目的 探討曲安奈德聯(lián)合磺胺嘧啶銀治療燒傷后增生性瘢痕的臨床療效。方法 回顧性分析2021年9月—2024年1月武漢市第三醫(yī)院燒傷及整形美容門診收治的98例燒傷后增生性瘢痕患者，根據(jù)治療方式不同將患者分為對(duì)照組和治療組，每組各49例。對(duì)照組患者給予磺胺嘧啶銀乳膏，直接涂于創(chuàng)面，約1.5 mm厚度，1次/d。治療組在對(duì)照組的治療基礎(chǔ)上給予醋酸曲安奈德注射液，于瘢痕周邊基底部點(diǎn)狀注射，至皮損輕微發(fā)白終止注射，1次/2周。兩組連續(xù)用藥8周。觀察兩組的臨床療效和癥狀及體征改善時(shí)間，比較兩組治療前后溫哥華瘢痕量表（VSS）評(píng)分、精簡(jiǎn)燒傷后健康量表（BSHS-B）評(píng)分、白細(xì)胞介素-2（IL-2）、轉(zhuǎn)化生長(zhǎng)因子-β1（TGF-β1）、血管內(nèi)皮生長(zhǎng)因子（VEGF）、腫瘤壞死因子-α（TNF-α）的變化情況。結(jié)果 治療后，治療組患者總有效率是97.96%，顯著高于對(duì)照組的81.63%（P＜0.05）。治療后，治療組出現(xiàn)皮膚瘙癢、皮膚灼痛、皮膚潮紅充血改善時(shí)間顯著短于對(duì)照組（P＜0.05）。治療后，兩組VSS評(píng)分較同組治療前顯著降低，而BSHS-B評(píng)分顯著升高（P＜0.05）；治療后，治療組VSS評(píng)分、BSHS-B評(píng)分改善優(yōu)于對(duì)照組（P＜0.05）。治療后，兩組患者血清TGF-β1、TNF-α、IL-2、VEGF水平均較同組治療前顯著降低（P＜0.05）；治療后，治療組患者這些炎性因子水平顯著低于對(duì)照組（P＜0.05）。結(jié)論 曲安奈德聯(lián)合磺胺嘧啶銀治療燒傷后增生性瘢痕具有較好的臨床療效，能有效改善增生性瘢痕組織的色澤及硬度，減弱機(jī)體局部的炎癥反應(yīng)，有效提高患者生活質(zhì)量，具有一定的臨床應(yīng)用價(jià)值。

Objective To explore the clinical study of triamcinolone combined with sulfadiazine silver in treatment of hypertrophic scars after burns. Methods A retrospective analysis was performed on 98 patients with post-burn hypertrophic scar admitted to the Burn and plastic Surgery Clinic of Wuhan Third Hospital from September 2021 to January 2024. According to different treatment methods, the patients were divided into control group and treatment group, with 49 cases in each group. Patients in control group were given Sulfadiazine Silver Cream, applied to the wound directly, about 1.5 mm thickness, once daily. Patients in treatment group were given Triamcinolone Acetonide Acetate Injection on the basis of treatment of control group, injected into the base of the scar in a spot shape, and terminated the injection until the skin was slightly white, once 2 weeks. Both groups were treated continuously for 8 weeks. The clinical efficacy and improvement time of symptoms and signs of the two groups were observed. The changes of Vancouver Scar Scale (VSS) score, Reduced Post-Burn Health Scale (BSHS-B) score, interleukin-2 (IL-2), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) before and after treatment were compared between two groups. Results After treatment, the total effective rate of treatment group was 97.96%, which was significantly higher than that of control group (81.63%, P < 0.05). After treatment, the improvement time of skin pruritus, skin burning pain and skin flushing congestion in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, VSS score in two groups was significantly decreased compared with before treatment, but BSHS-B score was significantly increased (P < 0.05). After treatment, VSS score and BSHS-B score in treatment group were better than those in control group (P < 0.05). After treatment, the serum levels of TGF-β1, TNF-α, IL-2 and VEGF in two groups were significantly decreased compared with before treatment (P < 0.05). After treatment, the levels of these inflammatory factors in treatment group were significantly lower than those in control group (P < 0.05). Conclusion Triamcinolone combined with sulfadiazine silver has a good clinical effect in treatment of hypertrophic scars after burns, and can effectively improve the color and hardness of hypertrophic scar tissue, weaken the local inflammatory response of the body, effectively improve the life quality of patients, which has certain clinical application value.

R986

湖北省衛(wèi)生健康委員會(huì)科研項(xiàng)目資助(WJ2019F163)