普萘洛尔治疗婴幼儿声门下血管瘤临床疗效及远期随访观察  

Clinical efficacy and long-term follow-up of propranolol in the treatment of infantile subglottic hemangioma

作　　者：王桂香[1] 张丰珍 张亚梅[1] 王华[1] 李宏彬 李晓丹[1] 赵靖[1] 张杰[1] WANG Guixiang;ZHANG Fengzhen;ZHANG Yamei;WANGHua;LI Hongbin;LI Xiaodan;ZHAO Jing;ZHANG Jie(Department of Otolaryngology Head and Neck Surgery,Beijing Children's Hospital,Capital Medical University,Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery,National Center for Children's Health(NCCH),Bejing,100045,China)

机构地区：[1]首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,儿童耳鼻咽喉头颈外科疾病北京市重点实验室,国家儿童医学中心,北京100045

出　　处：《中国耳鼻咽喉头颈外科》2020年第8期464-468,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：北京市医院管理中心“登峰”人才培养计划(DFL 20191201)。

摘　　要：目的探讨婴幼儿声门下血管瘤的诊断方法,优化诊疗流程,探讨口服普萘洛尔治疗婴幼儿声门下血管瘤的有效性,分析被误诊为其他疾病的声门下血管瘤病例特点,提高诊断准确率.方法回顾性分析2012年1月~2014年12月我院确诊为声门下血管瘤且使用普萘洛尔治疗的30例患儿的基本资料并进行远期随访.根据患儿入院时是否确诊为声门下血管瘤分为A、B两组,记录患儿主要症状、发病时间、检查方法、初步诊断及手段、用药情况、复查情况及转归情况.结果30例患儿中,男21例,女9例,男、女比例2.3:1,最小为40天,最大14个月,平均年龄(5.2±3.8)个月,所有患儿随访至停药后5年.A组患儿20例(门诊确诊声门下血管瘤),全部行电子喉镜检查,经颈部增强CT检查和/或颈部B超检查确诊,平均确诊时间(3.4±2.1)天,用药24~48小时后起效;B组患儿10例(门诊以其他诊断收入院,修正诊断后确诊为声门下血管瘤),行颈部增强CT检查和/或颈部B超检查修正诊断,平均确诊时间为(7.5±3.6)天.用药过程中1例患儿出现一过性低血糖,1例出现夜间心率减慢.随访5年,28例患儿用药后呼吸困难完全缓解,1例用药无效,1例部分缓解.全部患儿无复发病例.结论电子喉镜检查结合颈部B超检查可对声门下血管瘤做出快速诊断.口服普萘洛尔治疗声门下血管瘤安全有效.对可疑声门下血管瘤的患儿需快速诊断,及时用药,减少误诊,提高治疗成功率.OBJECTIVE To explore the rapid diagnosis process of in fantile subglottic hemangioma,analyze the effectiveness of oral propranolol in the treatment of infantile subglottic hemangioma,discuss the characteristics of cases misdiagnosed as other diseases,and optimize the diagnosis process and improve the diagnosis accuracy.METHODS Thirty children with infantile subglottic hemangioma in our hospital and treated with propranolol from January 2012 to December 2014 were analyzed retrospectively.The main symptoms,onset time,examination method,primarily diagnosis,confirmed diagnosi,medication method,and complications of the:30 children were recorded,and long-term follow-up were carried out.RESULTS Thirty children,aged from 40 days to 14 months were followed up for at least 5 years,including 21 males and 9 females.The patients were divided into two groups:Group A including 20 children,who were admitted into the hospital with confirmed diagnosis of subglottic hemangioma.Group B including 10 children,who were diagnosed primarily as other diagnosis and were corrected to subglottic hemangioma.Patients in group A were suspected to be subglottic hemangioma by electronic laryngoscope and confirmed by CT with contrast or B-ultrasound.The average diagnosing time of group A was(3.4±2.1)days.The symptoms of all the 20 patients significantly improved in 24-48 hours.Patients in group B were diagnosed mainly with CT with contrast or B-ultrasound.The average diagnosing time of group A was(7.5+3.6)days.Among the 30 patients,1 patient had transient hypoglycemia and 1 patient had slow heart rate at night during the course of using propranolol.The symptoms were completely relieved in 28 children after 5 years follow-up.1 patient failed by using propranolol and 1 patient's symptoms was partially relieved.There was no recurrence in all the patients.CONCLUSION Electronic laryngoscope combined with B-ultrasonography can diagnose the infantile subglottic hemangioma quickly.Oral propranolol is safe and effective in the treatment of subglottic hema

关 键 词：血管瘤 普萘洛尔 药物疗法 超声检查 婴幼儿 

分 类 号：R767.44[医药卫生—耳鼻咽喉科]