Centre for the Study & Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
J Plast Reconstr Aesthet Surg. 2011 Mar;64(3):292-9. doi: 10.1016/j.bjps.2010.06.010. Epub 2010 Jul 7.
In 2008, propranolol was serendipitously observed to cause accelerated involution of infantile haemangioma. However, the mechanism by which it causes this dramatic effect is unknown, the dosage empirical and the optimal duration of treatment unexplored. This study determines the minimal dosage and duration of propranolol treatment to achieve accelerated involution of problematic infantile haemangioma. Consecutive patients with problematic proliferating infantile haemangioma treated with propranolol were culled from our prospective vascular anomalies database. The patients were initially managed as inpatients and commenced on propranolol at 0.25 mg kg(-1) twice daily, and closely monitored. The dosage was increased to 0.5 mg kg(-1) twice daily after 24 h, if there was no cardiovascular or metabolic side effect. The dosage was increased further by 0.5 mg kg(-1) day(-1) until a visible effect was noticed or up to a maximum of 2 mg kg(-1) day(-1), and was maintained until the lesion had fully involuted or the child was 12-months old. A total of 15 patients aged 3 weeks to 8.5 months (mean, 11 weeks) underwent propranolol treatment for problematic proliferating infantile haemangioma, which threatened life (n=1) or vision (n=2) or nasal obstruction (n=3) and/or caused ulceration (n=6) and/or bleeding (n=2) and/or significant tissue distortion (n=12). The minimal dosage required to achieve accelerated involution was 1.5-2.0 mg kg(-1) day(-1). Rebound growth occurred in the first patient when the dose was withdrawn at 7.5 months of age requiring reinstitution of treatment. No rebound growth was observed in the remaining patients. No other complications were observed. Propranolol at 1.5-2.0 mg kg(-1) day(-1), administered in divided doses with gradual increase in the dose, is effective and safe for treating problematic proliferating infantile haemangioma in our cohort of patients. Treatment should be maintained until the lesion is completely involuted or the child is 12-months old. Larger scale studies confirming the safety and efficacy of propranolol may broaden the indications of treatment of proliferating infantile haemangioma.
2008 年，人们偶然发现普萘洛尔可加速婴儿血管瘤的退化。然而，其引起这种显著效果的机制尚不清楚，剂量是经验性的，治疗的最佳持续时间也尚未探索。本研究旨在确定普萘洛尔治疗以加速消退有问题的婴儿血管瘤所需的最小剂量和持续时间。从我们的前瞻性血管异常数据库中提取出接受普萘洛尔治疗的有问题的增殖性婴儿血管瘤的连续患者。这些患者最初作为住院患者进行管理，并以 0.25mg/kg 体重，每日两次的初始剂量开始接受普萘洛尔治疗，并密切监测。如果没有心血管或代谢副作用，24 小时后将剂量增加至 0.5mg/kg 体重，每日两次。如果需要，进一步将剂量每天增加 0.5mg/kg 体重，直到观察到明显效果或达到最大 2mg/kg 体重/天，并维持该剂量直至病变完全消退或患儿满 12 个月。共有 15 名年龄在 3 周至 8.5 个月（平均 11 周）的患者因有问题的增殖性婴儿血管瘤接受了普萘洛尔治疗，这些患者的病变威胁生命（n=1）或视力（n=2），或引起鼻阻塞（n=3）和/或溃疡（n=6）和/或出血（n=2）和/或明显组织变形（n=12）。实现加速消退所需的最小剂量为 1.5-2.0mg/kg 体重/天。当在 7.5 个月龄时停用该药物时，第一例患者出现反弹生长，需要重新开始治疗。其余患者未观察到反弹生长。未观察到其他并发症。在本患者队列中，普萘洛尔以 1.5-2.0mg/kg 体重/天的剂量，分剂量给药，并逐渐增加剂量，对于治疗有问题的增殖性婴儿血管瘤是有效且安全的。治疗应持续至病变完全消退或患儿满 12 个月。更大规模的研究确认普萘洛尔的安全性和疗效可能会扩大增殖性婴儿血管瘤治疗的适应证。
