不同剂量与给药时机口服普萘洛尔在婴幼儿血管瘤中的应用价值

Application Value of Oral Propranolol at Different Doses and Timing of Administration in Infantile Hemangioma

目的:探讨不同剂量与给药时机口服普萘洛尔在婴幼儿血管瘤中的应用价值。方法:选取2017年1月至2018年6月湖北省荆州市中心医院收治的96例血管瘤患儿,按随机数表法为A组和B组各48例。两组患儿均采用“阶梯式”治疗方法,A组最终维持剂量1.0 mg/(kg·d),B组最终维持剂量2.0 mg/(kg·d),比较两组患儿达到停药终点时的总体疗效、达到显效和临床治愈时间及持续治疗时间。依据开始治疗年龄将两组患儿各分为>3个月和≤3个月两个亚组,比较上述指标的差异。记录不良反应发生率和复发率。结果:达到停药终点时,A组和B组临床治愈率比较差异无统计学意义(P>0.05)。临床治愈患儿中,B组达到显效和临床治愈时间短于A组(P<0.05)。A组持续治疗时间长于B组(P<0.05)。达到停药终点时,≤3个月组临床治愈率高于>3个月组,但差异无统计学意义(P>0.05)。临床治愈患儿中,≤3个月组达到显效和临床治愈时间短于>3个月组(P<0.05)。≤3个月组持续治疗时间短于>3个月组(P<0.05)。两组患儿不良反应及复发率比较差异无统计学意义。结论:在婴幼儿血管瘤临床治疗中,普萘洛尔1.0 mg/(kg·d)可获得与2.0 mg/(kg·d)疗效相当的临床结局,且安全性更高,未增加复发风险,但1.0 mg/(kg·d)方案需更长疗程。此外,尽早(≤3月龄)给予普萘洛尔治疗更有利于提高临床治愈率,降低复发风险。

Objective:To explore the application value of oral propranolol at different doses and timing of administration in infantile hemangioma.Methods:A total of 96 infants with hemangioma admitted into Hubei Jingzhou Central Hospital from Jan.2017 to Jun.2018 were extracted to be divided into the group A and the group B via the random number table,with 48 cases in each group.Both groups were treated with“step-by-step”treatment,the final maintenance dose of group A was 1.0 mg/(kg·d),and the final maintenance dose of group B was 2.0 mg/(kg·d).The overall efficacy,time to significant efficacy and clinical cure,and the duration of continuous treatment were compared between two groups at the end of drug withdrawal.Two groups were divided into>3 months group and≤3 months group according to the starting age of treatment,and the differences of the above indicators were compared.Incidences of adverse drug reactions and recurrence were recorded.Results:At the end of drug withdrawal,there was no statistically significant difference in the clinical cure rate between the group A and the group B(P>0.05).Among the clinically cured children,the time to significant efficacy and clinical cure in the group B was shorter than that in the group A(P<0.05).The duration of continuous treatment in the group A was longer than that in the group B(P<0.05).At the end of drug withdrawal,the clinical cure rate of≤3 months group was higher than that of>3 months group,the difference was not statistically significant(P>0.05).Among the clinically cured children,the time to significant efficacy and clinical cure in≤3 months group was shorter than that in>3 months group(P<0.05).The duration of continuous treatment in≤3 months group was shorter than that in>3 months group(P<0.05).There was no significant difference in the incidences of adverse drug reactions and recurrence between two groups.Conclusion:In the clinical treatment of infantile hemangioma,propranolol 1.0 mg/(kg·d)can achieve the same clinical outcome as 2.0 mg/(kg·d),which is more secure and does not increase the risk of recurrence.However,propranolol 1.0 mg/(kg·d)needs a longer course of treatment.In addition,early treatment with propranolol(less than or equal to 3 months of age)is more beneficial to improve the clinical cure rate and reduce the risk of recurrence.