关键词: 难愈性创面, 改良CO₂点阵激光, 光动力治疗, 生长因子

Abstract:

Objective Explored the clinical efficacy and mechanism of improved CO₂ fractional laser on treatment for refractory wounds. Methods A total of 122 patients with refractory wounds who were admitted to the hospital from May 2022 to May 2024 were selected and randomly divided into a conventional group （conventional dressing change treatment + photodynamic therapy + conventional CO₂ fractional laser treatment） and an improved group （conventional dressing change treatment + photodynamic therapy + improved CO₂ fractional laser treatment） by lottery， with 61 cases in each group. The serum C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） levels， the number of wound bacteria before treatment and after 1， 2， and 3 weeks of treatment were compared between the two groups. The wound healing rates after 1， 2， and 3 weeks of treatment were compared between the two groups. The clinical efficacy of the two groups was compared. The levels of wound exudate basic fibroblast growth factor （bFGF） and angiopoietin-1 （Ang-1） before treatment and after 1， 2， and 3 weeks of treatment were compared. The adverse reactions of the two groups were compared. Results Repeated measures analysis of variance showed that there were an interaction effect between groups and over time in the serum CRP and ESR levels， the number of wound bacteria in both groups （P < 0.05）. There were no significant differences in the serum CRP and ESR levels and the number of wound bacteria between the two groups before treatment （P > 0.05）. The serum CRP and ESR levels and the number of wound bacteria in the improved group were lower than those in the conventional group after 1， 2， and 3 weeks of treatment （P < 0.05）. Repeated measures analysis of variance showed that there was an interaction effect between groups and over time in the wound healing rates of both groups （P < 0.05）. The wound healing rates in the improved group were higher than those in the conventional group after 1， 2， and 3 weeks of treatment （P < 0.05）. The total clinical effective rate of the improved group was higher than that of the conventional group （P < 0.05）. Repeated measures analysis of variance showed that there was an interaction effect between groups and over time in the levels of bFGF and Ang-1 in wound exudates of both groups （P < 0.05）. There was no significant difference in the levels of bFGF and Ang-1 in wound exudates between the two groups before treatment （P > 0.05）. The levels of bFGF and Ang-1 in wound exudates in the improved group were higher than those in the conventional group after 1， 2， and 3 weeks of treatment （P < 0.05）. There were no significant differences in the incidence of pain， pruritus and rash between the two groups （P > 0.05）. Conclusions In the treatment of refractory wounds， the combination of improved CO₂ fractional laser and photodynamic therapy could promote the secretion of wound exudate growth factors， inhibit wound bacterial growth and inflammatory response， accelerate wound healing， and improve clinical efficacy， with high safety. The mechanism of action is related to the promotion of wound exudate growth factor secretion.

Key words: refractory wounds, improved CO₂ fractional laser, photodynamic therapy, growth factors