Department of Otolaryngology, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA.
Laryngoscope. 2010 Apr;120(4):676-81. doi: 10.1002/lary.20807.
OBJECTIVES/HYPOTHESIS: Propranolol has recently been introduced as a novel pharmacologic treatment for infantile hemangiomas. Systematic examination of this treatment in a tertiary care setting has not been described. This study explores the impact of propranolol on both proliferative and involuting hemangiomas at a tertiary vascular anomalies center.
Retrospective single institution review.
We reviewed children treated with propranolol for problematic hemangiomas followed by a blinded prospective analysis of serial photographs taken during the course of their therapy. Parental questionnaires were obtained to evaluate perceived therapeutic response and complications to oral propranolol.
Thirty-two children with complete photo documentation were treated with oral propranolol for infantile hemangiomas between September 2008 and June 2009. Twenty-seven patients began therapy during the proliferative phase of their lesions (mean age, 4.9 months), whereas five patients began during the involutional phase (mean age, 19.4 months). Ninety-seven percent of patients displayed improvement in the quality of their hemangiomas during propranolol therapy. Patients were determined to be excellent responders (n = 16, 50%), partial responders (n = 15, 47%), or nonresponders (n = 1, 3%). Partial and nonresponders received adjuvant therapy (75%, laser therapy; 31%, steroid injections). Ten patients experienced minor but reportable side effects to propranolol, including somnolence (27.2%), gastroesophageal reflux (9.1%), respiratory syncytial virus exacerbation (4.5%), and rash (4.5%).
Propranolol may revolutionize the treatment of problematic hemangiomas that cause imminent functional or cosmetic sequelae. At therapeutic doses, propranolol is safe and effective in the majority of patients. Adjunctive therapies may still be required. Minor side effects, expected from beta-blocker therapy, are common but easily managed.
目的/假设：普萘洛尔最近被引入作为一种治疗婴儿血管瘤的新型药物。在三级保健机构中对这种治疗方法的系统检查尚未描述。本研究在一个三级血管畸形中心探讨了普萘洛尔对增殖期和消退期血管瘤的影响。
回顾性单机构研究。
我们回顾了在我们的中心接受普萘洛尔治疗的有问题的血管瘤的儿童，并对其治疗过程中的系列照片进行了盲法前瞻性分析。通过问卷调查获得了父母对口服普萘洛尔治疗的疗效和不良反应的评价。
2008 年 9 月至 2009 年 6 月，32 例有完整照片记录的儿童接受了口服普萘洛尔治疗婴儿血管瘤。27 例患者在病变增殖期开始治疗（平均年龄 4.9 个月），5 例患者在消退期开始治疗（平均年龄 19.4 个月）。97%的患者在普萘洛尔治疗期间血管瘤的质量得到改善。根据疗效，患者分为完全缓解（16 例，50%）、部分缓解（15 例，47%）和无缓解（1 例，3%）。部分缓解和无缓解的患者接受了辅助治疗（75%，激光治疗；31%，皮质激素注射）。10 例患者出现了轻微但可报告的普萘洛尔不良反应，包括嗜睡（27.2%）、胃食管反流（9.1%）、呼吸道合胞病毒加重（4.5%）和皮疹（4.5%）。
普萘洛尔可能会彻底改变那些导致即将出现功能或美容后遗症的有问题的血管瘤的治疗方法。在治疗剂量下，普萘洛尔对大多数患者安全有效。可能仍需要辅助治疗。从β受体阻滞剂治疗中预期的轻微副作用是常见的，但易于管理。
