黄芩油膏在增生性瘢痕点阵二氧化碳激光治疗后创面修复的疗效评价

发布时间：2017-12-27 00:16

本文关键词：黄芩油膏在增生性瘢痕点阵二氧化碳激光治疗后创面修复的疗效评价　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评估黄芩油膏在增生性瘢痕点阵二氧化碳(cO2)激光治疗后创面修复的临床疗效和安全性。方法:采用CO_2点阵激光治疗头面部增生性瘢痕的患者30例,所有患者均来自江苏省中医院整形美容外科门诊,男女不限,年龄18～45岁,随机分为治疗组与对照组,各15例,治疗组使用黄芩油膏涂抹创面,对照组使用金霉素眼膏涂抹创面。在患者术后观测30min、24h、3天、7天这四个时间段的疼痛指数;分别取术前、术后3d、术后7d瘢痕肉芽组织病理,行HE染色,并采用免疫组化检测表皮干细胞标志分子角蛋白19(CK19)、转录因子63(P63)在肉芽、各不同时期瘢痕及正常皮肤中的表达;最后的创面愈合时间;术前、术后一个月、术后三个月的温哥华瘢痕量表评分,来评价点阵激光治疗增生性瘢痕点阵二氧化碳(CO_2)激光治疗后利用黄芩油膏修复创面的疗效。结果:1、疼痛指数:两组治疗后均有痛感,前三天治疗组疼痛指数均低于对照组,且疼痛缓解时间明显缩短,组间差异有统计学意义(P0.05),7d时两组均无明显疼痛,无统计学意义。2、病理组织学观察:治疗组和对照组的纤维束呈均质性红染,且较治疗前排列整齐、纤维细胞少,瘢痕组织内血管少。3、免疫组化观察:两组治疗前CK19、P63表达极少,治疗组CK19、P63的表达在治疗后第3天增多,第7天时达到高峰;对照治疗后第3天CK19、P63表达达到高峰,第7天减少。治疗组CK19、P63强阳性表达率(80%、73.33%)明显高于对照组(33.33%、26.67%),组间差异有统计学意义(P0.05)。4、最后的创面愈合时间:创面愈合时间治疗组的(8.23±2.78)d明显优于对照组的(10.55±2.98)d,组间差异有统计学意义(P0.05)。5、温哥华瘢痕量表评分:治疗前两组瘢痕评分差别无统计学意义(P0.05),治疗组经治疗后,较同期对照组低,有显著性差异(P0.05)。6、治疗组总有效率86.67%明显高于对照组的46.67%,有显著性差异(P0.05)。7、色素沉着在治疗3个月后两组均有发生,治疗组6.67%发生率明显低于对照组46.67%,有显著性差异(P0.05)。结论:增生性瘢痕点阵二氧化碳(CO_2)激光治疗后的创面,采用黄芩油膏医疗技术,不仅可以促进创面修复,加速愈合,还可以减轻激光治疗后的的疼痛,更可以改善外观,减少色素沉着,疗效明显,值得推广。
[Abstract]:Objective: To evaluate the clinical efficacy and safety of Scutellaria ointment after laser treatment of hypertrophic scar lattice carbon dioxide (cO2) laser. Methods: 30 cases of CO_2 laser treatment of facial scar patients, all patients were from Jiangsu Province Traditional Chinese Medicine Hospital of plastic surgery clinic, male or female, aged 18 to 45 years old, were randomly divided into treatment group and control group, 15 patients in each treatment group, using baicalin ointment wipe the wound, the control group using eyeointment smear the wound. In patients with postoperative observation of 30min, 24h and 3 days, 7 days of the four time periods of pain index respectively; preoperative and postoperative 3D, 7d scar granulation tissue pathology, HE staining, and immunohistochemical detection of epidermal stem cell marker cytokeratin 19 (CK19), transcription factor 63 (P63) expression in different period of granulation and scar and normal skin in the last time; wound healing; three months before surgery, one month after operation, the Vancouver scar scale, to evaluate the laser treatment of hyperplastic scar matrix (CO_2) effect of baicalin ointment with carbon dioxide to repair the wound the use of laser therapy. Results: 1. Pain index: two groups had pain after treatment. The pain index of the treatment group was lower than that of the control group in the first three days, and the pain relief time was significantly shortened. There was a significant difference between the two groups (P0.05). There was no significant pain in the two groups at 7d. 2. Histopathological observation: the fiber bundles in the treatment group and the control group were homogeneous red, and were arranged more orderly than before treatment, with less fibroblasts and less blood vessels in the scar tissue. 3, immunohistochemical observation: two groups before treatment, CK19 and P63 expression was very few. The expression of CK19 and P63 in treatment group increased third days after treatment and reached peak at seventh days. After third days of treatment, the expression of CK19 and P63 reached a peak and decreased in seventh days. The positive expression rate of CK19 and P63 in the treatment group (80%, 73.33%) was significantly higher than that in the control group (33.33%, 26.67%), and the difference between the groups was statistically significant (P0.05). 4, the final wound healing time: wound healing time in the treatment group (8.23 + 2.78) d was significantly better than that in the control group (10.55 + 2.98) d, the difference between the two groups was statistically significant (P0.05). 5, Vancouver scar scale score: there was no statistically significant difference in scar score between the two groups before treatment (P0.05). After treatment, the treatment group was lower than that in the control group at the same time (P0.05). 6, the total effective rate of the treatment group was 86.67% significantly higher than that of the control group (46.67%), and there was a significant difference (P0.05). 7, pigmentation occurred in the two groups after 3 months of treatment, and the incidence of 6.67% in the treatment group was significantly lower than that of the control group (46.67%). There was a significant difference (P0.05). Conclusion: hypertrophic scar lattice of carbon dioxide (CO_2) laser wound after treatment with baicalin ointment, medical technology, not only can promote wound healing, accelerate healing, also can reduce the pain of the laser treatment, can improve the appearance, reduce pigmentation, obvious curative effect, worthy of promotion.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

【参考文献】