口服普萘洛尔治疗婴幼儿头颈部血管瘤的临床效果观察

Clinical observation of treating infantile head and neck hemangioma with oral propranolol

目的评价口服普萘洛尔治疗婴幼儿头颈部血管瘤的临床效果和药物安全性。方法收集头颈部血管瘤患儿共68例,男20例,女48例,年龄1-9个月,平均年龄4.2个月。均采用口服普萘洛尔治疗,初始3 d普萘洛尔的剂量分别为0.5、1.0、2.0 mg/（kg·d）,每8 h口服1次。第4天起以2.0 mg/（kg·d）维持量服用至1周岁。动态观察瘤体大小、质地、颜色变化及药物不良反应。结果 68例患儿治疗过程中,23例患儿（33.8%）出现不良反应,大部分对症处理后继续服药,有2例患儿因血压明显降低、肝功能异常而停止治疗。至疗程结束时,66例完成治疗,参照Achauer疗效评定法,疗效Ⅰ级6例,Ⅱ级11例,Ⅲ级17例,Ⅳ级32例。结论口服普萘洛尔治疗婴幼儿头颈部血管瘤显效快,疗效明显,耐受性良好,不良反应少,可作为治疗婴幼儿头颈部血管瘤的一线方法。

Objective To evaluate the treatment effect and drug safety of treating infantile head and neck hemangioma with oral propranolol. Methods Oral propranolol was applied to 68 infants（ male 20 cases, female 48 cases, from 1 to9-month-old, with an average age of 4. 2 month） with heamngiomas. The daily dose of propranolol was increased from0. 5 mg / kg at the first day to 1. 0 mg / kg at the second day, and to 2 mg / kg at the third day. The daily dose was given equally every 8 hours. A therapy dose of 2 mg / kg / day was given until 1-year old, and the patients were visited every month. The changes of tumor size, texture, color and adverse effects were monitored. The short-term results were evaluated and adverse effects after medication were observed and managed accordingly by Achauer criterion. Results Although side effects were noted in 23 cases（ 33. 8%）, most were mild adverse effects and propranolol therapy was continued after symptomatic treatment. 2 patients（ 2. 9%） were stopped therapy due to hypotension and abnormal liver function after drug administration. The results were evaluated using Achauer system, scale Ⅰ（ poor） in 6 patients（ 8. 8%）, scale Ⅱ（ moderate） in 11 patients（ 16. 2%）, scale Ⅲ（ good） in 17 patients（ 25%） and scale Ⅳ（ excellent） in 32 patients（ 47. 1%）. Conclusion Oral propranolol treatment of infantile hemangioma has elicited high efficacy and tolerance with few expected adverse effects. It might be used as the first-line treatment for infantile head and neck hemangioma.