大剂量普萘洛尔治疗严重婴幼儿血管瘤的初步临床观察

目的 初步探讨口服大剂量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4月至2011年2月为56例严重的婴幼儿血管瘤患儿行口服普萘洛尔治疗,治疗前行全面的临床评估、心电图、血常规、肝功能、心肌酶和肌钙蛋白检查,治疗时口服普萘洛尔剂量逐渐增加,前3 d的剂量分别为每天1 ms/kg、1.5 mg/kg、2 mg/kg,每天按12 h 1次,分2次,喂奶后半小时服用,住院6 d,患儿无异常表现后出院;出院后每周复测心率,每个月复诊,6个月为1个治疗疗程,治疗结束时逐渐减量后停药.结果 56例患儿在服药后第2～4天就可观察到血管瘤的颜色改变.治疗后1个月复诊时观察血管瘤明显改善,瘤体体积不同程度变小、质地变软,伴有溃疡的患儿除1例溃疡扩大外其余均愈合.56例中10例血管瘤完全消退,46例明显改善;1例治疗3个月后血管瘤消退停止;3例出现不良反应:1例在治疗1个月后出现肝功能轻度异常,1例治疗过程中CKMB升高,给予继续观察,1例CK-MB、LDH、ALT、GGT持续升高,给予停药.结论 大剂量口服普萘洛尔治疗严重的婴幼儿血管瘤显效快,疗效明显,患儿耐受性好,不良反应少,可显著缩短血管瘤的病程,可能成为治疗严重婴幼儿血管瘤的首选方法.

Abstract：

Objective To investigate the clinical results of the treatment of severe infantile hemangioma with high-dose propranolol in Chinese. Methods 56 cases with severe infantile hemangioma were treated with propranolol. Clinical evaluation, electrocardiography, and experimental examination of liver function and heart function were performed before treatment. The daily dose of propranolol was increased from 1 mg/kg at the first day to 1. 5 mg/kg at the second day, and to 2 mg/kg at the third day.The propranolol was given twice a day. The treatment was lasted for six months. The patients were visited every month. Results The lesion color was changed after 2-4 days of treatment in all the cases. All the lesions were dramatically improved after one month of treatment. The ulceration were healed, except one case. Until now, complete regression was achieved in 10 cases and marked improvement in 46 cases. Side effects were happened in 3 cases, including one case of abnormal liver function, one case of CK-MB increase and one case of continuous increase of CK-MB, LDH, ALT, GGT. Conclusions High-dose Propranolol is very effective in the treatment of infantile hemangioma with minor side effects and short disease period. It might be used as the first-line treatment for infantile hemangioma.

Preliminary clinical study on the treatment of severe infantile hemangioma with high-dose propranolol in China

Objective To investigate the clinical results of the treatment of severe infantile hemangioma with high-dose propranolol in Chinese. Methods 56 cases with severe infantile hemangioma were treated with propranolol. Clinical evaluation, electrocardiography, and experimental examination of liver function and heart function were performed before treatment. The daily dose of propranolol was increased from 1 mg/kg at the first day to 1. 5 mg/kg at the second day, and to 2 mg/kg at the third day.The propranolol was given twice a day. The treatment was lasted for six months. The patients were visited every month. Results The lesion color was changed after 2-4 days of treatment in all the cases. All the lesions were dramatically improved after one month of treatment. The ulceration were healed, except one case. Until now, complete regression was achieved in 10 cases and marked improvement in 46 cases. Side effects were happened in 3 cases, including one case of abnormal liver function, one case of CK-MB increase and one case of continuous increase of CK-MB, LDH, ALT, GGT. Conclusions High-dose Propranolol is very effective in the treatment of infantile hemangioma with minor side effects and short disease period. It might be used as the first-line treatment for infantile hemangioma.