口服普萘洛尔治疗中、高风险血管瘤159例的临床分析:3年回顾性研究

Propranolol for medium and high risk infantile hemangiomas: a 3-year retrospective study

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.