普萘洛尔治疗婴幼儿血管瘤

血管瘤是婴幼儿期间最常见的良性肿瘤,婴幼儿发病率为10%左右,在低体重的早产儿中发病率更高.婴幼儿血管瘤有自限性特点,大部分可自行消退,但位于特殊部位以及其他可能引起严重并发症的血管瘤需要积极干预治疗[1].最近文献陆续报道了普萘洛尔(心得安)治疗婴幼儿血管瘤的良好效果,本文就普萘洛尔治疗的相关问题做一综述.     

普萘洛尔治疗婴幼儿血管瘤

血管瘤是婴幼儿期间最常见的良性肿瘤,婴幼儿发病率为10%左右,在低体重的早产儿中发病率更高.婴幼儿血管瘤有自限性特点,大部分可自行消退,但位于特殊部位以及其他可能引起严重并发症的血管瘤需要积极干预治疗[1].最近文献陆续报道了普萘洛尔(心得安)治疗婴幼儿血管瘤的良好效果,本文就普萘洛尔治疗的相关问题做一综述.     

儿童脉管异常性疾病诊断治疗现状及展望

脉管异常性疾病(vascular anomolis)既往常称为“血管瘤”,是儿童期常见疾病,是一大类疾病的总称,总体发病率4％～5％[1],主要包括肿瘤和畸形两大类.该类疾病常见于头面、躯干、四肢等体表部位,亦可发生于全身深部器官和部位,临床因涉及多个学科,认识上不统一,诊断和治疗存在一定的混乱现象,需要引起业内同行重视. 一、脉管异常性疾病的诊断     

普萘洛尔治疗婴幼儿血管瘤的思考

血管瘤是婴幼儿常见的良性肿瘤之一,发病率约5％～10％,女：男约3：1。好发于头颈部。低出生体重儿及有血管瘤家族史的婴幼儿是发病的危险因素。Mulliken于1982年提出细胞生物学分类标准将先天性血管病变分为血管瘤和血管畸形,     

普萘洛尔治疗婴幼儿型血管瘤的几点思考

<正>婴幼儿型血管瘤(Infantile hemangioma,IH)是儿童期常见疾病,发病率约为4%,可见于全身各个部位,头面部占40%~60%。临床治疗中涉及多个学科,治疗方法尚不统一,文献报道主要有手术、药物(口服、局部注射,少数情况下静脉给药)、同位素、冷冻、激光、光动力、铜针通电、微波治疗、血管介入治疗,以及定期观察随访等~([1])。2008年Leaute-Labreze等~([2])报道口服普萘洛尔治疗11例IH取得良好疗效,其应用已逐渐成为临床一线选择。但其治疗机制仍不清楚,且对幼年群体安全性研究缺乏,影响了其临床推广。1机制的思考相对临床使用及观察的热度而言,目前普萘洛尔治疗婴幼儿型血管瘤作用机制研究仍     

口服普萘洛尔治疗婴幼儿头面部血管瘤

目的 探讨口服普萘洛尔治疗婴幼儿头面部增生期血管瘤的临床效果.方法 将婴幼儿头面部增生期血管瘤患儿90例,分为:口服普萘洛尔治疗组(普萘洛尔组)45例,口服强的松治疗组(强的松组)45例,随诊1～24个月.结果 普萘洛尔组总有效率为97.78％(44/45),强的松组总有效率为77.78％(35/45),普萘洛尔组疗效优于强的松组,且差异有统计学意义(P＜0.05).各组均未出现严重并发症.结论 口服普萘洛尔治疗婴幼儿头面部增生期血管瘤方法简单、疗效可靠、不良反应小,可作为婴幼儿血管瘤增生期的临床一线治疗方法.     

口服普萘洛尔治疗婴幼儿肝血管瘤的临床研究

目的探讨普萘洛尔治疗婴幼儿肝血管瘤(infantile hepatic hemangioma,IHH)的临床疗效。方法回顾性分析2013年至2018年于四川大学华西医院小儿外科接受普萘洛尔治疗的15例肝血管瘤患儿的病例资料。结果 15例患儿中男童4例,女童11例。肝脏肿大(9例,占60%)是最常见的临床表现;合并皮肤血管瘤12例(80.0%),甲状腺功能减退5例,心功能不全1例。15例患儿中,弥散性肝血管瘤2例;多发性肝血管瘤13例,其中包含2例结合性肝血管瘤。目前8例已经停止治疗,平均治疗时间23.8(18~30)个月;仍在治疗者6例,平均治疗时间20.5(6~41)个月;1例死于心脏衰竭和肝脏肿大引起的多器官功能障碍。治疗起始时最大瘤体平均体积为15.12 cm^3,在治疗6个月后,最大瘤体平均体积为6.49 cm3,获得Ⅴ级及Ⅵ级疗效(体积消退≥50%)者8例(53.3%);治疗12个月后,最大瘤体平均体积为3.56 cm^3,获得Ⅴ级或Ⅵ级疗效者10例(83.3%)。与治疗起始时瘤体体积相比,治疗第6个月和第12个月时瘤体消退明显,疗效显著,差异具有统计学意义(P<0.05)。所有患儿平均随访时间为29.5(2~48)个月,随访期间,无一例发生低血压、低血糖、气道高反应等普萘洛尔相关严重副作用,停药后无复发。结论口服普萘洛尔治疗IHH疗效明确,不良反应少,推荐普萘洛尔作为治疗IHH的有效选择药物。     

普萘洛尔治疗婴幼儿呼吸道血管瘤的疗效分析

目的 分析口服普萘洛尔治疗婴幼儿呼吸道血管瘤的效果。方法 回顾性分析2012年11月至2019年12月收治的、经支气管镜及喉部平扫增强CT/MRI确诊、且口服普萘洛尔治疗的婴幼儿呼吸道血管瘤患儿的临床资料。结果 共纳入20例患儿,所有患儿口服普萘洛尔治疗1~2 d后喉喘鸣、呼吸困难等症状均有改善,中位治疗时间为10个月（范围：6~12个月）。中位随访时间为10个月（范围：3~15个月）。19例（95%）患儿瘤体基本消退;1例（5%）患儿停药6个月后复查瘤体较停药前增大,予增加普萘洛尔剂量治疗6个月后,病情未出现反复;仅1例（5%）患儿出现不良反应;1例（5%）患儿尚在治疗中。结论 口服普萘洛尔可快速缓解呼吸困难等症状,使瘤体消退,不良反应少,可有效治疗婴幼儿呼吸道血管瘤。     

普萘洛尔治疗婴儿型血管瘤溃疡

目的 总结普萘洛尔治疗婴儿型血管瘤溃疡的经验. 方法 2010年1月至2012年12月我们收治婴儿型血管瘤伴溃疡患儿40例,男21例,女19例.记录血管瘤溃疡的发病年龄、就诊年龄、血管瘤类型,部位,溃疡类型,普萘洛尔治疗后疗效及副作用. 结果 患儿平均就诊年龄（5.1±1.9）个月,溃疡发生平均年龄（4.3±2.1）个月.92.5％的患儿为草莓状血管瘤,溃疡好发于四肢和臀部,溃疡平均深度（2.8±1.3）mm.普萘洛尔治疗时间（3.1±0.4）周,短于治疗前溃疡平均持续时间（P=0.04）.仅1例于服药期间出现出血、低血糖,1例出现心率减慢,经纠治后好转.100％的家属认为普萘洛尔对加速溃疡愈合有效. 结论 普萘洛尔治疗婴儿型血管瘤伴溃疡安全有效,值得推广应用.     

不同浓度普萘洛尔凝胶治疗婴幼儿血管瘤疗效观察

目的 评价不同浓度普萘洛尔凝胶外涂治疗婴幼儿体表血管瘤的临床疗效及安全性.方法 将2011年3月至2012年9月南京军区福州总医院普通外科收治的63例婴幼儿体表血管瘤患儿随机数字表法分成A、B、C3组,每组21例,分别采用药物浓度为1％(20 g∶200 mg,A组)、2％(20 g∶400 mg,B组)和3％(20 g∶600 mg,C组)的普萘洛尔凝胶外涂治疗,以均匀涂抹瘤体表面为准,3次/d,随访治疗6个月.详细记录患儿性别、年龄、肿物部位、并发症以及血管瘤大小、质地、颜色、用药后不良反应以及停药后复发情况.涂药后每月返院复查并对疗效进行评价.结果 经过6个月的治疗,A、B、C3组患儿有效率分别为52.38％(11/21例)、57.14％(12/21例)、90.48％(19/21例);彩超检查示3组患儿用药后血管瘤体厚度均明显变薄(P＜0.05),3组患儿用药后除少数出现局部皮肤轻微病变外均无全身不良反应,且C组患儿明显优于其他2组(P＜0.05).结论 普萘洛尔凝胶治疗婴幼儿血管瘤安全有效,3％浓度的普萘洛尔凝胶疗效要优于其他浓度组药物的疗效.     

Propranolol therapy for infantile hemangioma

Context

There has been widespread interest surrounding the use of beta-blockers (i.e. propranolol, timolol, nadolol, acebutolol) in the treatment of infantile hemangiomas (IH).

Objective

To review literature evaluating treatment of IH with propranolol.

Evidence Acquisition

We conducted a literature search on PubMed and investigated for case reports, case series, and controlled trials by using search terms including “hemangioma” and “propranolol.”

Results

Data suggest that beta-blockers are efficacious in cutaneous, orbital, subglottic, and hepatic hemangiomas and assist in the resolution of ulcerated hemangiomas. Improvement has also been documented in children with PHACE syndrome. Propranolol produces favorable results in children who do not respond to steroids and with no long-term adverse effects. Propranolol should be administered with caution due to rare but serious side effects including hypoglycemia, wheezing, hypotension, and bradycardia. Additionally, recurrence of lesions following the cessation of treatment has been documented.

Conclusions

Although large-scale randomized controlled trials must be conducted in order to further evaluate the safety and the possible role of propranolol in the treatment of IH, the reviewed literature suggests that propranolol carries promise as a potential replacement for corticosteroids as first-line therapy or as a part of a multimodal approach.     

Vincristine treatment for function- and life-threatening infantile hemangioma]

AIM: To evaluate the efficacy of vincristine treatment for function- and life-threatening hemangiomas. PATIENTS AND METHOD: Nine infants, eight girls and one boy, received vincristine treatment (VCR) for endangering hemangiomas. In six cases, the hemangiomas involved head and neck in a segmental unilateral or bilateral distribution (3/6 also had laryngeal and 2/6 tracheal location causing respiratory distress, 5/6 had eyelid and orbital involvement); one infant had disseminated neonatal hemangiomatosis (skin, liver, kidney); two infants had liver hemangiomas with cardiac failure. VCR was prescribed after failure of high-dosage corticosteroid treatment in six, and of both corticosteroids and interferon alpha 2b (5 months) in one; two infants received VCR as first line treatment. RESULTS: A dosage of 1 mg/m(2) IV injection was delivered, with weekly injections first, and then tapering, increasing the interval between injections, depending on the clinical response. The nine infants received from 5 to 25 injections (average: 16), for a length of treatment of 1.5-8 months (average: 5.5 months). In seven patients a clear clinical response was observed at the end of the first month of treatment, while a slow protracted response was noted in two. Transient mild side effects were present in four patients. DISCUSSION: Corticosteroid treatment, although a worldwide recognized treatment of problematic hemangiomas, cannot always control the growth of alarming hemangiomas. Interferon alpha 2a and 2b have proven a 90% effectiveness: treatment for cortico-resistant, function- and life-threatening, hemangiomas.     

Preliminary results of propranolol treatment for patients with infantile hemangioma

Propranolol, a non-selective beta-blocker, has recently been introduced as a treatment for infantile hemangiomas. In this study, we evaluated the effect of propranolol in 12 infants with hemangioma. Twelve infants (9 girls) with a median age of 4.5 months were included in the study. All of the patients in the study group received short-term (1-9 weeks, median: 4 weeks) systemic corticosteroids as a first-line therapy. All patients received propranolol 2 mg/kg/day, divided into three doses. They were treated in an inpatient setting for the first 72 hours of the treatment. Vital signs, blood pressure and blood glucose were monitored. Propranolol treatment was given for 4-9 months (median: 5 months). In the study group, regression rate of the mean dimension of the lesion was 38% +/- 15 (range 15%-50, median 45%) at the 2nd month of therapy. Over 9 months, which was the maximum follow-up period, the regression rate of the mean dimension of the lesion was 55% +/- 31 (range 20%-80, median 50%). One patient had transient bradycardia, which improved spontaneously. No other side effect was observed in the study population. Propranolol appears to be an effective drug for infantile hemangiomas with good clinical tolerance. We suggest that propranolol is the preferable drug as the first-line therapy for infantile hemangiomas.     

Hyperkalemia complicating propranolol treatment of an infantile hemangioma

Propranolol treatment was recently reported to be successful for the management of severe infantile hemangioma. Known adverse effects of propranolol treatment include transient bradycardia, hypotension, hypoglycemia, and bronchospasm (in patients with underlying spastic respiratory illnesses), which led to a general recommendation to gradually increase propranolol dosage and closely monitor patients' hemodynamics at the onset of therapy. To date, no serious or unexpected adverse effects that required specific intervention have been reported. In this report, we describe the case of a 17-week-old female preterm infant who presented with a large, ulcerated, cutaneous-subcutaneous hemangioma of the right lateral thoracic wall, which we treated successfully with propranolol. A few days into therapy, a potentially life-threatening adverse effect, severe hyperkalemia, was observed and required treatment with loop diuretics, fluids, and nebulized salbutamol to normalize her serum potassium levels. This therapy could be gradually tapered and finally discontinued only after several weeks of propranolol treatment. Our case report indicates that, at least during the initial phase of the propranolol treatment of infantile hemangioma, close monitoring of serum electrolytes, besides the monitoring of hemodynamics and blood glucose, is necessary.