透明质酸酶联合曲安奈德治疗瘢痕疙瘩的临床研究

发布时间：2018-01-22 20:01

  本文关键词： 曲安奈德 透明质酸酶 瘢痕疙瘩　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究联合应用透明质酸酶和曲安奈德治疗瘢痕疙瘩的疗效及安全性,为瘢痕疙瘩探索一种安全、有效的临床治疗方法。方法:选择2011年9月至2014年3月来潍坊市益都中心医院美容科就诊的瘢痕疙瘩患者96例为研究对象,随机分为两组,其中治疗组48例,采用透明质酸酶联合曲安奈德注射治疗,对照组48例,采用单纯曲安奈德注射治疗。采用温哥华量表评分判定瘢痕疙瘩的严重程度,此量表采用色泽、厚度、血管分布和柔软度四个指标对瘢痕进行描述性评估,并根据评分的高低将瘢痕疙瘩分为轻度、中度和重度。治疗方法:治疗组应用曲安奈德注射液1ml(40mg)+2%利多卡因注射液和透明质酸酶混合液2.5ml+2%利多卡因注射液0.5ml;对照组应用曲安奈德注射液1ml(40mg)+2%利多卡因注射液3ml。用高压注射器从瘢痕边缘向内分点穿刺,将药液缓慢注入均匀瘢痕组织内,至局部组织苍白为止,治疗1~2周重复1次,4次为1个疗程,一般1~2个疗程。治疗后3、6、12个月复诊。观察两组患者治疗前后临床症状、疤痕颜色、疤痕厚度及瘢痕柔韧性,同时根据疗效判断标准评价两种治疗方法的治愈率、有效率及并发症的发生率。结果:(1)两组患者治疗前一般资料比较:两组患者年龄、性别构成比、瘢痕面积、病程、发病部位及瘢痕原因等无明显的统计学差异(均P0.05)。(2)两组患者临床疗效比较:治疗组46例患者,治愈28例,显效16例,无效2例;对照组43例患者中,治愈18例,显效21例,无效4例,经秩和检验,治疗组患者临床疗效显著优于对照组(P0.01)。(3)两组患者治愈率和有效率比较:治疗组患者的治愈率为60.9%(28/46),有效率为95.7%(44/46),对照组患者的治愈率为41.9%(18/43),有效率为90.7%(39/43),治疗组患者的治愈率和有效率显著高于对照组(均P0.05)。(4)两组患者治疗前后温哥华量表评分比较:治疗组和对照组患者治疗前温哥华量表评分分别为8.63±1.67和8.28±1.35,无明显统计学差异(p0.05),治疗后两组患者温哥华量表评分分别为4.89±1.14和6.35±1.08,均较治疗前明显下降(p0.01),但治疗组下降更为明显,治疗组治疗后的温哥华评分显著低于对照组(p0.05)。(5)两组患者临床症状改善情况比较:治疗组、对照组患者治疗前疼痛评分和瘙痒评分无明显统计学差异(p0.05),治疗后疼痛评分、瘙痒评分均明显下降,与治疗前比较,均有显著统计学差异(均p0.01),但治疗组下降更为明显,治疗组治疗后的疼痛评分和瘙痒评分均显著低于对照组(均p0.05)。(6)两组治疗方法副作用和复发情况比较:两组在治疗中各有2位女性患者出现经期提前和月经量增大现象,未行治疗,于治疗结束后两月痊愈。对照组有1例患者出现局部皮肤发黑,但未破溃,一月后逐渐恢复。治疗组1例无效,1例复发;对照组1例无效,3例复发。结论:(1)透明质酸酶联合曲安奈德皮损内注射治疗瘢痕疙瘩有很好的疗效,疗效优于单纯曲安奈德皮损内注射,且安全可靠,值得临床广泛应用。(2)透明质酸酶联合曲安奈德皮损内注射瘢痕疙瘩操作简便,不需要大型设备,治疗费用低,疗效可靠,便于基层医院开展。
[Abstract]:Objective: To study the efficacy and safety of hyaluronidase and Cu Ann Ned treatment of keloid, explore a safe for keloid, effective clinical treatment. Methods: from September 2011 to March 2014 to Yidu Central Hospital of Weifang beauty hospital keloids patients 96 patients as the research object, randomly divided into two group, including 48 cases of treatment group with combined hyaluronidase Cu Ann Ned injection therapy, the control group of 48 cases, using a simple Cu Ann Ned injection. The Vancouver score in determining the severity of keloids, this scale by color, thickness, vascular distribution and softness of the four indicators for descriptive evaluation of scar, and the keloids were divided into scores according to the level of moderate and severe treatment. Methods: the treatment group used Triamcinolone Acetonide Injection 1ml (40mg) +2% lidocaine injection and hyaluronic acid The enzyme mixture 2.5ml+2% 0.5ml lidocaine injection; the control group used the Triamcinolone Acetonide Injection 1ml (40mg) +2% 3ml. lidocaine injection with high pressure injector puncture point from the scar edge inward, liquid will be slowly injected into the scar tissue in uniform, pale to local tissue until repeated 1 times, treatment 1~2 weeks, 4 times for 1 courses, general 1~2 courses. 3,6,12 months after treatment follow-up. Clinical symptoms, two groups of patients before and after treatment of scar scar thickness and scar color, flexibility, and according to the curative effect judgment the cure rate of two treatment methods for standard evaluation, the incidence of complications and efficiency. Results: (1) the general data of the two groups were compared: two groups of patients before treatment age, ratio, scar size, duration of gender, there is no significant difference between the incidence and causes of hypertrophic scar (P0.05). (2) comparison of two groups of patients with clinical curative effect: the treatment group of 46 cases, 娌绘剤28渚，

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