外涂普萘洛尔软膏治疗浅表型婴幼儿血管瘤疗效观察

目的 探讨局部外涂普萘洛尔软膏治疗浅表型婴幼儿血管瘤的临床疗效及安全性.方法 49例浅表型婴幼儿血管瘤患儿,女34例,男15例,年龄1～10个月,平均4.1个月.门诊接受瘤体表面外涂1％普萘洛尔软膏,每日3次,时间5～ 59周(平均21.1周),依据用药前后瘤体表面张力、大小、颜色变化,按照显著有效、部分有效、无效3级评分法对近期疗效进行评价.同时,观察用药后不良反应以评估用药安全性.结果 49例患儿中,26例(53.1％)显著有效;17例(34.7％)部分有效;6例(12.2％)无效,总有效率87.8％.所有患儿均未出现可检测到的不良反应.结论 外涂1％普萘洛尔软膏能有效促进浅表型婴幼儿血管瘤的消退,且未发现口服普萘洛尔常见的不良反应,可以作为婴幼儿血管瘤随访观察期间的一种安全、有效的辅助治疗手段.     

口服普萘洛尔治疗婴幼儿血管瘤的临床研究

目的:观察口服普萘洛尔治疗婴幼儿血管瘤的疗效。方法:2009年1月～2011年6月,笔者采用口服普萘洛尔治疗11例婴幼儿血管瘤,2mg/kg/天,分2次口服,3个月为1个疗程。如观察瘤体有复发表现,则重复1个疗程,至患儿1岁停药。结果:口服普萘洛尔后1周,瘤体颜色开始变淡、萎缩变软。治疗3个月后,大部分瘤体明显萎缩。至1岁时,瘤体基本消退,表面遗留毛细血管扩张。部分患儿出现心率减慢和腹泻,均在停药1周后恢复,继续治疗。结论:口服小剂量普萘洛尔治疗婴幼儿血管瘤具有良好疗效。     

口服普萘洛尔治疗婴幼儿体表血管瘤56例

目的探讨口服普萘洛尔治疗婴幼儿体表血管瘤的临床效果、安全性及方法。方法 2010年1月至2013年1月,口服普萘洛尔治疗56例婴幼儿体表血管瘤,瘤体范围0.8 cm×0.6 cm~4.0 cm×4.5 cm。初始剂量为0.5 mg/Kg·d,分2次餐后服用;若患儿无不良反应,则每日增加0.2 mg/Kg,直至1.5 mg/Kg·d;维持治疗4个月后,每日减少0.2 mg/Kg,逐日减量至停药。治疗期间每月随诊1次。治疗结束半年后参照Achauer标准进行疗效评价。结果 1例患儿服药不到1个月因出现疲劳乏力家属放弃治疗,2例服药3个月后瘤体基本消退而停药,其余53例均维持服药4个月。治疗结束时,大部分血管瘤明显缩小,颜色变淡,甚至消退。停药6个月后评定疗效:Ⅰ级2例(含复发1例),Ⅱ级6例(含复发5例),Ⅲ级17例,Ⅳ级31例,停药后复发6例。服药过程中1例出现明显疲劳乏力,6例出现间隙性腹泻但不影响饮食及治疗,未出现其他不良反应。结论口服普萘洛尔是治疗婴幼儿体表血管瘤的有效方法之一,其治疗效果及安全性可能与剂量及用药方式有关。     

普萘洛尔治疗婴幼儿血管瘤前后血清中色素上皮衍生因子水平探讨

目的:通过研究普萘洛尔治疗婴幼儿血管瘤前后血清中色素上皮衍生因子(Pigment epithelium-derived factor,PEDF)水平变化,进而探讨普萘洛尔治疗血管瘤的作用机制.方法:收集增殖期的血管瘤患者35例,消退期的血管瘤患者17例,脉管畸形患者7例,唇腭裂患者10例,增殖期血管瘤患者、消退期血管瘤...     

口服普萘洛尔治疗严重婴幼儿血管瘤的临床观察

目的:评估普萘洛尔治疗严重婴幼儿血管瘤的临床疗效和安全性。方法:2010年9月～2012年9月,笔者科室对34例严重婴幼儿血管瘤患儿进行口服普萘洛治疗,服药剂量为第1天1.0mg/kg,第2天1.5mg/kg,第3天2mg/kg,12h 1次、分2次服用。服药后1周、1个月和停药时进行疗效评价,并进行随访。结果:所有患儿在口服普萘洛尔1周后瘤体得到控制,服药1月和停药时,97.1%(33/34)的患儿表现为促进消退。3例伴发溃疡的血管瘤患儿,溃疡在服药后1个月内均愈合。8.8%(3/34)患儿有腹泻、食欲减退的不良反应。26.5%(9/34)患儿停药后有复发倾向。结论:普萘洛尔治疗婴幼儿血管瘤疗效明显,不良反应小,可作为严重婴幼儿血管瘤的治疗方法之一。     

普萘洛尔治疗增生期婴幼儿血管瘤的临床研究

目的：通过对普萘洛尔治疗婴幼儿血管瘤的临床研究,评估其治疗效果和安全性。方法：将我科从2009年9月至2010年8月收集的41例血管瘤患儿根据其家属的意见分为治疗组和观察组,其中治疗组20例,接受口服普萘洛尔治疗;观察组21例,接受门诊随访观察,比较两组的血管瘤变化情况,并检测治疗组服药前后患儿的心率、血糖、肝功能、肾功能、甲状腺功能等变化情况。结果：经过2个月的观察或治疗,治疗组显效9例,有效11例,无效0例;观察组显效0例,有效8例,无效13例。治疗组和观察组疗效有显著性差异,同时治疗组患儿治疗前与治疗后1h心率有所变化,其他如血糖和肝功能、肾功能及血FT3、FT4、sTSH等变化无明显统计学意义。结论：普萘洛尔在治疗婴幼儿血管瘤的过程中可抑制血管瘤的生长,部分患儿效果显著;治疗过程中不良反应少,安全性较高。     

小剂量普萘洛尔治疗婴幼儿血管瘤的临床观察

目的：探讨小剂量普萘洛尔治疗婴幼儿血管瘤的疗效及安全性。方法：收集增生期婴幼儿血管瘤23例（男6例,女17例）,口服普萘洛尔0.5～0.75 mg/（kg.d）,疗程1～9个月,并进行疗效评定和安全性评价。结果：疗效评定：优6例（26.1%）,良9例（39.1%）,中等8例（34.8%）;不良反应包括：心率轻度减慢8例（34.78%）,睡眠障碍2例（8.7%）,腹泻1例（4.3%）。不良反应轻,均1周内自行消失;安全性评定：15例为安全,8例为比较安全。结论：小剂量普萘洛尔治疗婴幼儿血管瘤,疗效良好,不良反应轻,安全性较好。     

普萘洛尔作为严重婴幼儿血管瘤一线治疗的前瞻性研究

目的 前瞻性评价普萘洛尔作为一线方案治疗严重婴幼儿血管瘤的疗效和安全性.方法 2009年3月至2010年2月对78例严重婴幼儿血管瘤患儿口服普萘洛进行治疗,用药剂量为每天2 mg/kg.患儿性别、年龄、肿物部位、并发症以及患儿入选该治疗的指征、不良反应、停药后有无复发等均被详细记录.针对服药后1周、1个月和停药时疗效分别评价.平均随访时间为16.7个月(12.1～23.6个月).结果 初始服药平均年龄为3.7个月(1.1～9.2个月),停止服药的平均年龄为11.2个月(5.2～22.3个月).疗程平均7.6个月(2.1～18.3个月).所有患儿口服普萘洛尔1周后肿物生长有效控制,其中88.5%(69/78)的患儿表现为促进消退.服药1个月和停药时,表现为促进消退的患儿达98.7%(77/78).14例伴发溃疡的血管瘤患儿,溃疡在服药后2个月内均愈合.15.4%(12/78)患儿有轻微不良反应.35.9%(28/78)患儿停药后有复发倾向.结论 普萘洛尔治疗婴幼儿血管瘤疗效明显,不良反应小,可作为严重婴幼儿血管瘤的一线治疗.

Abstract：

Objective To prospectively assess the efficacy and safety of propranolol as a first-line treatment for problematic infantile haemangioma in China. Methods From Mar. 2009 to Feb. 2010, 78 patients with problematic infantile hemangioma were included in the prospective study. The characteristics of the tumor, including sex, age, site, complications, were recorded. The response to treatment at 1 week, at 1 month and at the end of treatment was evaluated. The efficacy of treatment was graded as no response, stabilization, or accelerated regression. The indications for treatment, side effects and relapse after treatment were documented. The mean follow-up period was 16.7 months (range, 12.1-23.6 months). Results Oral therapy was initiated at mean age of 3. 7 months (range, 1.1-9.2 months) as first-line therapy. The mean age at the end of treatment was 11.2 months ( range, 5. 2-22. 3 months) . The treatment was lasted for 7. 6 months (range, 2. 1-18. 3 months). One week after treatment beginning, the hemangioma growth was controlled in all the patients. The accelerated regression was achieved in 88. 5% (69/78) of patients after one week of treatment, and 98.7% (77/78) of patients after 1 month of treatment and at the end of treatment. Ulceration was occurred in 14 cases before treatment, which was healed after treatment for 2 months. Minor side effects were happened in 15.4% ( 12/78) of patients.Rebound growth of lesion was noticed in 35. 9% (28/78 ) of patients. Conclusions Propranolol is effective in the treatment of infantile hemangioma with minor side effect. We suggest it should be used as the first-line treatment.     

口服普萘洛尔治疗眶周部增生期婴幼儿血管瘤

目的 探讨口服普萘洛尔治疗眶周部增生期婴幼儿血管瘤的疗效及安全性.方法 2009年9月至2010年10月,临床治疗12例眶周部增牛期婴幼儿血管瘤患儿,女9例,男3例,年龄1.5～8.5个月,平均3.3个月,采用口服普萘洛尔治疗.服药剂量每日2 mg/kg,分3次给药,治疗时间为4～41周(平均16周),依据服药前后瘤体大小、颜色变化进行疗效评价,通过服药疗程及期间出现的并发症情况进行安全性评估.结果 12例患儿中,9例服药后瘤体明显消退;2例瘤体生长明显受抑制;1例服药后,因药物不良反应而终止治疗.服药期间,除少数患儿出现轻度的心率、血压暂时性降低及胃返流外,未出现其他较为严重的并发症.结论 口服普萘洛尔治疗眶周部增生期婴幼儿血管瘤安全有效,随着临床研究的不断深入,有望成为非手术治疗婴幼儿血管瘤的重要方法之一.

Abstract：

Objective To observe the efficacy and safety of oral propranolol in the treatment of periorbital proliferating phase infantile hemangioma. Methods A retrospective review of patient medical records was performed. 12 patients (9 female, 3 male; 1.5-8.5 months, average 3.3 months) with periorbital proliferating phase infantile hemangioma underwent oral propranolol therapy. The dosage was slowly increased to 2 mg/kg daily in divided doses for a mean duration of 16 weeks ( range 4 weeks41 weeks). Therapeutic outcomes and safety were established by evaluating colour, size of lesion, duration of treatment and side-effects of treatment before and after treatment. Results Of these, 9 had a signification reduction in colour and size of the lesions, 2 had no further growth. 1 is stopped therapy due to hypotension after drug administration. 11 other patients, although mild adverse effects were noted, no symptoms were severe enough to discontinue treatment. Conclusions Propranolol appears to be a safe and effective treatment in the management of periorbital proliferating phase infantile hemangioma.     

普萘洛尔治疗婴幼儿血管瘤的临床研究进展

血管瘤多发生于婴幼儿期,是起源于血管内皮细胞的一种良性肿瘤,发生率为5%～10%[1].婴幼儿血管瘤(infantile hemangioma, IH)多具有自限性,有85%～90%的患儿在7～10岁时自然消退,但一些血管瘤因其显著生长或影响机体功能而须及时干预治疗[2].目前的治疗方法有药物、手术、激光、冷冻等.2008年,Léauté-Labrèze等[3] 偶然发现并提出普萘洛尔可作为一种新的药物治疗方法.随后,多国专家学者进行了一系列临床研究和科学分析,相继报道了普萘洛尔治疗IH的良好疗效及其安全性,并建议将其作为治疗IH的一线药物.笔者就近年来普萘洛尔治疗IH的临床研究现状进行综述.     

普萘洛尔凝胶治疗婴幼儿血管瘤的疗效观察

目的 评价普奈洛尔凝胶外涂治疗婴幼儿血管瘤的临床疗效与安全性.方法 2010年10月至2011年9月,采用外涂普萘洛尔凝胶的方法治疗51例血管瘤患儿,动态观察患儿血管瘤大小、质地、颜色、瘤体血流峰值、阻力系数等变化及不良反应.结果 按照Achauer疗效评定法,51例患儿疗效评定Ⅰ级4例(7.84％),Ⅱ级18例(35.29％),Ⅲ级22例(43.14％),Ⅳ级7例(13.73％,P＜0.05).彩色超声多普勒血流仪检查示血管瘤血流峰值减少、阻力系数增加(P＜0.05).浅表型血管瘤疗效优于深部型及混合型血管瘤(P＜0.05),而不同部位的血管瘤疗效之间比较差异无统计学意义(P＞0.05).结论 外涂普萘洛尔凝胶治疗婴幼儿浅表型血管瘤治疗效果满意,无明显不良反应.     

普萘洛尔在婴儿严重血管瘤中的临床应用

目的 探讨普萘洛尔治疗婴儿血管瘤的应用及疗效.方法 在临床和超声评估后,给予口服普萘洛尔,起始剂量为每天1～2mg/kg,分3次给药.治疗开始3h内监测血压和心率.住院治疗3d,出院连续服药,每30d复诊观察血管瘤变化并采用超声测量血管瘤最大厚度,按四级评分法对近期疗效进行评价.自2010年3～11月,收治血管瘤患儿25例.结果 本组所有25例患儿,在服药后24h内血管瘤颜色和质地均显示出即时效果,平均服药时间4个月.随访3～8个月,疗效Ⅳ级5例(20%),Ⅲ级14例(56%),Ⅱ级6例(24%),Ⅰ级0例.在治疗60d时,超声检查提示肿瘤最大厚度平均缩小38%.结论 口服普萘洛尔每天1～2mg/kg具有快速的治疗效果,能够极大缩短血管瘤自然进程,不良反应轻微, 可作为婴幼儿血管瘤快速增长期的临床一线治疗方法.     

Surgical resection of infantile hemangiomas following medical treatment with propranolol versus corticosteroids

Purpose

There has been a paradigm shift from corticosteroid to propranolol treatment for infantile hemangiomas (IHs), with surgical resection reserved for complicated or persistent IHs. The purpose of this study was to determine if propranolol treatment was associated with decreased utilization of surgical resection compared to corticosteroids.

普萘洛尔联合脉冲染料激光治疗婴幼儿血管瘤疗效观察

目的：评估普萘洛尔联合脉冲染料激光治疗婴幼儿血管瘤的疗效。方法：将24例婴幼儿血管瘤初诊患者随机分成两组。治疗组：采用脉冲染料激光联合口服普萘洛尔药物治疗,激光间隔30d重复治疗,直至皮损完全消退。统计激光治疗次数和并发症情况;对照组：单纯采用脉冲染料激光治疗,间隔30d重复治疗,直至皮损消退,统计激光治疗次数和并发症。结果：治疗组激光治疗次数明显少于对照组,并发症发生率亦明显少于对照组。结论：普萘洛尔联合脉冲染料激光治疗婴幼儿血管瘤疗效明显,有很好的临床应用前景。     

口服普萘洛尔治疗婴幼儿体表血管瘤临床观察

目的:探讨口服普萘洛尔治疗婴幼儿血管瘤的临床疗效、安全性及方法。方法:共收治56例体表血管瘤患儿,完善检查后口服普萘洛尔治疗,初始剂量为0.5mg/kg/d,分2次餐后服用,若患儿无不良反应,则每日增加0.2mg/kg至总量1.5mg/kg/d,维持治疗4个月后每日减少0.2mg/kg至停药,治疗结束半年后参照Achauer标准进行疗效评定。结果:其中1例服药不到1个月因出现疲劳、乏力,家属放弃治疗,2例服药3个月后瘤体基本消退而停药,其余53例均维持服药4个月,治疗结束时,大部分血管瘤明显缩小,颜色变淡,甚至消退,停药6个月后评定疗效:Ⅰ级2例(含复发1例),Ⅱ级6例(含复发5例),Ⅲ级17例,Ⅳ级31例,停药后复发6例。结论:口服普萘洛尔是治疗婴幼儿血管瘤有效方法之一,其疗效及安全性可能与剂量及用药方式有关。     

普萘洛尔与糖皮质激素比较治疗婴幼儿血管瘤临床疗效的Meta分析

目的：探讨普萘洛尔与糖皮质激素比较治疗婴幼儿血管瘤的临床疗效.方法：计算机检索Cochrane图书馆、Medline数据库、Wiley数据库、CNKI数据库及万方数据库,以“普萘洛尔”、“糖皮质激素”、“婴幼儿血管瘤”为关键词,检索各自数据库自2008年至201 3年7月期间所有普萘洛尔与糖皮质激素比较治疗婴幼儿血管瘤的随机对照试验,评价纳入研究的方法学质量并进行资料提取后,采用RevMan5.2软件进行Meta分析.结果：共纳入10个随机对照试验（RCT）,试验组口服普萘洛尔31 0例,对照组口服糖皮质激素247例,一共包括557例血管瘤患儿.Meta分析结果显示：试验组和对照组治疗有效率差异有统计学意义[0R=4.85,95％CI（3.245,7.26）,P＜0.00001],试验组优于对照组;试验组和对照组的不良反应发生率差异有统计学意义[0R=0.08,95％CI（0.05,0.14）,P＜0.00001],试验组低于对照组.结论：本研究结果证明普萘洛尔与糖皮质激素治疗婴幼儿血管瘤相比较,普萘洛尔能明显提高有效率和降低不良反应发生率.     

Treatment of infantile hemangiomas before and after the introduction of propranolol: a retrospective study

Background

Propranolol was introduced as systemic pharmacotherapy for problematic hemangiomas in 2008 and is now considered superior to corticosteroid. Other available treatment modalities include surgery and laser therapy. In November 2008, the first patient was treated with propranolol at The Center for Vascular Anomalies, Aarhus University Hospital. The aim of this study was to compare the treatment modalities applied before and after the actual date.

Methods

The present study was a retrospective study of patients treated for hemangioma between 1995 and 2012 at the University Hospital of Aarhus, Denmark. Outcome measures of interest included age at referral, the extent of evaluation by different specialties, and the treatments administered.

Results

One hundred twenty-one patients were included in the study. The patients were divided into two groups, patients treated before (study period 1) and after (study period 2) November 2008, respectively. In study period 2, patients were referred earlier for evaluation (0.82 versus 1.91 years, p?=?0.011). Fewer patients were seen by plastic surgeons in study period 2 (63.9 versus 98.8 %, p?<?0.001), with more patients being referred for systemic treatment (12.9 versus 86.1 %, p?<?0.001). No difference in the number of patients evaluated by dermatologists was detected (p?=?0.417). In study period 2, fewer patients were treated with surgery (38.9 versus 92.2, p?<?0.001) and laser therapy (13.9 versus 42.4, p?=?0.003). After November 2008, more patients have been treated with systemic pharmacotherapy (4.7 versus 80.6 %, p?<?0.001).

Conclusion

The introduction of propranolol has resulted in a decline in surgery and laser therapy at our institution. More patients are being referred for systemic pharmacotherapy due to the treatment protocol of propranolol. Level of Evidence: Level IV, therapeutic study.