口服普萘洛尔治疗婴幼儿血管瘤的临床观察

目的：评价普萘洛尔治疗婴幼儿血管瘤的安全性和临床疗效。方法：2010年9月至2013年3月，我科对44例血管瘤患儿予口服普萘洛尔，治疗前行心电图、超声心动图、血常规、肝功能、心肌酶谱等检查进行评估。服药剂量为第1天1．0mg·kg^-1，第2天1．5mg·kg^-1，第3天2mg·kg^-1，分2次服用，每12h服药1次。住院治疗期间严密监测心率、血压、呼吸情况变化，无异常表现者住院1周出院，并每月复诊，治疗结束时逐渐减量至停药。对服药后1周、1个月和停药时疗效分别作评价。患者平均随访时间为12．3个月（9．2～20．3个月）。结果：所有患儿在口服普萘洛尔1周后血管瘤瘤体生长受到抑制，服药1个月和停药时95．5％（42／44）的患儿表现为瘤体缩小。4例伴发溃疡的血管瘤患儿在服药后1个月内溃疡均愈合。用药期间6．8％（3／44）患儿出现腹泻、食欲减退，22．7％（10／44）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。

Clinical observation of oral propranolol in treatment of infantile hemangioma

Objective： To estimate the efficacy and safety of oral propranolol in treatment of infantile hemangioma. Methods： From Sep, 2009 to Mar, 2013,44 infantile hemangioma were treated with oral propranolol in our department. Clinical evaluation, electrocardiography, and experimental examination of blood routine, liver function and myocardial enzyme levels were performed before treatment. The daily dose of propranolol was increased from 1 mg· kg ^-1 at the first day to 1.5 mg· kg^-1 at the second day, and to 2 mg·kg^-1 at the third day. The propranolol was given twice a day. The response to treatment at 1 week, 1 month and at the end of treatment was evaluated. The mean follow-up period was 12.3 months （range 9. 2 -20. 3 months）. Results： One week after treatment the hemangioma growth was controlled in all patients. The accelerated regression was achieved in 95.5% （42/44） of patients after 1 month of treatment and at the end of treatment. Ulceration was occurred in 4 cases before treatment, which was healed after treatment for 1 months. Diarrhea or appetite decrease was happened in 6.8% （3/44） of the patients. Rebound growth of lesion was noticed in 22.7% （10/44） of patients. Conclusions： Propranolol is effective in the treatment of infantile hemangioma with minor side effects. We suggest it should be used as the first-line treatment.