目的 探讨曲安奈德联合磺胺嘧啶银治疗烧伤后增生性瘢痕的临床疗效。方法 回顾性分析2021年9月—2024年1月武汉市第三医院烧伤及整形美容门诊收治的98例烧伤后增生性瘢痕患者，根据治疗方式不同将患者分为对照组和治疗组，每组各49例。对照组患者给予磺胺嘧啶银乳膏，直接涂于创面，约1.5 mm厚度，1次/d。治疗组在对照组的治疗基础上给予醋酸曲安奈德注射液，于瘢痕周边基底部点状注射，至皮损轻微发白终止注射，1次/2周。两组连续用药8周。观察两组的临床疗效和症状及体征改善时间，比较两组治疗前后温哥华瘢痕量表（VSS）评分、精简烧伤后健康量表（BSHS-B）评分、白细胞介素-2（IL-2）、转化生长因子-β1（TGF-β1）、血管内皮生长因子（VEGF）、肿瘤坏死因子-α（TNF-α）的变化情况。结果 治疗后，治疗组患者总有效率是97.96%，显著高于对照组的81.63%（P＜0.05）。治疗后，治疗组出现皮肤瘙痒、皮肤灼痛、皮肤潮红充血改善时间显著短于对照组（P＜0.05）。治疗后，两组VSS评分较同组治疗前显著降低，而BSHS-B评分显著升高（P＜0.05）；治疗后，治疗组VSS评分、BSHS-B评分改善优于对照组（P＜0.05）。治疗后，两组患者血清TGF-β1、TNF-α、IL-2、VEGF水平均较同组治疗前显著降低（P＜0.05）；治疗后，治疗组患者这些炎性因子水平显著低于对照组（P＜0.05）。结论 曲安奈德联合磺胺嘧啶银治疗烧伤后增生性瘢痕具有较好的临床疗效，能有效改善增生性瘢痕组织的色泽及硬度，减弱机体局部的炎症反应，有效提高患者生活质量，具有一定的临床应用价值。

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

湖北省卫生健康委员会科研项目资助(WJ2019F163)