■激光治疗在儿科烧伤疤痕的治疗中发挥了重要作用;然而,文献中存在异质性,特别是关于启动激光治疗的最佳时机。本研究旨在探讨瘢痕年龄等因素的影响,激光类型和激光治疗间隔时间对儿童烧伤瘢痕结局的影响通过对以往研究的荟萃分析。
■2022年5月,在七个数据库中进行了文献检索,通过对激光干预前后的标准化平均差(SMD)进行meta分析,了解激光治疗对儿科患者烧伤瘢痕结局的影响。使用综合Meta分析软件4.0版进行Meta分析。当没有显著的异质性时,选择固定模型,当发现显著异质性时,选择随机效应模型进行分析。对于所有分析,p值<0.05被认为是显著的。
■7项研究纳入荟萃分析,共467例患者。激光治疗显着改善温哥华疤痕量表(VSS)/总患者和观察者疤痕评估量表(总POSAS),血管,柔韧性,烧伤疤痕的色素沉着和疤痕高度。在研究之间发现了显著的异质性,因此进行了亚组分析。早期激光治疗(伤后<12个月)与潜在治疗(伤后>12个月)相比显著改善VSS/POSAS评分{SMD-1.97[95%置信区间(CI)=-3.08;-0.87],p<0.001vs-0.59[95CI=-1.10;-0.07],p=0.03}以及血管分布{SMD-3.95[95CI=-4.38;-3.53],p<0.001vs-0.48[95CI=-0.66;-0.30],p<0.001}。非烧蚀激光最有效,显著降低VSS/POSAS,血管,与消融相比,柔韧性和疤痕高度结果,脉冲染料激光器以及烧蚀和脉冲染料激光器的组合。与4至6周的间隔相比,<4周的较短治疗间隔显着降低了VSS/POSAS和疤痕高度结果。
■激光疗法在儿科人群中的疗效受瘢痕年龄的影响,激光类型和激光治疗应用之间的间隔。这项研究的结果特别挑战了目前接受的激光治疗的开始时间。在研究中观察到显著的异质性,这表明需要探索影响激光治疗后烧伤瘢痕结局的其他混杂因素.
UNASSIGNED: Laser therapy has emerged to play a valuable role in the treatment of paediatric burn scars; however, there is heterogeneity in the literature, particularly concerning optimal timing for initiation of laser therapy. This study aims to investigate the effect of factors such as scar age, type of laser and laser treatment interval on burn scar outcomes in children by meta-analysis of previous studies.
UNASSIGNED: A literature search was conducted across seven databases in May 2022 to understand the effects of laser therapy on burn scar outcomes in paediatric patients by metanalysis of standardized mean difference (SMD) between pre- and post-laser intervention. Meta-analyses were performed using the Comprehensive Meta-Analysis software version 4.0. Fixed models were selected when there was no significant heterogeneity, and the random effects model was selected for analysis when significant heterogeneity was identified. For all analyses, a p-value < 0.05 was considered significant.
UNASSIGNED: Seven studies were included in the meta-analysis with a total of 467 patients. Laser therapy significantly improved Vancouver Scar Scale (VSS)/Total Patient and Observer Scar Assessment Scale (Total POSAS), vascularity, pliability, pigmentation and scar height of burn scars. Significant heterogeneity was found between the studies and thus subgroup analyses were performed. Early laser therapy (<12 months post-injury) significantly improved VSS/POSAS scores compared to latent therapy (>12 months post-injury) {SMD -1.97 [95% confidence interval (CI) = -3.08; -0.87], p < 0.001 vs -0.59 [95%CI = -1.10; -0.07], p = 0.03} as well as vascularity {SMD -3.95 [95%CI = -4.38; -3.53], p < 0.001 vs -0.48 [95%CI = -0.66; -0.30], p < 0.001}. Non-ablative laser was most effective, significantly reducing VSS/POSAS, vascularity, pliability and scar height outcomes compared to ablative, pulse dye laser and a combination of ablative and pulse dye laser. Shorter treatment intervals of <4 weeks significantly reduced VSS/POSAS and scar height outcomes compared to intervals of 4 to 6 weeks.
UNASSIGNED: Efficacy of laser therapy in the paediatric population is influenced by scar age, type of laser and interval between laser therapy application. The result of this study particularly challenges the currently accepted initiation time for laser treatment. Significant heterogeneity was observed within the studies, which suggests the need to explore other confounding factors influencing burn scar outcomes after laser therapy.