普萘洛尔治疗婴幼儿血管瘤的临床效果评价

Clinical evaluation of propranolol in the treatment of infantile hemangioma

目的评价口服普萘洛尔治疗婴幼儿血管瘤的临床疗效及安全性。方法收集2013年9月至2015年9月在青岛市市立医院口腔颌面外科确诊为血管瘤的患儿52例,男10例,女42例,年龄2~26个月,平均(6.14±1.31)个月;头面颈部受累30例,四肢躯干受累16例,全身多处受累6例。所有患儿均采用口服普萘洛尔治疗,初始剂量为0.5mg/(kg·d),1日2次,间隔时间为8小时。最大维持剂量为2.0mg/(kg·d)。动态观察瘤体色泽与体积的变化及不良反应。结果 52例患儿全部完成治疗,治疗过程中出现腹泻4例、便秘6例,无严重不良反应者。疗效评定参照Achauer法,总有效率为94.23%,疗效Ⅰ级3例,Ⅱ级5例,Ⅲ级8例,Ⅳ级36例;颌面颈部与四肢躯干血管瘤疗效比较差异无显著性(P>0.05)。所有患儿均随访1年,未见复发者。结论普萘洛尔治疗婴幼儿血管瘤疗效明显、不良反应较少,可推荐为治疗婴幼儿血管瘤的一线用药。

Objective To evaluate the clinical efficacy and safety of propranolol in treatment of infantile hemangioma （IH）. Method Medical records of 52 eligible patients were retrospectively analyzed, of which there were 10 males and 42 females. The mean age at start of treatment with propranolol was 6.14 months （range, 2-26 months）. There were 30 patients with infantile hemangioma in the skin of face and neck, 16 patients of extremities and trunk, 6 patients in multiple sites. The initiation dosage for patients was 0.5mg/（kg·d） for twice per day, followed by 2.0mg/（kg·d） in max maintenance doses. Dynamic monitoring in the treatment includes the IH changes in size and color and adverse drug reaction of propranolol. Result All 52 patients had completed the treatment uninterruptedly. The total effective rate was 94.23 %, with results including 3 patients of classⅠ（poor）, 5 patients of classⅡ（moderate）, 8 patients of classⅢ （good）, and 36 patients of classⅣ （excellent）, respectively 4 patients with diarrhea and 6 patients with astriction were found during the treatment. None of our patients showed severe side effects at the beginning of or during the treatment. There was no significant difference in curative effect between the group with hemangioma in face and neck and the other group for extremities and trunk. Recurrence was not observed after termination of treatment. Conclusion Our report supports the excellent effect and good tolerance of this novel therapy. We propose the use of propranolol as first-line treatment for IH.