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1、word整理版 喜泊芬- LED-IB复合窄光谱光动力治疗鲜红斑痣50例何瑞明 1戴耕武21.成都长峰医院 2.四川省人民医院 邮政编码：610023【摘要】目的：探讨喜泊芬注射液作为光敏剂配合LED-IB复合窄光谱光动力治疗鲜红斑痣的临床效果。方法: (1) 做好治疗前的准备工作。将喜泊芬避光保存于-10冰柜内，先划痕试验阴性者方可注射光敏剂。照射前应沿拟照射光斑区周边按其形状贴好胶布条, 并用双层黑布遮盖非照射区域, 要注意胶布条不要覆盖住红斑, 以离开其边缘1mm 为宜。照射区要尽量选择在一个平面上, 同时要保持照射区的清洁卫生, 并剔净遮挡的毛发等。同时还要注意保持呼吸道通畅。(2)
2、静脉滴注光敏剂。光敏剂喜泊芬一般用量为2.5 mg/ kg 体重,用250ml生理盐水稀释后静脉滴注，可一边推注光敏剂, 一边照光。(3) 照光。照光前要按治疗方案调整并测定光纤末端输出功率, 定时在功率计上监测。激光照射剂量一般儿童为80mW/cm2, 成人为100mW/ cm2。照射时应保持扩束头与照射平面垂直, 注意光斑的大小, 密切观察照射区的变化情况, 并结合患者年龄、肤色等因素, 准确掌握照射时间( 照射时间一般为1530min) 。对某些特殊部位( 如鼻唇沟, 嘴角,眼角、耳廓及颏部等) 应适当缩短照射时间(一般为1020 min) ; 对面积较大者可分次、分区照射。照射区的选择
3、一般遵照先侧面后正面的原则, 假设照射面不平, 可适当调整照射角度以保证垂直照射。直至红斑颜色改变。治疗完毕后冰敷。外涂美宝或绿药膏，避光1个月，每次治疗间隔13个月。结果: 50 例鲜红斑痣患者经14次，喜泊芬-PDT治疗,随访观察,完全治愈42例,根本治愈6例,明显好转2例,总有效率达100%。结论: 喜泊芬注射液作为光敏剂配合LED-IB复合窄光谱光动力治疗鲜红斑痣是一种安全、有效、简便易行的方法。【关键词】鲜红斑痣 喜泊芬 LED-IB复合窄光谱光动力Abstract Objective: To explore the hi-Park-fun Injection as a photos
4、ensitizer with 520nm semiconductor laser photodynamic treatment of PWS clinical effect. Methods: (1) do the preparatory work before the treatment. Hi parked Fen stored in the freezer of -10 first scratch test negative before injection of the photosensitizer. Be irradiated spot area surrounding their
5、 shape stickers textile strip before irradiation along the non-irradiated area and covered with a double layer of black cloth tape strips to pay attention not to cover erythema, to leave its edges 1mm appropriate. Irradiation area to try to choose the same time to maintain the cleanliness of the irr
6、adiated areas, and tick net blocked hair in a plane. Also note that to keep the airway open. (2) intravenous infusion of the photosensitizer. Photosensitizer hi parked Fen general dosage of 5 mg / kg body weight, diluted with 250ml of saline intravenous infusion, you can enjoy a bolus photosensitize
7、r side illuminated. (3) illumination. Illuminated before adjustment according to the treatment plan and the determination of the end of the fiber output power, the timer on the power meter monitoring. The laser dose general for children 80mW/cm2, and adult of 100 mW / cm2. The irradiation should be
8、kept the head and perpendicular to the irradiated surface of the beam expander, and pay attention to the size of the light spot, close observation of the changes of the irradiated area, and the combination of factors such as patient age, color, accurate knowledge of the irradiation time (irradiation
9、 time is usually 35 to 60min). Some special parts (such as nasolabial folds, mouth, eye, ear and chin, etc.) should be appropriate to shorten the exposure time (usually for 20 min); those who are larger can be divided into sub-partitions irradiation. The choice of the irradiated areas generally in c
10、ompliance with the principle of positive after the first side, if the irradiated surface is uneven, may be appropriate to adjust the illumination angle to ensure vertical irradiation. Until erythema color change. Ice after the end of treatment. Coated Mabel or green cream, dark months, each treatmen
11、t interval of 1 to 3 months. Results: 5 cases of patients with port wine stains by 1-4 times hi parked Fen-PDT treatment, follow-up observation, completely cured two cases, the basic cure two cases, significantly improved in 1 case, with a total effective rate of 100%. Conclusion: hi parked Fen inje
12、ction as a photosensitizer with 520nm semiconductor laser photodynamic treatment of PWS is a safe, effective, and easy method. Key words port wine stains the hi parked Fen photodynamic 鲜红斑痣又称葡萄酒样痣, 俗称胎记, 常在一出生或生后不久出现。病损为淡红或紫红色的斑片, 不突出皮肤, 外表平滑, 压之褪色,形状不规则, 常见于面部、颈部, 头皮等处, 也可见于上下肢、前胸部或手掌、手背等身体其他部位。以往对
13、鲜红斑痣曾采用了多种治疗方法, 如外科植皮、X 线照射或同位素贴敷、冷冻、电灼、各种外用药、磁疗和多种激光( CO2、YAG、氩离子、铜蒸气、KTP ) 治疗, 但均因会损伤皮肤遗留瘢痕, 或无法消除病变而难以被病人承受。 我院选择应用喜泊芬（重庆市华鼎现代生物制药有限责任公司生产）作为光敏剂，选择波长为300nm的LED-IB复合窄光谱光动力治疗仪作为光动力学（photodynamic therapy，PDT）治疗设备治疗鲜红斑痣患者50例,获得了良好效果。现报道如下。1. 临床资料和方法 1.1一般资料：鲜红斑痣患者50例,其中男15例,女35例，年龄245岁。有5例曾行激素和局部硬化剂治
14、疗，3例应用32P同位素局部治疗，1 例曾进展过单纯激光治疗，均效果不佳。11例未作任何治疗.病变部位:面部13例,颈部5例，腿部2例。 1.2治疗设备及方法：采用波长为300nm的LED-IB复合窄光谱光动力治疗仪（北京长峰国际血管瘤研究院与武汉亚格激光设备厂联合研制并获国家实用新型专利），能量200300mJ。光敏剂使用喜泊芬（重庆市华鼎现代生物制药有限责任公司生产）治疗方法及操作步骤(1) 做好治疗前的准备工作。将喜泊芬避光保存于-10冰柜内，先划痕试验阴性者方可注射光敏剂。照射前应沿拟照射光斑区周边按其形状贴好胶布条, 并用双层黑布遮盖非照射区域, 要注意胶布条不要覆盖住红斑, 以离开
15、其边缘1mm 为宜。照射区要尽量选择在一个平面上, 同时要保持照射区的清洁卫生, 并剔净遮挡的毛发等。同时还要注意保持呼吸道通畅。(2) 静脉滴注光敏剂。光敏剂喜泊芬一般用量为2.5 mg/ kg 体重,用250ml生理盐水稀释后静脉滴注，可一边推注光敏剂, 一边照光。(3) 照光。照光前要按治疗方案调整并测定光纤末端输出功率, 定时在功率计上监测。激光照射剂量一般儿童为80mW/cm2, 成人为100mW/ cm2。照射时应保持扩束头与照射平面垂直, 注意光斑的大小, 密切观察照射区的变化情况, 并结合患者年龄、肤色等因素, 准确掌握照射时间( 照射时间一般为1530min) 。对某些特殊部
16、位( 如鼻唇沟, 嘴角,眼角、耳廓及颏部等) 应适当缩短照射时间(一般为1020 min) ; 对面积较大者可分次、分区照射。照射区的选择一般遵照先侧面后正面的原则, 假设照射面不平, 可适当调整照射角度以保证垂直照射，直至红斑颜色改变。治疗完毕后冰敷。外涂美宝或绿药膏，避光1个月，每次治疗间隔13个月。 1.3疗效评定标准：完全治愈（级）：病变红色全部消退,呈正常皮肤；根本治愈（级）：病变红色大局部消退，增厚部变平；明显好转（级）：病变红色局部消退，增厚部明显变平；改善（级）：病变红色略减退，增厚部位略变薄；无效（级）：无改变。总效率以级疗效的病例数计。2. 结果20 例鲜红斑痣患者经14次，喜泊芬-PDT治疗,随访观察,完全治愈42例,根本治愈6例,明显好转2例,总有效率达100%3
