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目的了解普萘洛尔治疗重症婴幼儿血管瘤的起始时间、剂量、维持时间、停药方法。方法回顾性研究2014年11月至2015年1月就诊于河南省人民医院血管瘤科口服心得安的重症婴幼儿血管瘤患儿30例,剂量由0.5 mg/(kg·day)逐渐增加至2 mg/(kg·day),监测用药前后1h、2h、3h心率,用药前后1h血糖水平,用药期间是否有胃肠道反应,观察用药24h后瘤体大小、颜色变化,停药后是否有瘤体反弹情况。结果 30例患儿在用药期间均未出现低血压、低血糖,烦躁、嗜睡、兴奋等精神异常症状,无厌奶、呕吐、腹泻等胃肠道症状。所有患儿起始用药后24h,瘤体体积明显缩小、颜色较用药前变暗,年龄≤3个月的效果优于>3个月。用药6个月后及停药后2周复查均无反弹。结论普萘洛尔治疗重症婴幼儿血管瘤时用药时间宜早、停药时间宜晚(维持6~10个月,较重的可适当延长用药时间),从低剂量逐步增加至维持剂量2mg/(d·kg)(分为早晚各一次,每次1mg/kg)较安全,先天性卵圆孔未闭不是普萘洛尔治疗的绝对禁忌,立即停药后瘤体反弹较少。
Objective To understand the propranolol treatment of severe infantile hemangioma start time, dose, maintenance time, withdrawal method. Methods A retrospective study of 30 patients with severe infantile hemangiomas admitted to Department of Hematology, Henan Provincial People's Hospital from November 2014 to January 2015 was conducted. The dosage gradually increased from 0.5 mg / (kg · day) to 2 mg / (kg · day). The heart rate at 1 hour, 2 hours and 3 hours before and after the drug administration was monitored. The blood glucose level at 1 hour before and after the drug administration was monitored. The gastrointestinal reaction was observed during the medication. The tumor size and color change Body bounce situation. Results None of the 30 children experienced any psychiatric symptoms such as hypotension, hypoglycemia, irritability, drowsiness, or excitement during the course of medication. There was no gastrointestinal symptoms such as milk leakage, vomiting and diarrhea. All patients started 24 hours after treatment, tumor volume was significantly reduced, darker than before treatment, the effect of age ≤ 3 months is better than> 3 months. No rebound after 6 months of treatment and 2 weeks after drug withdrawal. Conclusion Propranolol should be taken as early as possible in the treatment of severe infantile hemangioma, and the withdrawal time should be late (for 6 to 10 months, heavier may be appropriate to extend the medication time), gradually increase from low dose to maintain the dose of 2mg / (d · kg) (divided into morning and evening, each time 1mg / kg) is safe, congenital patent foramen ovale is not the absolute contraindication of propranolol treatment, the tumor rebounded less immediately after stopping.