“阶梯加量法”口服普萘洛尔治疗婴幼儿血管瘤疗效分析  

Treatment of infantile hemangioma by oral "ladder dosage" propranolol:a study of 56 cases

作　　者：刘超[1] 张蕾[1] 李香[1] 孙超[1] 周琦[1] 孙皓[1] 

机构地区：[1]山东大学齐鲁医院儿外科,山东省青岛市266035

出　　处：《临床小儿外科杂志》2016年第6期590-593,共4页Journal of Clinical Pediatric Surgery

摘　　要：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(P<0.05)。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。Objective To explore the efficacy and safety of ＂ladder dosage＂ propranolol for infantile he- mangioma. Methods From December 2013 to December 2014, a total of 56 infants with hemangioma （72 tumors） were treated by taking a gradually incremental dose of propranolol. Prior to treatment, comprehensive assessments of electrocardiogram （ECG）, blood glucose, liver function, myoeardial enzymes and blood routine were conducted. After excluding contraindications, the dose of propranolol gradually increased from 0. 5 mg·kg^-1·d^-1 to 1.5 ~2 mg·kg^-1·d^-1. Propranolol was taken once daily. After medication, ECG was moni- tored for 2 ~ 3 hours. Dynamic observations were made of tumor size, texture, color and other changes or an onset of adverse reactions. After discharge, regular follow-ups were performed with a 4-grade method. Results Within 72 hours after dosing, 50 cases had different degrees of color change or tumor consistency softening. During the first three days after 1 ~ 1.5 mg/（kg · d）, the change of tumor was the fastest. After medications, 12 cases ：were followed up for 1 ~ 3 months, 16 for 3 - 6 months, 26 for 6 - 12 months and 2 for 〉 12 months. According to the 4-grade method, （ n = 10, 17.86% ） were evaluated as grade 1V （ excellent ） , （ n = 30, 53.57%） grade m （good）, （n=14, 25%） grade Ⅱ （medium） and （n=2,3.57%） grade I （poor）.The curative effect of strawberry hemangioma was better than that of spongy/mixed type hemangioma（ P 〈 0.05 ）. According to the statistics of major adverse reactions, 56 cases developed bradycardia （ 100% ）, drowsiness （ n =6, 10. 7% ） , diarrhea （ n = 3, 5.4% ）, glucopenia （ n = 1, 1.8% ） and mild liver dysfunction （ n = 1, 1. 8% ）. After treatment, all adverse reactions disappeared. Conehtsions The efficacy of oral ＂ladder dos- age＂ propranolol is definite for infantile haemangioma. During medication, close attention should be paid to theoccurrences of adverse reactions.

关 键 词：阶梯加量 普萘洛尔 婴幼儿 血管瘤 

分 类 号：R732.2[医药卫生—肿瘤]