595nm-1 064nm双波长激光治疗酒渣鼻的疗效观察

595nm/1 064nm双波长激光治疗酒渣鼻的疗效观察[摘要]目的：探讨595nm/1 064nm双波长激光治疗酒渣鼻的疗效及安全性。方法：采用595nm/1 064nm双波长激光对20例红斑期、毛细血管扩张期酒渣鼻患者实施治疗。所用光斑直径为7mm，595nm 激光脉宽20～40ms，能量密度7.0～8.0j/cm2；1 064nm激光脉宽20～40ms，能量密度70～80j/cm2,双光间隔100ms。根据受试者fitzpatrick光生物学分型、皮肤耐受程度、血管粗细、血管颜色、血管深浅等选择治疗参数，治疗3～4次，每次治疗间隔时间均为4～5周。结果：治疗后即刻血管颜色加深或消失，红斑颜色加深或者出现紫癜；4次治疗后治疗部位的红斑指数均值显著下降，85%以上的受试者皮损清除率达到50%以上，75%以上的受试者对治疗满意或非常满意。不良反应为轻微疼痛，暂时性红斑和紫癜，约7～10天后自然消退。结论：595nm/1 064nm双波长可安全、有效地治疗酒渣鼻。

[关键词]酒渣鼻；双波长激光；疗效

clinical observation of a dual-wavelength laser system (595 nm and 1 064 nm) for rosacea

xu tian-hua, xu yuan-yuan, liu jia, wu yan, chen hong-duo, li yuan-hong

(department of dermatology, no.1 hospital of china medical university, shenyang 110001, liaoning, china)

abstract: objective to explore the efficacy and safety

of a dual-wavelength laser system (595 nm and 1 064 nm) for rosacea. methods twenty patients of rosacea with persistent erythema and telangiectasia were enrolled. a dual-wavelength laser system (595 nm and 1 064 nm) was performed at 4 to 5-week intervals for 3～4 sessions. the settings are determined according to the patient’s skin color, lesional morphology, response and tolerance to the treatment. to sum up: 595nm （pulse width of 20～40ms, fluence of 7.0～8.0 j/cm2）; 1,064nm (pulse width of 20～40 ms, fluence of 70～80 j/ cm2), time delay of 100 ms between delivery of the two wavelengths. results immediately after the laser, the vessels became darken or disappeared. the red macules became darkened or purpura developed. the mean erythema index decreased dramatically after the treatment. more than 85% patients got over 50% clearance. more than 75% patients were satisfied or very satisfied with the treatment. adverse effects include slight pain, transient erythema, and purpura, which disappeared naturally with 7～10 days. conclusion the dual-wavelength laser system (595 nm and 1064 nm) is both effective and safe for treating rosacea.

key words: rosacea; dual-wavelength laser system; efficacy 酒渣鼻是一种慢性皮肤血管神经性疾病。其基本病理改变是局部

毛细血管的扩张，主要表现为面中部弥漫性红斑，伴有丘疹、脓疱及毛细血管扩张，严重影响面部美观[1]。目前主要采用药物、冷冻、激光、整形手术等方法治疗。脉冲颜料激光(pulsed dye laser，pdl) 发射595nm波长，可被氧合血红蛋白吸收，穿透深达1.2mm，有很好的血管凝固作用。长脉冲掺钕钇铝石榴石激光（neodymium-doped yttrium aluminium garnet laser，nd:yag）激光发射的1 064nm光可穿透真皮，治疗位置较深和直径更大的血管。有研究报道治疗头依次发射595nmpdl和1 064nm nd:yag的双波长激光，对微静脉畸形、毛细血管扩张等血管性疾病疗效显著，明显优于单用pdl激光或nd:yag激光[2-3]，且副作用明显减小，易被患者接受。自2009年6月以来，笔者科室将595nm/1 064nm

双波长激光用于治疗酒渣鼻，取得了满意疗效，现报道如下。

1 临床资料和方法

1.1一般资料：20例酒渣鼻患者来自中国医科大学附属第一医院皮肤科门诊，均为红斑期，其中女性10例，男性10例，年龄20～40岁，病程2～10年，皮损表现为鼻部红斑，红斑基础上可见毛细血管扩张。排除标准：①妊娠及哺乳期妇女；②严重的单纯疱疹感染史，系统性疾病者；③患有其他可能影响试验观察的面部皮肤病者；④试验前1周内采用外用药物治疗者、试验前1个月内服用过抗痤疮药物者。本试验经中国医科大学伦理委员会审批，所有志愿者均签署正式的知情同意书。

1.2 实验步骤：治疗前常规清洁皮肤，部分患者要求治疗区域应