COVID-19流行期间远程医疗启动口服普萘洛尔治疗婴儿血管瘤的有效性及安全性评估

Efficacy and Safety of Oral Propranolol in the Treatment of Infantile Hemangioma Initiated by Telemedicine During Covid-19 Epidemic

目的回顾COVID-19流行期间远程医疗启动口服普萘洛尔治疗婴儿血管瘤的临床疗效和安全性。方法回顾性分析2020年10月—2021年10月在首都儿科研究所附属儿童医院互联网医院诊断为婴儿血管瘤(IH)并启动口服普萘洛尔治疗、且完成治疗后随访半年的35例患儿资料。给予患儿普萘洛尔2~3 mg/(kg·d),每天分2次口服,分别在第0、4、12、24周于远程门诊复诊。使用血管瘤活跃度评分(the hemangioma activity score,HAS)评估疗效及瘤体消退程度,并记录可能与服药相关的不良事件及持续时间。结果35例血管瘤患儿均接受口服普萘洛尔治疗24周。患者基线HAS评分为5.00(4.50,5.50),第4周HAS评分为3.50(3.00,4.00),第12周HAS评分为2.00(1.50,2.33),第24周HAS评分为0.75(0.00,1.25),差异有统计学意义(P<0.001)。HAS评分最大降幅100%,最小65%,评分下降80%以上者24例(68.57%),下降90%以上者13例(37.14%),10例(28.57%)完全缓解。服药相关的不良反应事件共20例,其中中枢神经系统反应4例,β2受体相关不良事件7例,消化道不良反应9例。所有不良事件持续时间均未超过4周。未出现重度呼吸系统症状、低血压、低血糖、心动过缓、房室传导阻滞等严重不良事件。结论在COVID-19流行期间远程医疗启动口服普萘洛尔治疗婴儿血管瘤疗效显著且安全性良好,服药期间无严重不良反应。由于婴儿血管瘤增生期较短,尽早启动治疗可预防不良结局。远程医疗可让高危风险婴儿血管瘤得到及时转诊,标准风险婴儿血管瘤尽快启动治疗。

ObjectiveTo analyse the efficacy and safety of oral propranolol in the treatment of infantile hemangioma(IH)initiated by telemedicine during the covid-19 epidemic.Methods The data of 35 children with IH diagnosed in the InternetHospital of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from October 2020 to October2021 and treated with oral propranolol were retrospectively analyzed,and they were followed up for half a year.The children were given propranolol 2-3 mg/(kg?d)orally twice a day,and were revisited in the remote outpatient department at 0,4,12 and 24 weeks respectively.The hemangioma activity score(HAS)was used to evaluate the curative effect and the degree of tumor regression,and the adverse reactions were recorded.Results All 35 children with IH were treated with oral propranolol for 24 weeks.The baseline score of HAS was 5.00(4.50,5.50),the 4th week was 3.50(3.00,4.00),the 12th week was 2.00(1.50,2.33),and the 24th week was 0.75(0.00,1.25).The difference was statistically significant(P<0.001).The maximum decrease of HAS score was 100%,and the minimum was 65%.The score decreased by more than 80%in 24 cases(68.57%),decreased by more than 90%in 13 cases(37.14%),and completely relieved in 10 cases(28.57%).There were 20 cases of drug-related adverse reactions as follows:There were 4 cases with central nervous system reactions,7 cases withβreceptor related adverse reactions,9 cases with gastrointestinal adverse reactions.The duration of all adverse reactions did not exceed 4 weeks.There were no serious adverse reactions such as severe respiratory symptoms,hypotension,hypoglycemia,bradycardia,atrioventricular block.Conclusion During the epidemic period of covid-19,oral propranolol initiated by telemedicine is effective and safe in the treatment of IH,and there are no serious adverse reactions.Due to the short proliferative period of IH,early treatment can prevent adverse outcomes.Telemedicine can enable high-risk IH to be referred in time,and start treatment for standard risk IH as soon as possible.