中华皮肤科杂志 ›› 2022, Vol. 55 ›› Issue (9): 784-789.doi: 10.35541/cjd.20210711

• 论著 • 上一篇    下一篇

医用冷敷贴缓解海姆泊芬光动力治疗鲜红斑痣术后灼痛及恢复皮肤稳态的疗效观察

祝贺1，2    吴英英1    杨蓉娅1    王聪敏1    敖俊红1   

  1. 1解放军总医院第七医学中心皮肤科，北京  100700；2解放军医学院，北京  100853
  • 收稿日期:2021-09-28 修回日期:2022-08-05 发布日期:2022-09-02
  • 通讯作者: 敖俊红 E-mail:aojunhong@sina.com

Efficacy of medical cold patches in relieving burning pain and restoring skin homeostasis after hematoporphyrin monomethyl ether-based photodynamic therapy for the treatment of port-wine stains

Zhu He1,2, Wu Yingying1, Yang Rongya1, Wang Congmin1, Ao Junhong1   

  1. 1Department of Dermatology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing 100700, China; 2Chinese PLA Medical School, Beijing 100853, China
  • Received:2021-09-28 Revised:2022-08-05 Published:2022-09-02
  • Contact: Ao Junhong E-mail:aojunhong@sina.com

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摘要： 【摘要】 目的 观察医用冷敷贴缓解海姆泊芬光动力治疗鲜红斑痣术后灼痛及修复皮肤稳态的疗效。方法 收集2019 年11月至2021年4月解放军总医院第七医学中心皮肤科符合纳排标准的面中部鲜红斑痣患者40 例，随机分为试验组和对照组，每组20例。接受海姆泊芬光动力治疗后，试验组术后即刻治疗部位使用医用冷敷贴1 h，之后每日敷贴1 h，连续使用3 d；对照组无特殊处理，自然恢复。分别于术后即刻与0.5、1、12 h进行疼痛指数（NRS）评分。于术前10 min，术后即刻与30 min、1 h检测皮肤表面温度。于术前10 min，术后即刻与24、48、72 h检测经皮水分丢失（TEWL）和角质层含水量（WCSC）。统计两组术后1、2、3周结痂率。治疗前后不同时间点观察指标的比较采用两因素重复测量方差分析，组间和组内比较采用Bonferroni或Sidak′s检验。结果 术前试验组与对照组年龄、性别构成及TEWL、WCSC差异均无统计学意义（P > 0.05）。术后即刻，试验组与对照组NRS评分差异无统计学意义（8.00 ± 1.17、8.20 ± 1.06，F = 0.30，P = 0.592）；术后0.5、1 h时试验组NRS评分（6.25 ± 1.29、4.80 ± 0.77）均低于对照组（7.15 ± 0.99、6.50 ± 0.69，均P < 0.05）。术后即刻试验组与对照组皮肤表面温度分别升高至（35.211 ± 1.333） ℃和（35.637 ± 0.832） ℃，两组差异无统计学意义（P = 0.062）；术后30、60 min时试验组分别为（29.11 ± 1.59） ℃、（32.46 ± 1.07） ℃，均低于对照组［（35.01 ± 0.91）、（34.86 ± 0.74） ℃，F = 212.63、100.20，P < 0.001］。术后48 、72 h时试验组TEWL分别为（12.44 ± 0.67）、（10.85 ± 0.81） g·h-1·m-2，均低于对照组［（14.61 ± 0.34）、（14.93 ± 0.24） g·h-1·m-2，F = 195.87、520.54，P < 0.001］，而WCSC分别为（57.83 ± 9.29）、（52.64 ± 8.09） AU，均高于对照组［（43.87 ± 4.82）、（38.68 ± 5.33） AU，F = 24.41、49.22，P＜0.001］。试验组术后1周有3例结痂，对照组为6例，两组结痂率差异无统计学意义（P = 0.451）。结论 海姆泊芬光动力治疗鲜红斑痣术后应用医用冷敷贴可降低表皮温度，发挥镇痛作用，缩短术后疼痛时间，同时促进皮肤通透屏障功能的恢复。

关键词: 葡萄酒色痣, 光化学疗法, 医用冷敷贴, 疼痛, 皮肤稳态

Abstract: 【Abstract】 Objective To evaluate the efficacy of medical cold patches in relieving burning pain and restoring skin homeostasis after hematoporphyrin monomethyl ether-based photodynamic therapy （HMME-PDT） for the treatment of port-wine stains. Methods Forty patients with port-wine stains in the middle face, who met the inclusion and exclusion criteria, were collected from Department of Dermatology, the Seventh Medical Center of Chinese PLA General Hospital from November 2019 to April 2021, and randomly and equally divided into test group and control group. Patients in the test group received cold compress with medical cold patches at treatment sites for 1 hour immediately after HMME-PDT, and then once a day for 3 consecutive days, while those in the control group received no special treatment and experienced a spontaneous recovery. Pain numeric rating scale （NRS） scores were recorded immediately, 0.5, 1 and 12 hours after HMME-PDT. Skin surface temperature was measured 10 minutes before, and immediately, 30 minutes and 1 hour after HMME-PDT. Transepidermal water loss （TEWL） and water content of the stratum corneum （WCSC） were measured 10 minutes before, and immediately, 24, 48 and 72 hours after HMME-PDT. The scabbing rate was calculated at weeks 1, 2 and 3 after HMME-PDT. Two-way repeated measures analysis of variance was used for comparisons of observation indicators at different time points before and after treatment, and Bonferroni or Sidak′s test was used for comparisons between groups and within groups. Results There were no significant differences in age, gender composition, TEWL or WCSC between the test group and control group before HMME-PDT （all P > 0.05）. Immediately after HMME-PDT, no significant difference in the NRS score was observed between the test group and control group （8.00 ± 1.17 vs. 8.20 ± 1.06, F = 0.30, P = 0.592）; at 0.5 and 1 hour after HMME-PDT, the NRS score was significantly lower in the test group （6.25 ± 1.29, 4.80 ± 0.77, respectively） than in the control group （7.15 ± 0.99, 6.50 ± 0.69, respectively, both P < 0.05）. Immediately after HMME-PDT, the skin surface temperature in the test group and control group increased to 35.21 ± 1.333 ℃ and 35.64 ± 0.832 ℃, respectively, and there was no significant difference between the two groups （P = 0.062）; at 30 and 60 minutes after HMME-PDT, the skin surface temperature in the test group was 29.11 ± 1.59 ℃ and 32.46 ± 1.07 ℃ respectively, which were significantly lower than those in the control group （35.01 ± 0.91 ℃, 34.86 ± 0.74 ℃, F = 212.63, 100.20, respectively, both P < 0.001）. At 48 and 72 hours after HMME-PDT, the TEWL in the test group was 12.44 ± 0.67 g·h-1·m-2 and 10.85 ± 0.81 g·h-1·m-2 respectively, which were significantly lower than those in the control group （14.61 ± 0.34 g·h-1·m-2, 14.93 ± 0.24 g·h-1·m-2, F = 195.87, 520.54, respectively, both P < 0.001）, while the WCSC was significantly higher in the test group （57.83 ± 9.29 AU, 52.64 ± 8.09 AU, respectively） than in the control group （43.87 ± 4.82 AU, 38.68 ± 5.33 AU, F = 24.41, 49.22, respectively, both P < 0.001）. At 1 week after HMME-PDT, scab formation was observed in 3 cases in the test group, as well as in 6 cases in the control group, and there was no significant difference in the scabbing rate between the two groups （P = 0.451）. Conclusion The application of medical cold patches after HMME-PDT for the treatment of port-wine stains can reduce skin surface temperature, exert analgesic effects, shorten duration of postoperative pain, and promote the recovery of skin permeability barrier function.

Key words: Port-wine stain, Photochemotherapy, Medical cold patch, Pain, Skin homeostasis