【摘要】：目的:探討強脈沖光(Intense Pulsed Light,IPL)及Q開關(guān)1064nm(Nd:YAG)激光聯(lián)合治療黃褐斑臨床療效及安全性。方法:收集2013年5月至2015年1月于成都天使之翼美天整形美容醫(yī)院就診,要求治療黃褐斑并能按要求定期接受治療和隨訪的患者資料。分別采用輝煌360工作平臺的強脈沖光(IPL以色列Alma飛頓公司生產(chǎn))及Q開關(guān)1064nm(Nd:YAG)激光MedLiteC6(美國HoYa_conBio公司出產(chǎn))及二者聯(lián)合對87例黃褐斑患者進行治療。87例均為女性,其中IPL組32例,Q開關(guān)1064nm(Nd:YAG)激光組25例,IPL聯(lián)合Q開關(guān)1064nm(Nd:YAG)激光組30例;患者的平均年齡為29.7歲,平均病程為7.4年。根據(jù)患者皮膚Fitzpatrick分型、膚色、色斑顏色及色斑面積選擇不同的波長、能量密度、脈沖寬度、光斑大小及頻率。療程為10次,每次間隔4周。選擇某一固定位置作為觀察部位,以VISIA皮膚檢測儀分別記錄每次治療前的照片以及斑點的特征計數(shù),分值,百分位數(shù)進行定量檢測[1],在每次治療前及第10次治療后1個月由同一醫(yī)護人員對觀察部位拍照采集影像資料并存檔。療程結(jié)束后隨訪3個月觀察療效以及不良反應(yīng):同時評定醫(yī)生及患者對黃褐斑療效的主觀滿意程度。結(jié)果:所有黃褐斑治療后斑點絕對值均隨治療次數(shù)增加而下降,差異具有統(tǒng)計學(xué)意義(P0.05);IPL組及Q開關(guān)1064nm激光組每次治療后色斑變化率比較發(fā)現(xiàn),IPL組的色斑變化率前五次均顯著高于Q開關(guān)1064nm激光組,但10次治療后,兩者的有效率差異不具有顯著性。IPL及Q開關(guān)1064nm激光聯(lián)合治療組色斑變化率均顯著高于單獨應(yīng)用。隨訪3個月,所有患者均無不良反應(yīng)發(fā)生。單純應(yīng)用IPL組基本治愈率為50.0%,總有效率為78.1%;單純應(yīng)用Q開關(guān)1064nm激光組基本治愈率72.0%,總有效率為84.0%;IPL聯(lián)合Q開關(guān)1064nm激光組基本治愈率為86.7%,總有效率為93.3%。差異有統(tǒng)計學(xué)意義(P0.05)。各組的醫(yī)生滿意度:IPL組總滿意率為71.9%,Q開關(guān)1064nm激光組總滿意率為84.0%,IPL聯(lián)合Q開關(guān)1064nm激光組總滿意率為93.3%。各組的患者滿意度:IPL組總滿意率為75.0%,Q開關(guān)1064nm激光組總滿意率為88.0%,IPL聯(lián)合Q開關(guān)1064nm激光組總滿意率為96.7%。兩者差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:聯(lián)合應(yīng)用強脈沖光及Q開關(guān)1064nm(Nd:YAG)激光治療黃褐斑療效顯著優(yōu)于其單獨應(yīng)用、且安全無副作用,色斑變化率與其治療次數(shù)、皮膚顏色、治療前色斑顏色,面積有關(guān),醫(yī)生和患者均滿意。
[Abstract]:Objective: to investigate the clinical efficacy and safety of intense pulsed light (Intense Pulsed Light,IPL) and Q-switched 1064nm (Nd:YAG) laser in the treatment of chloasma. Methods: from May 2013 to January 2015, we collected the data of patients who were treated with chloasma and who could be treated and followed up regularly. 87 cases of chloasma were treated with high-power pulse light (produced by IPL Israel Alma Fiden), Q-switch 1064nm (Nd:YAG) laser MedLiteC6 (produced by HoYa_conBio Company of USA) and the combination of the two methods. 87 cases were female. There were 32 cases in IPL group, 25 cases in Q-switched 1064nm (Nd:YAG) laser group and 30 cases in IPL combined with Q-switched 1064nm (Nd:YAG) laser group. The average age of the patients was 29.7 years and the average course of disease was 7.4 years. Different wavelengths, energy density, pulse width, light spot size and frequency were selected according to the skin Fitzpatrick classification, skin color, color and area of the spot. The course of treatment was 10 times, with an interval of 4 weeks. A fixed position was selected as the observation site, and the VISIA skin detector was used to record the photographs before each treatment and the characteristic count and score of the spots, respectively. The percentile was measured quantitatively [1]. Before each treatment and 1 month after the 10th treatment, the same medical staff took pictures of the observation site and collected the image data and archived them. The therapeutic effects and adverse reactions were observed at the end of the course of treatment. The subjective satisfaction of doctors and patients with chloasma was evaluated at the same time. Results: the absolute value of spots decreased with the increase of treatment times. The difference was statistically significant (P0.05) in); IPL group and Q-switched 1064nm laser group. The results showed that the change rate of color spot in IPL group was significantly higher than that in Q-switched 1064nm laser group in the first five times, but after 10 times of treatment, the change rate of color spot in IPL group was significantly higher than that in Q-switched 1064nm laser group. There was no significant difference in the effective rate between the two groups. The change rate of color spot in IPL and Q-switched 1064nm laser combined treatment group was significantly higher than that in single treatment group. All patients were followed up for 3 months without adverse reactions. The basic cure rate of IPL group was 50.0, the total effective rate was 78.1%, the basic cure rate was 72.0 in Q switch 1064nm laser group, the total effective rate was 84.0%, and the total effective rate was 86.7% and 93.3% in 1064nm laser group. The difference was statistically significant (P0.05). The total satisfaction rate of IPL group was 71.9 Q switch 1064nm laser group. The total satisfaction rate of 1064nm laser group was 84.0%. The total satisfaction rate of 1064nm laser group was 93.3%. The total satisfaction rate of IPL group was 75.0 Q switch 1064nm laser group. The total satisfaction rate of 1064nm laser group was 88.0%. The total satisfaction rate of 1064nm laser group was 96.7%. The difference was not statistically significant (P0.05). Conclusion: the combined use of intense pulsed light and Q-switched 1064nm (Nd:YAG) laser in the treatment of chloasma is more effective than that in the treatment of chloasma alone, and the change rate of macula is related to the times of treatment, the color of skin, the color and area of macula before treatment. Both the doctor and the patient were satisfied.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R758.42

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