Objective: To explore the effect of combined application of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) in the treatment of pediatric large burn scars at early stage. Methods: One hundred and twenty pediatric patients with large burn scars at early stage conforming to the study criteria were admitted to the People's Hospital of Hunan Province from January 2016 to December 2019. Their data were retrospectively analyzed by the method of single case-control study. There were 78 males and 42 females with age of (4.2±0.8) years and scar area of (100.3±0.7) cm(2). PDL combined with UFCL was used for the first time. The treatment interval of PDL was a month and the treatment interval of UFCL was 3 months. The total treatment cycle was 6 months, with 2 PDL treatments alone and two combined treatments. Before the first combined treatment and 6 months after two combined treatments, the curative effect was assessed using Patient and Observer Scar Assessment Scale (POSAS) by doctors and family members of pediatric patients. Satisfaction degrees of the family members of pediatric patients were recorded, and the overall satisfaction rate was calculated 6 months after two combined treatments. The adverse effects during the whole treatment course were recorded. Data were statistically analyzed with paired t test. Results: (1) Six months after two combined treatments, the scores of pediatric patients' scar vascularity, pigment, thickness, relief, pliability, surface area, and overall valuation in POSAS by doctors and the scores of pain, itch, color, stiffness, thickness, irregularity, and overall valuation in POSAS by family members of pediatric patients were all significantly lower than those before the first combined treatment (t=16.6, 16.0, 16.9, 14.9, 20.8, 29.3, 30.7, 20.4, 29.3, 18.1, 27.9, 25.8, 20.8, 45.3, P<0.01). The overall evaluation scores by doctors were (8.1±0.8) and (2.7±0.6) points, and the overall evaluation scores by family members of pediatric patients were (8.2±0.8) and (2.4±0.5) points respectively before the first combined treatment and six months after two combined treatments. (2) Six months after two combined treatments, 110 (92%) family members of pediatric patients were very satisfied with the curative effect, 6 (5%) family members of pediatric patients were satisfied, and 4 (3%) family members of pediatric patients were relatively satisfied with no unsatisfied reported. The overall satisfaction rate was 97% (116/120). (3) During the treatment, pruritus and rash appeared in 5 pediatric patients 3 to 4 days after the first treatment; pigmentation appeared in 3 pediatric patients 3 weeks after the first treatment; pruritus and vesicle appeared in 1 patient 1 week after the third treatment. No adverse effects such as aggravated scar or infection were observed on the wounds. Conclusions: In treating pediatric large burn scars at early stage, PDL combined with UFCL has demonstrated significant effect with short treatment cycle, few adverse effects. The combined treatment can alleviate symptoms and improve the quality of pediatric patients' life, and is worthy to be popularized and applied in clinic.
目的： 探讨脉冲染料激光(PDL)联合超脉冲点阵二氧化碳激光(UFCL)治疗小儿早期烧伤瘢痕的效果。 方法： 2016年1月—2019年12月，湖南省人民医院收治符合入选标准的120例早期烧伤瘢痕患儿，采用单组病例对照研究对其资料进行回顾性分析。患儿中男78例、女42例，年龄(4.2±0.8)岁，瘢痕面积(100.3±0.7)cm(2)。首次治疗采用PDL联合UFCL治疗，随后PDL每次治疗间隔1个月，UFCL每次治疗间隔3个月。总治疗周期为6个月，共行2次PDL单独治疗、2次联合治疗。首次联合治疗前、2次联合治疗后6个月，采用患者与观察者瘢痕评估量表(POSAS)对医师和患儿家属进行疗效评估。2次联合治疗后6个月，统计患儿家属疗效满意度并计算总体满意率。记录整个治疗过程中的不良反应情况。对数据行配对t检验。 结果： (1)2次联合治疗后6个月，患儿瘢痕血管分布、色素沉着、厚度、凹凸程度、柔软度、表面范围和总体评价，疼痛、瘙痒、颜色、硬度、厚度、形状和总体评价的POSAS医师和患儿家属评分均明显低于首次联合治疗前(t＝16.6、16.0、16.9、14.9、20.8、29.3、30.7，20.4、29.3、18.1、27.9、25.8、20.8、45.3，P<0.01)。其中首次联合治疗前、2次联合治疗后6个月，医师总体评价分别为(8.1±0.8)、(2.7±0.6)分，患儿家属总体评价分别为(8.2±0.8)、(2.4±0.5)分。(2)2次联合治疗后6个月，110例(92%)患儿的家属对疗效非常满意，6例(5%)患儿的家属满意，4例(3%)患儿的家属较为满意，无不满意，总满意率为97%(116/120)。(3)5例患儿首次治疗后3～4 d创面出现瘙痒、红疹。3例患儿首次治疗后3周出现色素沉着。1例患儿3次治疗后1周创面可见小水疱，并伴瘙痒。所有创面均未出现瘢痕加重、感染等不良反应。 结论： PDL联合UFCL治疗小儿早期烧伤瘢痕，疗效较明显，治疗周期较短，可减轻症状并改善小儿生活质量，且不良反应少，临床可推广应用。.
Keywords: Burns; Child; Cicatrix; Lasers, dye; Ultra-pulsed fractional carbon dioxide laser.