Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia
Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia
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DOI：
10.1001/jamadermatol.2018.5249
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发表时间：
2019-04-01
期刊：
影响因子：
10.9
通讯作者：
Geronemus, Roy G.
中科院分区：
文献类型：
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作者：
Jeon, Hana;Bernstein, Leonard J.;Geronemus, Roy G.
重要性 最近对 3 岁以下儿童重复使用全身麻醉的担忧使得围绕开始鲜红斑痣 (PWS) 激光治疗的时间的争议变得更加重要。 目的 评估 1 岁或以下儿童在没有全身麻醉的情况下在办公室环境中使用 PWS 治疗的情况。 设计、环境和参与者 基于单个大容量激光中心的医疗记录审查的回顾性队列研究2000 年至 2017 年间，1 岁或以下儿童的 PWS 接受脉冲染料激光治疗。数据截止时间为初始治疗后 1 年，以获得可比较的数据点。 主要结果和测量 主要结果是使用前后照片的 PWS 改善情况，由 4 名医生独立审查，并使用以下 5 点视觉模拟量表 (VAS) 进行评分：差（1 级：0%-25%）改善）、一般（2 级：26%-50% 改善）、良好（3 级：51%-75% 改善）、优秀（4 级：76%-99% 改善）和完全（5 级：100% 改善）清除。 结果 在 197 名患者中（73 名 [37.1%] 男孩；124 名 [62.9%] 女孩），大多数（149 名） [75.6%]）有面部损伤。首次治疗时的平均年龄为 3.38 个月（范围为 5-355 天），平均治疗次数为 9.8 次（范围为 2-23；中位数为 10）。根据 197 名患者的平均医师 VAS 分级，51 名患者 (25.9%) 显示 100% 清除（平均[范围] VAS 评分为 4.78 [4.5 - 5]）； 81 名患者 (41.1%) 表现出 76% 至 99% 的改善（平均 [范围] VAS 评分为 3.91 [3.5 至
IMPORTANCE Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment.OBJECTIVE To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points.MAIN OUTCOMES AND MEASURES The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance.RESULTS Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5 - 5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to