發(fā)布時(shí)間：2018-07-15 08:03

【摘要】：目的探討IPL(Intense Pulsed Laser,強(qiáng)脈沖光)聯(lián)合果酸治療中重度痤瘡的臨床療效與安全性。方法根據(jù)痤瘡診斷標(biāo)準(zhǔn)和嚴(yán)重程度分級(jí)選取門(mén)診中重度痤瘡患者61例,所有患者均完成試驗(yàn),年齡在18歲-35歲之間,隨機(jī)分為三組:A組16例,B組23例,C組22例。治療前詳細(xì)了解患者基本情況并向患者仔細(xì)交代注意事項(xiàng)。每次治療前徹底清潔患者面部皮膚,由同一位觀察者確定皮損程度及類(lèi)型,記錄皮損的改善情況,并進(jìn)行療效與安全性評(píng)價(jià)。A組:IPL聯(lián)合果酸治療;B組:單純果酸治療;C組:單純IPL治療。分別在治療結(jié)束后第4、8周末評(píng)估最終療效。結(jié)果三組患者性別、年齡、病程和痤瘡嚴(yán)重程度均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。治療結(jié)束后4周時(shí),A組16例中5例痊愈,顯效7例,有效3例,無(wú)效1例,痊愈率為31.25%,總有效率為75.00%;炎性皮損減退率為74.00%,非炎性皮損減退率為65.00%。B組23例中3例痊愈,顯效8例,有效8例,無(wú)效4例,痊愈率為13.04%,總有效率為47.83%;炎性皮損減退率為65.00%,非炎性皮損減退率為65.00%。C組22例中4例痊愈,顯效10例,有效6例,無(wú)效2例,痊愈率為18.18%,總有效率為63.64%;炎性皮損減退率為49.00%,非炎性皮損減退率為49.00%。治療結(jié)束后8周時(shí),A組16例中6例痊愈,顯效8例,有效1例,無(wú)效1例,痊愈率為37.50%,總有效率為87.50%;炎性皮損減退率為79.00%,非炎性皮損減退率為73.00%。B組23例中4例痊愈,顯效8例,有效8例,無(wú)效3例,痊愈率為17.39%,總有效率為52.17%;炎性皮損減退率為69.00%,非炎性皮損減退率為65.00%。C組22例中3例痊愈,顯效8例,有效8例,無(wú)效3例,痊愈率為13.64%,總有效率為50.00%;炎性皮損減退率為60.00%,非炎性皮損減退率為45.00%。治療結(jié)束后4、8周后對(duì)三組療效進(jìn)行比較,結(jié)果A組療效優(yōu)于B和C組,其中A組對(duì)炎性丘疹及膿皰效果更好,炎性結(jié)節(jié)明顯減退。首次治療(果酸濃度20%)出現(xiàn)的即刻反應(yīng)中,39位受試者中14位面頰部或額部出現(xiàn)輕度紅斑,25位患者出現(xiàn)中度紅斑(尤以皮損處明顯),終止治療后紅斑即刻減輕;所有IPL及果酸治療患者(除個(gè)別出現(xiàn)較明顯疼痛感(經(jīng)多次治療后均能耐受))僅出現(xiàn)微弱的刺痛感。16例患者在使用果酸換膚治療后出現(xiàn)皮膚干燥,輕微脫屑,經(jīng)保濕潤(rùn)膚后好轉(zhuǎn),4例患者在第1次治療后皮損數(shù)量增多,經(jīng)過(guò)多次治療后皮損明顯減少。IPL治療反應(yīng)較一致,均出現(xiàn)短暫性紅斑反應(yīng),持續(xù)數(shù)小時(shí)或經(jīng)冷敷后消退,無(wú)色素沉著及色素減退。結(jié)論IPL聯(lián)合果酸治療中重度痤瘡療效優(yōu)于單獨(dú)治療。兩者治療中重度痤瘡具有協(xié)同作用,療效更好;治療時(shí)間短,幾乎沒(méi)有誤工期,治療過(guò)程中出現(xiàn)痛苦較小,患者依從性高,遠(yuǎn)期療效較明顯。是一種起效快,療效好,不良反應(yīng)可控的治療方法,值得推廣。
[Abstract]:Objective to investigate the clinical efficacy and safety of IPL (Intense Pulsed Laser) combined with fruit acid in the treatment of moderate and severe acne. Methods Sixty-one patients with moderate and severe acne were selected according to the criteria of acne diagnosis and severity classification. All the patients, aged between 18 and 35, were randomly divided into three groups: group A, n = 16, group B, n = 23, group C, n = 22. Before treatment, understand the patient's basic situation in detail and explain the matters needing attention carefully to the patient. Before each treatment, the patient's facial skin was thoroughly cleaned. The same observer determined the extent and type of skin lesions and recorded the improvement of the lesions. The curative effect and safety were evaluated. Group A: 1: IPL combined with fruit acid. Group B: group C: simple IPL. The final outcome was evaluated at the end of the 8th week after treatment. Results there was no significant difference in sex, age, course of disease and severity of acne among the three groups (P0.05). In group A, 5 cases were cured, 7 cases were effective, 3 cases were effective, 1 case was ineffective, the cure rate was 31.25 and the total effective rate was 75.000.The rate of inflammatory hypodermosis was 74.00 and that of non-inflammatory lesion was 65.00.B. 8 cases were effective, 4 cases were ineffective, the cure rate was 13.04 and the total effective rate was 47.83, the decrease rate of inflammatory lesions was 65.00, and the rate of non-inflammatory lesions was 65.00. C group, 4 cases were cured, 10 cases were effective, 6 cases were effective, 2 cases were ineffective. The cure rate was 18.18 and the total effective rate was 63.64. The decrease rate of inflammatory lesions and non-inflammatory lesions was 49.00 and 49.00 respectively. In group A, 6 cases were cured, 8 cases were effective, 1 case was ineffective, the cure rate was 37.50, and the total effective rate was 87.50%. Effective 8 cases, ineffective 3 cases, cure rate 17.39%, total effective rate 52.17, inflammatory lesion decrease rate 69.00%, non-inflammatory lesion decline rate 65.00% 3 cases cured, remarkable effect 8 cases, effective 8 cases, ineffective 3 cases. The cure rate was 13.64 and the total effective rate was 50.00.The decrease rate of inflammatory lesions and non-inflammatory lesions was 60.00and 45.00 respectively. The results showed that the curative effect of group A was better than that of group B and C, and group A had better effect on inflammatory papules and pustules, and inflammatory nodules decreased obviously. Mild erythema appeared in 14 of 39 subjects (20%) in the first treatment (20% acid concentration). Mild erythema was found in 25 patients (especially in the lesions), and the erythema was alleviated immediately after the termination of treatment. All patients treated with IPL and fruit acid (except individual patients with obvious pain (which can be tolerated after several treatments) had only weak tingling sensation. 16 patients had dry skin and slightly desquamated skin after skin replacement therapy with fruit acid. After moisturizing and moisturizing the skin, the number of skin lesions in 4 patients increased after the first treatment. After several treatments, the skin lesions decreased obviously. The response of IPL was consistent, and all of them had transient erythema reaction, which lasted for several hours or subsided after cold compress. No pigmentation and hypopigmentation. Conclusion IPL combined with fruit acid is more effective than single treatment in the treatment of moderate and severe acne. The treatment of moderate and severe acne has synergistic effect and better curative effect. The treatment time is short, there is almost no delay period, the pain in the treatment process is small, the patient compliance is high, and the long-term effect is obvious. It is an effective, effective and controllable treatment method with adverse reaction, which is worth popularizing.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R758.733

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本文編號(hào)：2123409