4%盐酸普萘洛尔乳膏局部治疗浅表型血管瘤的疗效观察

The application of 4% propranolol cream in treating infantile local superficial hemangioma

目的评价4%盐酸普萘洛尔乳膏局部治疗浅表型婴儿血管瘤的疗效和安全性。方法 48例浅表型血管瘤患儿年龄1～6个月35例,7～12个月13例,分为治疗组(24例,给予4%盐酸普萘洛尔乳膏局部涂抹,3次/d)和观察组(24例,不做任何治疗),临床疗效评价分级:Ⅰ:无效(继续生长);Ⅱ:控制生长;Ⅲ:瘤体缩小<25%;Ⅳ:瘤体及皮损颜色消退≥25%～50%;Ⅴ:瘤体及皮损颜色消退≥51%～75%;Ⅵ:皮损消退>75%,瘤体消失及病损皮肤恢复或接近正常肤色。有效率以Ⅲ级及以上计算。结果治疗组治疗4个月后Ⅰ级1例(4.2%)、Ⅱ级5例(20.8%)、Ⅲ级3例(12.5%),Ⅳ级11例(45.8%)、Ⅴ级3例(12.5%)、Ⅵ级1例(4.2%),仅发现2例患儿用药后出现一过性皮肤微红,短暂停药3d后,继续用药无不良反应,未观察到其他不良反应。观察组:Ⅰ级17例(70.8%)、Ⅱ级6例(25.0%)、Ⅲ级1例(4.2%),Ⅳ级0例(0%)、V级0例(0%)、Ⅵ级0例(0%)。治疗4个月时治疗组总有效率75%,观察组总有效率4.2%,差异有显著性(P<0.05)。结论 4%普萘洛尔乳膏局部应用治疗婴儿血管瘤,安全有效,对浅表小面积的婴儿血管瘤尤其适用,可减少全身应用毒副作用,且使用更方便,值得临床推广和应用。

Objective To evaluate the efficacy and safety of 4% propranolol hydrochloride cream in treating infantile local superficial hemangioma. Methods 48 children with superficial hemangioma were enrolled in this study, with 35 children at the age of 1 -6 months and 13 children at the age of 7-12 months. All patients were divided into treatment group （24 cases, given 4% propranolol hydroehloride cream, 3 times/d ） and control Group （24 cases, no treatment ）. Clinical efficacy evaluation was graded in six levels. Level Ⅰ ： no effect with continuous tumor growth. Level Ⅱ ： limited tumor growth. Level. Ⅲ ： tumor mass reduced by less than 25%. Level Ⅳ： skin color and tumor mass reduced by ≥25% -50%. Level Ⅴ： skin color and tumor mass drop by 51% -75%. Level VI： Skin loss subsided by more than 75% , tumor mass disappeared and lesion skin recovered with skin color back to normal complexion. Efficiency was calculated by dividing the number of patients reaching Level m and above by the total number of patients. Results After 4-month treatment, the efficacy results were： 1 patient at level Ⅰ （4.2%）, 5 patients at level Ⅱ 5 （20.8%）, 3 patients at level Ⅲ （12.5%） 11 patients at level Ⅳ （45.8%）, 3 patients at level Ⅴ （ 12.5% ）, and 1 patients at level Ⅵ （4.2%）. Only 2 patients experienced reddish skin at the beginning of the treat-ment. The adverse effect disappeared after the medicine was stopped for three days and it didn＇ t reappear even with the resumption of treatment. In the control Group, 17 patients were at level Ⅰ（70. 8% ）, 6 patients at level Ⅱ （25%）, and 1 patient at level Ⅲ （4.2%）. No patient reached level Ⅳ or above. The total effective rate of the treatment group was 75% in 4 months while that was only 4. 2% in the control group. Statistical analysis showed that this difference was statistically significant （P 〈 0.05 ）. Conclusions The application of 4% propranolol cream in treating infantile hemangioma is very effective and safe, especially for children with small area, which can reduce the side effects of systemic application and be more convenient to use.