口服普萘洛尔治疗婴幼儿鼻部血管瘤的临床观察及随访

Clinical observation of oral propranolol in the management of infants with high-risk nasal and perinasal infantile hemangiomas

目的观察口服普萘洛尔治疗婴幼儿鼻部血管瘤的疗效及安全性。方法回顾性分析2011年3月—2017年3月徐州市儿童医院49例鼻部血管瘤住院患儿的临床资料,每月门诊随访并拍照,记录瘤体的变化、不良反应和复发情况,通过影像学检查和照片对口服普萘洛尔的疗效和安全性进行评价,并进行随访。口服普萘洛尔的起始剂量为0.5 mg/(kg·d),72 h内逐渐加量至1.5 mg/(kg·d)。结果49例患儿中女32例,男17例,就诊年龄1~9个月龄,平均年龄3个月龄。治疗总疗程4~16个月龄,平均疗程6.4个月龄。最易受累的区域是鼻尖部,其次是鼻根。服药至6个月时有效率为89.4%,出现轻微不良反应患儿5例,其中以肝酶升高最多见。出现并发症8例,脂肪组织残留最常见。停药6个月后复诊无复发。结论口服普萘洛尔治疗婴幼儿鼻部高风险血管瘤安全有效,早期干预可减少鼻部变形的风险。

Objcetive To assess the safety and efficacy of oral propranolol in the management of perinasal capillary hemangiomas of infants. Methods This retrospective study was conducted in Xuzhou Children’s Hospital. The medical records of 49 infants diagnosed with perinasal capillary hemangioma during a period of 6 years from 2011 to 2017 were retrospectively reviewed. The data collected included demographic details, clinical features and details of imaging studies, adverse events during treatment, length of treatment, and recurrences. The response to the treatment was assessed clinically as well as by radiographic imaging. Photographic documentation was collected periodically. All patients received oral propranolol under the supervision of a pediatrician.The initial dose was 0.5 mg/kg/day, which was increased to 1.5 mg/kg/day(in 2 divided doses) in 72 hours if there was no adverse reaction to the initial dose. Results Out of the 49 patients, 32 were females and 17 were males.The median age of onset was 3 months. The mean length of treatment was 6.4 months(range from 4 to 16 months). The most common presenting region was nose tip, followed by nasion. The effective rate was 89.4% in 6 months.There were 5 patients with mild adverse reactions, of which slight elevated liver enzymes was most frequently. Complications were found in 8 cases, and adipose tissue residue was the most common. No patients required discontinuation of treatment due to adverse events, and there were no cases of recurrence or tumor regrowth noted during the mean follow-up period of 6 months. Conclusion Oral propranolol is highly effective and safe in the treatment of nasal and perinasal capillary hemangiomas of infants. Early intervention should be considered to reduce risk of nasal deformation and improve esthetic outcomes.