口服普萘洛尔治疗婴儿血管瘤疗效观察

目的 探讨口服普萘洛尔治疗婴儿血管瘤的临床疗效.方法 47例婴儿血管瘤患儿于2009年1月至2010年3月间接受口服普萘洛尔治疗,动态观察患儿血管瘤大小、质地、颜色变化及不良反应.结果 按照cchauer疗效评定法,Ⅰ级14例,Ⅱ级13例,Ⅲ级15例,Ⅳ级5例.草莓状血管瘤疗效优于海绵状及混合型血管瘤(P＜0.05),而不同部位的血管瘤疗效之间差异无统计学意义(P＞0.05).结论 口服普萘洛尔治疗婴儿草莓状血管瘤疗效确切,无明显不良反应.

Abstract：

Objective The objective of this study is to evaluate the efficacy of propranolol in treatment of infantile hemangioma. Methods Oral propranolol was applied to 47 infants with heamngiomas in Fuzhou General Hospital of Nanjing Military Command,Department of General Surgery from January 2009 to Match 2010. The patients received medication at home and were revisited every 2 weeks. The changes of tumor size, texture,color and adverse effects were monitored and recorded at a regular interval. Results The results were evaluated using Achauer system; scale Ⅰ(poor) in 14 patient,scale Ⅱ(moderate) in 13 patients,scale Ⅲ(good) in 15 patients and scale Ⅳ(excellent) in 5 patients. The treatment response for strawberry hemangioma was significantly better than other hemangiomas (P＜0. 05) ,but no significant diffierence was found among different primary sites (P＞0. 05). Conclusions Oral propranolol treatment is an effective treatment for strawberry hemangiomas.     

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.     

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.     

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.     

普萘洛尔片剂口服治疗婴幼儿血管瘤68例临床分析

目的探讨口服普萘洛尔片剂方法治疗婴幼儿血管瘤的临床疗效及安全性。方法2011年11月-2015年6月在门诊就诊的68例血管瘤患儿,接受普萘洛尔片剂治疗(每日总量1.5~2 mg/kg,分3~4次口服,一周加至足量);观察记录血管瘤大小、颜色的变化以及相关副作用,以评价其疗效及安全性。结果服药3个月、6个月、1年治疗有效率分别为88.2%、98.1%、98.1%;疗效达V级及以上者分别为33.8%、80.8%、100%。多数患儿在治疗12个月时已经停药,继续用药的患儿,其疗效分级均为Ⅵ级。疗效与性别、开始服药月龄、病灶部位均无关(P0.05)。本组3例患儿出现一过性普洛萘尔相关不良反应,停药后恢复。结论口服普萘洛尔方法治疗婴幼儿血管瘤疗效显著、副作用少。     

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。     

“阶梯加量法”口服普萘洛尔治疗婴幼儿血管瘤疗效分析

目的 探讨“阶梯加量”口服普萘洛尔治疗婴幼儿血管瘤的疗效及安全性。方法2013年12月至2014年12月,共56例血管瘤婴幼儿(共计72枚瘤体)在本院接受住院“阶梯加量”口服普萘洛尔治疗;治疗前全面评估,并行心电图、血糖、肝功能、心肌酶及血常规检查,排除禁忌症后,均给予“阶梯加量”口服普萘洛尔,剂量从0.5 mg·~(-1)~·d~(-1)逐渐增加至1.5~2 mg·kg~(-1)·d~(-1),每日一次性顿服,服药后予心电监测2~3 h,动态观察瘤体大小、质地、颜色等变化,以及患儿有无相关不良反应,出院后定期随访,按4级评分法进行疗效评价。结果 56例患儿服药72 h内,50例出现瘤体不同程度颜色变浅或质地变软,剂量增加至1~1.5 mg·kg~(-1)·d~(-1)后的前3 d内瘤体性质变化最快。服药后随访1~3个月者12例,3~6个月者16例,6~12个月者26例,超过12个月者2例;疗效评价:Ⅳ级(优)10例(10/56,17.86%),Ⅲ级(好)30例(30/56,53.57%),Ⅱ级(中)14例(14/56,25%),Ⅰ级(差)2例(2/56,3.57%)。草莓状血管瘤的疗效优于海绵状及混合型血管瘤(P0.05)。主要不良反应为心率减慢56例(56/56,100%),嗜睡6例(6/56,10.7%),腹泻3例(3/56,5.4%),低血糖1例(1/56,1.8%),肝功能轻度异常1例(1/56,1.8%),给予对症处理后均恢复正常。结论 “阶梯加量”口服普萘洛尔治疗婴幼儿血管瘤疗效确切,用药时应密切注意不良反应。     

口服普萘洛尔对婴幼儿血管瘤患儿血糖影响的初步研究

目的探讨口服普萘洛尔治疗血管瘤患儿血糖的变化情况。方法我院2013年1月-{2014年12月69例婴幼儿血管瘤患儿,口服普萘洛尔治疗,将普萘洛尔均分为3份在三餐餐后短时间内服用,服药1h后监测血糖,梯度加量,连续监测3d,直至2mg/(kg·d)的维持剂量。结果服药前,所有患儿血糖在正常范围。服用不同剂量的普萘洛尔对血糖无明显影响。1例患儿服药第2d血糖下降至3.8 mmol/L,低血糖发生率为1.4%。结论通过连续性监测,口服普萘洛尔治疗的血管瘤患儿血糖未发现有显著性差异的变化,初步提示我们的临床用法相对安全,但仍需进一步深入研究。     

婴幼儿血管瘤患者口服小剂量普萘洛尔前后动态心电图的比较

目的探讨口服小剂量普萘洛尔在治疗婴幼儿血管瘤过程中对患儿心率变异性(HRV)、心率加速力(AC)、心率减速力(DC)以及心脏传导功能等方面的影响。方法对118例1岁以内血管瘤患儿口服小剂量普萘洛尔[1 mg/(kg·d)]治疗前及治疗1个月后行24 h动态心电图检查,观察治疗后HRV时域指标[RR间期总体标准差(SDNN)、RR间期平均值的标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、NN50占所有NN间期个数的百分数(PNN50)]与频域指标[低频功率(LF)、高频功率(HF)]、AC、DC的变化,同时观察治疗后有无心脏传导功能及其他方面的异常。结果普萘洛尔治疗后SDNN、RMSSD、LF、HF、PNN50均大于治疗前(P0.01);治疗后AC、平均心率(HR)、最慢心率均小于治疗前(P0.01)。治疗后24 h动态心电图结果异常比例高于治疗前,但差异无统计学意义。结论普萘洛尔治疗婴幼儿血管瘤可抑制交感神经活性,使心脏传导功能受阻,但不会造成严重不良后果。     

普萘洛尔影响婴幼儿血管瘤患儿中枢神经系统功能的新进展

婴幼儿血管瘤(infantile hemangioma,IH)是婴儿期最常见的良性肿瘤,目前β肾上腺素能受体阻滞剂普萘洛尔是IH的主要治疗药物,但是这种亲脂性药物能够透过血脑屏障,可能会对婴幼儿中枢神经系统功能产生潜在影响。本综述将从短期和长期记忆、精神运动功能、睡眠质量和情绪几个方面来阐述普萘洛尔对IH患儿中枢神经系统功能的潜在影响,以期为评估普萘洛尔治疗IH的安全性研究提供方向。     

Treatment of infantile subglottic hemangioma with oral propranolol

Infantile subglottic hemangioma (SH) can cause biphasic stridor, respiratory distress and even life‐threatening airway compromise. Treatment of SH in infants has traditionally been characterized as a challenging situation with multiple therapeutic options without consensus as to which one is the best and with risks of severe side‐effects. Four infants with SH were treated with propranolol. Treatment with oral propranolol resulted in resolution of symptoms within 2 days, followed by complete recovery. Propranolol appears to be an effective treatment for SH and should be used as a first‐line treatment for SH when intervention is required.     

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。     

Preliminary experience on treatment of infantile hemangioma with low-dose propranolol in China

We aimed to assess the efficacy and safety of low-dose propranolol for treatment of infantile hemangiomas (IHs) in China. Our prospective study included data from 89 patients with IH, aged 1–12 months. Plasma renin activity, angiotensin II, and aldosterone were measured before initiation of propranolol therapy. Patients were administered propranolol (0.75–1 mg/kg/day) under close observation. The volume, texture, and color of lesions were used to evaluate efficacy. Safety endpoints included heart rate, systolic and diastolic blood pressures, alanine transaminase, aspartate transaminase, thyroid function tests, and fasting blood glucose. Adverse effects were recorded. Mean plasma angiotensin II concentration in patients with IH was higher than that in age-matched healthy children, whereas mean plasma renin activity was lower. Mean aldosterone level was higher at 1–3 months but lower at 4–12 months, than values reported previously. After propranolol therapy for 6 months, IH regression was classed as grade IV in 44 patients (49.4 %), grade III in 21 patients (23.6 %), and grade II in 24 patients (27.0 %); none were grade I. Mild adverse effects, including diarrhea, restless sleep, nausea, cold extremities, and hypoglycemia, occurred in 12 patients (13.5 %). Slight decreases in heart rate and blood pressure occurred in all patients (p?<?0.05). The IHs of four patients (4.5 %) relapsed after treatment cessation at 4–5 months. Conclusion: Low-dose propranolol is effective and safe for Chinese children with IH, and larger-scale studies are merited. Mechanisms underlying IH pathogenesis, and possible involvement of the renin–angiotensin–aldosterone system, deserve study.     

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.     

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.     

Response to propranolol in infantile hemangioma

Propranolol, 2 mg/kg/day, is effective in the treatment of infantile hemangioma. We report the response to propranolol in infants with hemangioma at a dose of 1 mg/kg/day. Sixteen infants with newly diagnosed infantile hemangioma were given propranolol at a dose titrated from 0.5 mg/kg/day then increased to 1 or 2 mg/kg/day based on response to treatment until the lesions showed clinical stability for 3 consecutive months. Five out of 16 patients (31.2%) responded to propranolol at 1 mg/kg/day, while the remainder required 2 mg/kg/day for response. Vascular endothelial growth factor significantly decreased after treatment (median, 117.8 pg/mL; range, 35.3–468.7 pg/mL vs 59.2 pg/mL; range, 26.3–133.0 pg/mL; P = 0.016). Therefore, we recommend initiating treatment at 0.5 mg/kg/day for 2 days, then 1 mg/kg/day for 1 month. If the hemangioma has not decreased in size by 1 month follow up, the dose is subsequently increased to 2 mg/kg/day.