趙秀榮　陳新　李娜

[摘要]目的：本研究旨在采用半張臉（Split-face）模式自身對照觀察點(diǎn)陣CO2激光結(jié)合強(qiáng)脈沖光治療中國人群的光老化皮膚臨床效果與安全性。方法：選擇2019年3月-2019年12月筆者醫(yī)院整形美容科門診就診的28例Fitzpatricks Ⅲ和Ⅳ型皮膚的中國女性就醫(yī)者為研究對象。采用隨機(jī)數(shù)字表法選取一側(cè)面頰部給予單獨(dú)治療（強(qiáng)脈沖光治療3次），另一側(cè)給予聯(lián)合治療（強(qiáng)脈沖光治療2次，點(diǎn)陣CO2激光治療1次）。在治療前和治療后30d評估患者的皮膚狀況，包括含水量、經(jīng)表皮失水率、彈性、斑點(diǎn)、紫外線光斑、紅色區(qū)域、棕色斑、皺紋、膚質(zhì)、毛孔孔徑，以及不良反應(yīng)。結(jié)果：與單獨(dú)強(qiáng)脈沖光治療相比較，點(diǎn)陣CO2激光聯(lián)合強(qiáng)脈沖光可顯著增加皮膚彈性、減小毛孔孔徑、改善皺紋和膚質(zhì)（分別為P=0.004、P=0.039、P=0.015及P=0.035）。兩種治療方法在改善光老化引起的色素沉著方面效果相似。聯(lián)合治療不損害表皮的屏障功能，治療后無感染、色素減退或瘢痕形成。點(diǎn)陣CO2激光治療后1個月發(fā)生炎癥后色素沉著，在所有療程結(jié)束后30d消失。結(jié)論：點(diǎn)陣CO2激光結(jié)合強(qiáng)脈沖光治療中國人群的光老化皮膚優(yōu)于單用強(qiáng)脈沖光，安全性好。

[關(guān)鍵詞]點(diǎn)陣CO2激光;強(qiáng)脈沖光;光老化;Split-face模式

[中圖分類號]R616.4? ? [文獻(xiàn)標(biāo)志碼]A? ? [文章編號]1008-6455（2021）09-0103-04

Study on the Clinical Effect and Safety of Carbon Dioxide Lattice Laser Combined with Intense Pulsed Light in the Treatment of Photoaged Skin in Chinese Population

ZHAO Xiu-rong， CHEN Xin， LI Na

（Department of Plastic Surgery，the Second People's Hospital of Liaocheng，Liaocheng 252601，Shandong，China）

Abstract： Objective The purpose of this study is to observe the clinical effect and safety of carbon dioxide dot-matrix laser combined with intense pulsed light on the photoaging skin of the Chinese population by using a split-face mode. Methods? This study included 28 Chinese female patients with Fitzpatricks Ⅲ and Ⅳ skin who visited theThe Department of Aesthetic Plastic Surgery of our hospital from March to December 2019. The patient's random one side of the cheek was treated with single treatment （3 times of intense pulsed light treatment）， and the other side was treated with combined treatment （2 times of intense pulsed light treatment and 1 time of carbon dioxide dot laser treatment）. The patient's skin condition was evaluated before treatment and 30 days after treatment， including water content， transepidermal water loss， elasticity， spots， ultraviolet spots， red areas， brown spots， wrinkles， skin texture， pore size， and adverse reactions. Results? Compared with intense pulsed light treatment alone， CO2 dot-matrix laser combined with intense pulsed light can significantly increase skin elasticity， reduce pore size， and improve wrinkles and skin texture （P=0.004， 0.039， 0.015， and 0.035， respectively）. The two treatments have similar effects in improving pigmentation caused by photoaging. The combined treatment does not damage the barrier function of the epidermis， and there is no infection， hypopigmentation， or scarring after treatment. Post-inflammatory pigmentation occurred 1 month after CO2 laser treatment and disappeared 30 days after treatment. Conclusion? CO2 dot-matrix laser combined with intense pulsed light is better than the strong pulsed light alone in treating Chinese people's photoaging skin， and it is safe.

[5]Kearney C，Brew D. Single-session combination treatment with intense pulsed light and nonablative fractional photothermolysis： a split-face study[J].Dermatol Surg， 2012，38（7）：1002-1009.

[6]Weiss RA，Weiss MA，Beasley KL.Rejuvenation of photoaged skin： 5 years results with intense pulsed light of the face， neck， and chest[J].Dermatol Surg，2002，28（12）：1115-1119.

[7]Brightman LA， Brauer JA， Anolik R， et al. Ablative and fractional ablative lasers. Dermatol Clin，2009，27（7）：479-489.

[8]Hedelund L，Due E，Bjerring P，et al. Skin rejuvenation using intense pulsed light： a randomized controlled split-face trial with blinded response evaluation[J]. Arch Dermatol，2006，142（8）：985-990.

[9]Ozog DM， Liu A， Chaffins ML，et al. Evaluation of clinical results， histological architecture， and collagen expression following treatment of mature burn sears with a fractional carbon dioxide laser[J].JAMA Dennatol，2013，149（1）：50-57.

[10]Magnani LR，Schweiger ES.Fractional CO2 lasers for the treatment of atrophic acne scars：a review of the literature[J].J Cosmet Lasel Ther，2014，16（2）：48-56.

[11]Weiss RA，Goldman MP，Weiss MA.Treatment of poikiloderma of Civatte with an intense pulsed light source[J].Dermatol Surg，2000，26（3）：823-827.

[12]Sadick NS， Weiss R， Kilmer S， et al. Photorejuvenation with intense pulsed light： results of a multi-center study[J].J Drugs Dermatol，2004，3（1）：41-49.

[13]Sadick NS， Weiss R.Intense pulsed-light photorejuvenation[J].Semin Cutan Med Surg，2002，21（2）：280-287.

[14]Gotkin RH，Sarnoff DS，Cannarozzo G，et al. Ablative skin resurfacing with a novel microablative CO2 laser[J].J Drugs Dermatol，2009，8（2）：138-144.

[15]Berlin AL，Hussain M，Phelps R，et al.A prospective study of fractional scanned nonsequential carbon dioxide laser resurfacing： a clinical and histopathologic evaluation[J].Dermatol Surg，2009，35（2）：222-228.

[16]Stulhofer Buzina D，Lipozencic J，Bukvic Mokos Z，et al.Ablative laser resurfacing： is it still the gold standard for facial rejuvenation？ [J].Acta Dermatovenerol Croat 2010，18（3）：190-194.

[17]Li YH，Chen JZ，Wei HC，et al.A Chinese experience of fractional ultrapulsed CO2 laser for skin rejuvenation[J].J Cosmet Laser Ther，2010，12（6）：250-255.

[18]Shin MK，Kim MJ，Baek JH，et al.Analysis of the temporal change in biophysical parameters after fractional laser treatments using reflectance confocal microscopy[J].Skin Res Technol，2013，19（1）：e515-520.

[19]Borges J，Manela-Azulay M，Cuzzi T.Photoaging and the clinical utility of fractional laser[J].Clin Cosmet Investig Dermatol，2016，9（5）：107-114.

[20]Aslam A，Alster TS.Evolution of laser skin resurfacing： from scanning to fractional technology[J].Dermatol Surg，2014，40（11）：1163-1172.

[21]Antonov D，Schliemann S，Elsner P. Methods for the assessment of barrier function[J]. Curr Probl Dermatol，2016，49（4）：61-70.

[22]Zhu J，Ji X，Li M，et al.The efficacy and safety of fractional CO2 laser combined with topical type a botulinum toxin for facial rejuvenation： a randomized controlled split-face study[J].Biomed Res Int，2016，2016（6）：3853754.

[23]Lee HM，Haw S，Kim JK，et al.Split-face studyusinga1，927nm thulium fiber fractional laser to treat photoaging and melasma in Asian skin[J]. Dermatol Surg，2013， 39（6）：879-888.

[24]Negishi K，Wakamatsu S，Kushikata N，et al.Full-face photorejuvenation of photodamaged skin by intense pulsed light with integrated contact cooling： initial experiences in Asian patients[J].Lasers Surg Med，2002，30（4）：298-305.

[25]Feng Y，Zhao J， Gold MH. Skin rejuvenation in Asian skin： the analysis of clinical effects and basic mechanisms of intense pulsed light[J].J Drugs Dermatol，2008，7（3）：273-279.

[收稿日期]2020-06-10

本文引用格式：趙秀榮，陳新，李娜.點(diǎn)陣CO2激光結(jié)合強(qiáng)脈沖光治療中國人群的光老化皮膚臨床效果及安全性研究[J].中國美容醫(yī)學(xué)，2021，30（9）：103-106.