摘要
目的:探讨口服盐酸普萘洛尔治疗中、高风险婴幼儿血管瘤的疗效和可行性。方法:选取2013年3月至2016年3月期间我科门诊确诊的中、高风险血管瘤患儿,给予口服普萘洛尔治疗:首日剂量为0. 50 mg/(kg·d),分2次口服;第二天剂量增加至0. 75 mg/(kg·d),分2次口服;第三天剂量调整为1. 00 mg/(kg·d),分2~3次口服;服药1周后复诊观察患儿皮损变化情况及对药物的敏感程度,酌情加量至每日1. 50~2. 00 mg/(kg·d)维持治疗,每天分2~3次口服,连续服用6~12个月。服药期间每月复诊1次,复查血常规、血糖、血压、心电图、B超,每2~3个月复查心肌酶谱、肝肾功能、电解质等。撤药时逐渐减量,每月减量0. 50 mg/(kg·d)。患儿治疗前均完善影像学、生化检查,治疗过程中进行多普勒超声检查并观察皮损大小等,观察临床疗效及转归情况。结果:共168例中、高风险血管瘤患儿接受口服普萘洛尔治疗,其中159例完成了所有的治疗和随访,完成率为94. 64%。患者平均首诊年龄为(2. 29±0. 84)月龄,平均给药持续时间为(13. 67±4. 43)个月,平均最大给药剂量为(1. 86±0. 35) mg/(kg·d)。其中未完成治疗和随访的9例患者中,2例(1. 19%)因心脏方面的副作用停药,5例(2. 98%)治疗6个月及以上无效后行手术切除治疗,2例(1. 19%)散发型血管瘤患儿(肝脏受累)在服药4个月肝脏血管瘤完全消退后自行停药脱失。完成治疗和随访的患者中,男女患者、多发与单发血管瘤患者、节段型与散发型与局灶型、溃疡型与非溃疡型的治疗效果间比较没有明显的差异(P值均>0. 05)。结论:口服普萘洛尔对各类型的中、高风险血管瘤有明显疗效,与血管瘤分型无明显差异。
Objective:To study the efficacy of propranolol in treatment of medium and high risk infantile hemangiomas in out-patient agency. Methods: All patients were received oral propranolol started at 0.50mg/(kg·d) with an increase by 0.25mg/(kg·d) everyday at the first 3 days, the maximum doses was 2.00mg/(kg·d). Complete blood tests and doppler ultrasound were conducted before, during and after treatment. The sizes of skin lesion were used to be compared. Results:There are 168 medium and high-risk infantile hemangiomas into this study. All of them, 159(94.64%) finished all the treatment and follow up. The average age of first consultation was (2.29±0.84) months. The average duration of treatment was (13.67±4.43) months. The average of maximum doses was (1.86±0.35) mg/(kg·d). Among 9 patients who did not complete the treatment and follow up,2 (1.19%) of them withdrawal from the therapy due to cardiac side effects, 5 (2.98%) of them were showed poor response in 6 months then selected surgical treatment, 2 (1.19%) cases with intermitidated hemangiomas (liver involvement) had been departed after 4-month of therapy with liver hemagniomas vanished. There were no difference between male and female, single and multiple, focal and intermitidated with the therapy (P valve all>0.05). Conclusions:Propranolol has an effective modality of treatment for perianal infantile hemangiomas. It seems to be both efficacious for infantile hemangiomas with or without ulcer, and solitary or multiple.
作者
陈茜岚
钱秋芳
杨芸
林晓
黄迎
周景
CHEN Xi-lan;QIAN Qiu-fang;YANG Yun;LIN Xiao;HUANG Ying;ZHOU Jing(Department of Dermatology,Shanghai Children's Hospital,Shanghai 200040,China)
出处
《皮肤性病诊疗学杂志》
2018年第6期344-349,共6页
Journal of Diagnosis and Therapy on Dermato-venereology
基金
上海市科学技术委员会上海市科研计划项目-西医引导项目(编号:18411969400)