普萘洛尔治疗225例儿童血管瘤疗效及安全性初步分析

Efficacy and safety of propranolol for Hemangioma in 225 chicdren

目的 通过对口服普萘洛尔治疗血管瘤的临床病例进行分析,评价其疗效与安全性.方法 2009年12月至2010年11月湖南省儿童医院皮肤科采用口服普萘洛尔治疗血管瘤患儿225例,其中男74例,女151例;年龄20 d至16岁,平均9.13个月;单发性血管瘤199例;多发性血管瘤18例（2～5个部位）,其中合并肝血管瘤1例;婴儿泛发性血管瘤6例,其中合并肝血管瘤3例;血管瘤-血小板减少综合征2例.以15例血管畸形为对照组,入院后完善心电图、腹腔B超、肿块彩超、心脏彩超,核磁共振、甲轴全套、血糖及肝肾功能后,予以普萘洛尔1.5～2 mg·kg-1·d-1,分2次口服,服药前3 d予心电监护,服药观察3～4 d后带药回家继续服药,并每1～2个月门诊复诊,按4级评分法评价疗效,均于2010年12月统一随访.结果 213例坚持口服普萘洛尔1个月以上患儿中,疗效Ⅰ级（差）19例,Ⅱ级（中）52例,Ⅲ级（好）60例,Ⅳ级（优）82例,有效率91.08%,17例完全痊愈.其疗效明显优于血管畸形组（P〈0.001）,且随着用药时间延长,疗效增加.不良反应少,发生率为2.08%,1例心率减慢,1例手足凉,2例出院后转氨酶升高.结论 普萘洛尔治疗儿童血管瘤疗效显著,无明显不良反应,可作为婴幼儿血管瘤的一线治疗药物.

Objective To evaluate the efficacy and safety of propanolol in the treatment of infantile hemangiomas. Methods A total of 225 patients aged 20 days to 16 years underwent propanolol treatment for problematic proliferating haemangioma, 74 boys and 151 girls. 199 patients had a solitary haemangioma, 18 had multiple haemangiomas （2 -5 area） , 2 had hemangioma-thrombocytopenia syndrome and 6 had infants generalized hemangioma （3 had hepatic hemangioma）. 15 cases of vascular malformation patients as the control group. All the patients were initially managed as inpatients and received tumor, abdominal and heart color ultrasound scan, ultrasound scan, ECG, head MRI, blood glucose, thyroid function, liver function and nephric function examination before taking propanolol. Then they were treated with propanolol at 1.5 - 2 mg/kg/day in 2 divided doses. All the patients received general electrocardiogram monitoring in the first three days. They were discharged with oral propanolol if no cardiovascular or metabolic side effect were observed after 3 or 4 days. The patients were revisited once a month and the therapeutic effects were evaluated using a 4 - point scale system. All patients Were followed up in December 2010. Results 213 patients insisted on the treatment for more than 1 months,among them, 19 was scale Ⅰ （poor）, 52 was scale Ⅱ （moderate）, 60 was scale m （good） and 82 scale Ⅳ （excellent）. The efficacy rate was 91.08% and 17 of the patients recovered completely. Its efficacy was significantly higher than the group of vascular malformation （P 〈 0. 001 ）. The efficacy was increased with prolonged treatment. No significant adverse reactions was observed and the overall adverse event incidence rate was 2.08%. Conclusion Propanolol is safe and effective in the treatment of hemangiomas, no serious side effects was observed and should be first line therapeutic strategy for hemangioma.