口服盐酸普萘洛尔治疗婴幼儿外阴血管瘤7例临床分析

Chnical Anaylsis of Propranolol Hydrochloride for Vulvar Hemangiomas in 7 Cases of Infants

目的：探讨口服盐酸普萘洛尔治疗婴幼儿外阴血管瘤的疗效。方法：选取2013年3月至2014年2月来我院儿科门诊就诊的外阴血管瘤患儿7例,包括溃疡型2例和非溃疡型5例,均给予盐酸普萘洛尔：首日剂量0.50 mg/（kg·d）,分2次口服;第二天剂量增加为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1.50~2.00 mg/（kg·d）维持,连续服用6~12个月,每天分2~3次口服。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、生化检查及眼底检查,治疗过程中进行多普勒超声检查并观察皮损大小等以评价临床疗效及转归情况。结果：2例溃疡型血管瘤在服药1周后溃疡面逐渐愈合,1个月后完全愈合,形成瘢痕,溃疡外周红色斑块颜色逐渐变暗、消退。5例非溃疡型血管瘤患儿中4例疗效较好,另1例为多发性血管瘤患儿,B超示其肝脏10余个零星占位,服药1个月后复查B超示肝脏占位减少、缩小,2个月后完全消失,躯干及外阴皮损部位颜色明显变暗,但2个月后服药时有不规律,4个月后自行停药。患儿服药期间血常规、血糖、血压、心功能和肝肾功能检查均未发现明显异常。结论：口服盐酸普萘洛尔对各类型婴幼儿外阴血管瘤均有明显疗效。

Objective： To study the efficacy of propranolol hydrochloride for the treatment of vulvar hemangiomas in infants. Methods：Seven children presenting vulvar hemangiomas were selected, two cases of children were ulcerative type and five cases were non-ulcerative type. All children received treatment with oral propranolol hydrochloride started at 0.50 mg /（ kg·d） with an increase by0.25 mg /（ kg·d） everyday at the first 3 days,up to 1.50 mg /（ kg·d）,with the maximum doses of 2.00 mg /（ kg·d）. Complete blood tests and imageological diagnosis were obtained before treatment,Doppler ultrasonography were proceeded during and after treatment.The sizes of the lesion,clinical effect and outcomes were observed. Results： Two children with ulcer were healing after one week of taking drugs,and perfectly healed with scars instead after 1 month,the peripheral red plaque of ulcer decreased and declined. Four of five non-ulcerative type children have better effect. The other one was multiple lesions with liver infiltration,the proportion of liver infiltration decreased after 1 month,all liver hemangiomas disappeared after 2 months. But this child took medicine irregularly after 2months and stopped to taking medicine after 4 months. Blood tests,ECG and hepatic-renal function were normal before and after oral propranolol. Conclusion： Oral propranolol hydrochloride has an obvious effective for vulvar hemangiomas in infants.