Ainipully Arun Mohanan, Narayanan Sarath Kumar, Vazhiyodan Arun Preeth, Somnath Prathap
Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India.
J Indian Assoc Pediatr Surg. 2019 Jul-Sep;24(3):170-175. doi: 10.4103/jiaps.JIAPS_12_18.
The primary treatment for the subset of infantile hemangiomas (IHs) which develops complication is pharmacological intervention, and propranolol has become a popular choice. Here, we evaluated the efficacy and safety of propranolol in a clinical cohort of IHs and analyzed clinical characteristics associated with a good outcome.
We retrospectively reviewed a total of 52 IHs patients, between ages 1 and 48 months (median age: 7.5 months), who were treated with oral propranolol, with dose ranging from 2 to 3 mg/kg/day. Efficacy was evaluated using mean percentage reduction, visual analog scale (VAS), and parental satisfaction levels at week 2 and months 1, 2, 6, and 12. The adverse effects were noted and responses after 6 months were graded. Statistical analyses of the outcome were also performed for the responses with regard to age at propranolol initiation, site of lesion, and mean duration of treatment.
A therapeutic response with at least 50% mean percentage reduction in size was noted in 84.6% at the end of 6 months. VAS score and parental satisfaction levels correlated well with mean percentage reduction (63.7 ± 15.6) at 6 months. Patients aged <6 months and those with cephalic lesions exhibited a greater therapeutic response rate with shorter overall mean duration of the treatment.
Oral propranolol at 2-3 mg/kg/day dosing has shown to be effective and safe for IHs in pediatric age group. Intervention in the early proliferative phase, with especially, the cephalic lesions result in better resolution rates with shorter duration of overall treatment.
对于出现并发症的婴儿血管瘤(IHs)子集,主要治疗方法是药物干预,而普萘洛尔已成为一种常用选择。在此,我们评估了普萘洛尔在一组IHs临床队列中的疗效和安全性,并分析了与良好预后相关的临床特征。
我们回顾性分析了总共52例年龄在1至48个月(中位年龄:7.5个月)之间接受口服普萘洛尔治疗的IHs患者,剂量范围为2至3毫克/千克/天。使用平均缩小百分比、视觉模拟量表(VAS)以及在第2周和第1、2、6、12个月时家长的满意度来评估疗效。记录不良反应,并对6个月后的反应进行分级。还针对普萘洛尔开始治疗时的年龄、病变部位和平均治疗持续时间对结果进行了统计学分析。
在6个月末,84.6%的患者出现了至少50%的平均大小缩小的治疗反应。VAS评分和家长满意度水平与6个月时的平均缩小百分比(63.7±15.6)密切相关。年龄小于6个月的患者以及头部有病变的患者表现出更高的治疗反应率,且总体平均治疗持续时间更短。
每天2 - 3毫克/千克剂量的口服普萘洛尔已被证明对儿童年龄组的IHs有效且安全。在早期增殖期进行干预,尤其是对于头部病变,可使治愈率更高,总体治疗持续时间更短。