Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington 98105-0371, USA.
Otolaryngol Head Neck Surg. 2011 Jan;144(1):78-84. doi: 10.1177/0194599810390445.
To outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas.
Retrospective review.
Academic tertiary care pediatric hospital.
Forty-nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3-hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting.
Outpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3-hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure.
In most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues.
概述门诊起始普萘洛尔治疗婴儿血管瘤的安全、标准化方案。
回顾性研究。
学术性三级保健儿科医院。
49 例婴儿血管瘤患者接受普萘洛尔治疗并纳入研究。排除需要住院的患者。筛选包括心脏病学评估，包括心电图和有指征时的超声心动图。目标起始剂量为 2 至 3mg/kg/d，分为 3 次剂量。初始给药后，在诊所基线时、1 小时和 2 小时监测血压和心率。后来又增加了 3 小时的时间点。向患者家属提供有关家庭心率监测、副作用和禁食的标准化说明。
44 例患者中的 39 例（89%）安全地在门诊开始普萘洛尔治疗。5 例患者需要短暂入院：1 例有心力衰竭的临床体征/症状，3 例有气道受累，1 例因社会原因。普萘洛尔给药会短暂降低血压；最大降幅出现在 2 小时，促使增加 3 小时的时间点以确保恢复。没有患者出现症状性低血压、心动过缓或心力衰竭。
在大多数患有婴儿血管瘤的儿童中，普萘洛尔治疗可以作为门诊治疗安全启动。经验丰富的临床医生进行仔细的心血管评估对于治疗前评估、住院（必要时）、初始给药后血压和心率监测以及家长教育至关重要。与住院策略相比，这种标准化的多学科门诊启动计划降低了开始治疗的成本，同时仍为潜在治疗并发症提供了适当的监测。正在进一步评估当前剂量和治疗持续时间的普萘洛尔治疗效果。
