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普萘洛尔作为婴幼儿血管瘤一线治疗的有效性和安全性

β受体阻滞剂是治疗复杂婴幼儿血管瘤（IH）的大有前途的治疗方案，但是有关其疗效客观评价以及药物对血液动力学影响的资料甚少。作者对口服心得安（普萘洛尔）治疗的一组增生期血管瘤患儿进行回顾性研究，采用VAS对治疗前后照片进行盲法评价，辅以超声检查和眼科检查（必要时）。记录耐受性及血液动力学指标，服药前2天，住院观察2周。25例患者纳入研究对象，平均年龄3.6个月。中位随访期14.3 （11.4～22.1）个月，14例患者完成治疗，平均疗程10.5 （7.5～16）个月， 治疗结束时的平均年龄为14.3 （11.4～2.1）个月。治疗7个月后，所以患者的血管瘤颜色均变浅，体积显著缩小。B超检查，病变治疗时的平均厚度为14（7～28）mm，治疗1个月后为10 （5～23）mm，差异显著。在眶州受累的患儿，用药8周后，散光和弱势均快速消失。总体耐受性良好，血液动力学未见明显改变。证实心得安是治疗婴幼儿血管瘤安全有效的方法，耐受性良好，可作为IH的一线治疗。

Schiestl C, Neuhaus K, Zoller S, Subotic U, Forster-Kuebler I, Michels R, Balmer C, Weibel L. Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas. Eur J Pediatr. 2011 Apr;170(4):493-501.

Division of Plastic Surgery, University Children's Hospital Zurich, Zurich, Switzerland.

Beta-blockers are a highly promising treatment modality for complicated infantile hemangiomas (IH). However, data on propranolol as first-line treatment, objective outcome measures and impact on hemodynamics in young infants is limited. We retrospectively evaluated a homogenous group of infants with proliferating complicated IH treated with propranolol (2 mg/kg/day). Outcome was assessed by blinded evaluation of clinical photographs by visual analogue scale (VAS), ultrasound examination and ophthalmological review (if appropriate). Tolerance and hemodynamic variables were recorded over time, including a 2-day in-patient observation at the initiation of therapy. Twenty-five infants (median age 3.6 (1.5-9.1) months) were included in the study. The median follow-up-time was 14 (9-20) months and 14 patients completed treatment at a median age of 14.3 (11.4-22.1) months, after a duration of 10.5 (7.5-16) months. In all patients, there was significant fading of colour (with a VAS of -9 (-6 to -9) after 7 months) and significant decrease in size of the IH (with a VAS of -8 (-3 to -10) after 7 months). Median thickness of the lesions assessed by ultrasound at baseline and after 1 month was 14 (7-28) mm and 10 (5-23) mm, respectively (p < 0.01). In children with periocular involvement, astigmatism and amblyopia resolved rapidly within 8 weeks. The overall tolerance of propranolol was good, and no relevant hemodynamic changes were noted. CONCLUSION: Our report supports the excellent effect and good tolerance of this novel therapy, and we propose the use of propranolol as first-line treatment for IH.

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