Lv Kaiyang, Liu Huazhen, Xu Haiting, Wang Caixia, Zhu Shihui, Lou Xiaozhen, Luo Pengfei, Xiao Shichu, Xia Zhaofan
Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092; People's Republic of China.
Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China.
Burns Trauma. 2021 Jul 27;9:tkab023. doi: 10.1093/burnst/tkab023. eCollection 2021.
Poor sleep quality is associated with a decrease in quality of life in patients with major burn scars, combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study, we investigated the efficacy of CO-ablative fractional laser (AFL) surgery conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome.
In total 68 consecutive patients undergoing scar surgical treatment were recruited, including a CO-AFL surgery cohort ( = 35) and a conventional surgery cohort ( = 33). A subgroup from the AFL cohort was selected. Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO-AFL surgery.
The CO-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort, the CO-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores, and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score, brief pain inventory (BPI) total, VAS pruritus score, 5-D itch scale total, four-item itch questionnaire (FIIQ) total and PSQI total.
CO-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency.
The Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 May 2020.
睡眠质量差与重度烧伤瘢痕患者的生活质量下降相关，同时伴有瘙痒和疼痛。据报道，很少有干预措施能改善瘢痕患者的睡眠质量。在当前这项前瞻性队列研究中，我们以睡眠质量作为主要研究结局，调查了剥脱性点阵二氧化碳激光（AFL）手术与传统手术相比，对烧伤后增生性瘢痕患者的疗效。
共招募了68例接受瘢痕手术治疗的连续患者，包括一个AFL手术队列（n = 35）和一个传统手术队列（n = 33）。从AFL队列中选取一个亚组，对睡眠质量、疼痛和瘙痒进行评估。进行多元线性回归分析以揭示AFL手术的效果。
在最后一次手术治疗后，AFL手术队列的匹兹堡睡眠质量指数（PSQI）总体得分显著低于传统手术队列。在接受硬件睡眠监测的患者亚组中，AFL显著增加了深度睡眠时间、深度睡眠效率，并缩短了初始睡眠潜伏期。与传统手术队列相比，AFL队列的疼痛和瘙痒评分显著更低。相关性分析表明，疼痛和瘙痒与PSQI评分显著相关，且疼痛评分与瘙痒评分之间也存在显著相关性。多元线性回归分析表明，手术方式与视觉模拟量表（VAS）疼痛评分、简明疼痛问卷（BPI）总分、VAS瘙痒评分、5-D瘙痒量表总分、四项瘙痒问卷（FIIQ）总分和PSQI总分呈负线性相关。
AFL手术显著改善了增生性瘢痕患者的睡眠质量，减轻了疼痛和瘙痒。睡眠障碍的缓解与包括深度睡眠时间和深度睡眠不足在内的深度睡眠质量改善有关。
中国临床试验注册中心（ChiCTR200035268）于2020年5月5日批准了回顾性注册。
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