目的 探究改良CO₂点阵激光治疗难愈性创面的临床疗效及机制。 方法 选取2022年5月至2024年5月医院接诊的难愈性创面患者122例，以抽签法随机分为常规组（常规换药治疗 + 光动力治疗 + 常规CO₂点阵激光治疗）、改良组（常规换药治疗 + 光动力治疗 + 改良CO₂点阵激光治疗），各61例。比较治疗前及治疗1、2、3周后两组血清C反应蛋白（CRP）、红细胞沉降率（ESR）水平及创面细菌数量；比较治疗1、2、3周后两组创面愈合率；比较两组临床疗效；比较治疗前及治疗1、2、3周后创面渗液碱性成纤维细胞生长因子（bFGF）、促血管生成素-1（Ang-1）水平；比较两组不良反应。 结果 重复测量方差分析显示，两组血清CRP、ESR水平及创面细菌数量在组间、时间上均存在交互作用（P < 0.05）；治疗前两组血清CRP、ESR水平及创面细菌数量比较，差异无统计学意义（P > 0.05）；治疗1、2、3周后改良组血清CRP、ESR水平及创面细菌数量均低于常规组（P < 0.05）；重复测量方差分析显示，两组创面愈合率在组间、时间上均存在交互作用（P < 0.05）；治疗1、2、3周后改良组创面愈合率均高于常规组（P < 0.05）；改良组临床总有效率高于常规组（P < 0.05）。重复测量方差分析显示，两组创面渗液bFGF、Ang-1水平在组间、时间上均存在交互作用（P < 0.05）；治疗前两组创面渗液bFGF、Ang-1水平比较，差异无统计学意义（P > 0.05）；治疗1、2、3周后改良组创面渗液bFGF、Ang-1水平均高于常规组（P < 0.05）；两组疼痛、瘙痒、红疹发生率比较，差异均无统计学意义（P > 0.05）。 结论 难愈性创面的治疗中改良CO₂点阵激光联合光动力疗法可促进创面渗液生长因子分泌，抑制创面细菌繁殖及炎症反应，加快创面愈合，提高临床疗效，且安全性高，其作用机制与促进创面渗液生长因子分泌有关。

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.