疮瘢痕的疗效和安全性。方法：本试验对26名痤疮瘢痕患者进行点阵激光治疗，并分别于术前、术后7天、术后1个月、术后3个月分别进行数码照相、无创皮肤检测、记录恢复过程和副作用。通过前后对比，观察临床效果和副作用。医生对治疗效果进行4级评分，患者对疗效的满意率也进行4级评分。结果：超脉冲二氧化碳点阵激光是痤疮瘢痕的有效治疗手段。术后3个月，80.8%的患者改善率超过50%；92.3%的患者达到满意或非常满意的效果。
[关键词]点阵激光；痤疮瘢痕
[中图分类号]R758.73+4 [文献标识码]A [文章编号]1008-6455(2011)01-0093-03
Clinical Observation of fractionated Ultrapulse CO2 laser in treating acne scar
LUO Yao-jia, WU Yan, GAO Xing-hua, CHEN Hong-duo, LI Yuan-hong
(Department of Dermatology，First Hospital of China Medical UniversityShenyang 110001，China Key Laboratory of Immunodermatology, Ministry of Health)
Abstract: Objective To investigate the efficacy and safety of fractionated ultrapulse CO2 laser in treating acne scar.Methods Twenty-six patients with acne scar were treated with fractionated CO2 laser. Digital photos and non-invasive skin measurements were taken before the treatment,1 to 7days, 1 month and 3 months after the treatment to evaluate the efficacy.The recovery process and side effects were also recorded to assess the safety. Dermatologists rate the efficacy in a 4-points scales. The patients of overall satisfaction in a 4-point scales. Result Fractionated ultrapulse CO2laser is an effective way to treat acne scar with minimized side effects. Three months post treatment 80.8% of the patients have improvement of over 50% and 92.3% of the patients are satisfied or very satisfied with the overall efficacy.
Keywords: Fractional laser; acne scar
激光磨削一向是治疗痤疮瘢痕的有效手段，但是由于其副作用大，尤其是在深肤色人种中的高色素沉着率，它的应用非常受限[1]。而点阵激光通过点状穿透剥脱的模式，既保留了二氧化碳激光穿透深、高效能的优点，又大大缩短了恢复时间，并最大程度地减少了色素沉着等副作用的发生，目前已经成为治疗痤疮瘢痕的有效手段[2-3]。
1 资料和方法
1.1 一般资料：共收集26例痤疮瘢痕患者，皮肤类型均为FitzpatricⅣ型，年龄(36.04±8.12)岁，其中男6例，女20例。纳入标准：①中至重度皮肤痤疮瘢痕患者；②自愿参加本试验；③了解试验的目的、过程；④同意留取照片或进行无创性皮肤检测。排除标准：皮肤肿瘤、妊娠妇女、精神异常、有日光暴晒史、有光敏药物服用史的患者。每位志愿者试验前均签署点阵激光知情同意书，参与试验知情同意书、照片使用协议。
1.2 激光参数及治疗过程：采用的超脉冲二氧化碳激光为美国科医人公司的UltraPulse Encore(Lumenis Inc.,Santa Clara，美国加州)，手具为DeepFXTM 。激光参数：能量10mJ，密度10%，频率300Hz，时间间隔0.5s。治疗前，嘱患者清洁面部，外涂复方利多卡因乳膏(2.5%利多卡因和2.5%丙胺卡因，50mg，北京紫光制药有限公司生产)，封包1h。术前将表面麻醉药除去。全面部激光治疗约需15min，术后即刻外涂丙酸氟替卡松乳膏(克廷肤，葛兰素史克公司)和重组人表皮生长因子凝胶(易孚，桂林华诺威基因药业有限公司)，配合冰敷至少30min。嘱患者每日外涂丙酸氟替卡松乳膏(早晚各一次)，共3天，外涂重组人表皮生长因子凝胶(4次/天)共7天。术后24h开始洗脸(建议使用柔和洗面奶 ......
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