Propranolol as First-line Treatment of Head and Neck Hemangiomas
Propranolol as First-line Treatment of Head and Neck Hemangiomas
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DOI：
10.1001/archoto.2011.55
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发表时间：
2011-05-01
影响因子：
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通讯作者：
Froehlich, Patrick
中科院分区：
文献类型：
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作者：
Fuchsmann, Carine;Quintal, Marie-Claude;Froehlich, Patrick
目的：报告普萘洛尔作为儿童头颈部血管瘤一线治疗的疗效，并提出一种治疗血管瘤的优化方案。设计：多机构回顾性研究。设置：两个三级护理转诊儿科中心。患者：39名儿童头颈部婴儿血管瘤接受治疗。主要结果测量：回顾临床记录。结果：普萘洛尔是60%患者的唯一治疗，39例患者中有33例在平均4.1个月（年龄范围，1-11个月）时开始早期干预。普萘洛尔治疗导致39个部位中的37个部位的血管瘤在2天至2周内减轻和减少。1例声门下血管瘤和1例鼻尖血管瘤没有反应或仅显示部分反应;在这些患者中，普萘洛尔治疗延迟，随后出现其他治疗失败。在成功的治疗回归后，6例复发;当重新引入普萘洛尔时，普萘洛尔再次有效。长期治疗可避免复发。26例血管瘤发生在以前不会开始皮质类固醇治疗的部位（鼻、唇和腮腺区域），除非发生并发症，否则用普萘洛尔治疗并迅速控制。普萘洛尔治疗的平均持续时间为8.5个月。没有实例的β受体阻滞剂停药，因为并发症发生，但普萘洛尔代替醋丁洛尔在5例患者，因为sleeping.Conclusions：普萘洛尔是一种有效的治疗头部和颈部婴儿血管瘤，特别是当开始早期的快速增长阶段，是第一线治疗眼眶和喉血管瘤。普萘洛尔的有效性和耐受性使我们能够治疗一些血管瘤患者，而这些患者是我们以前观察到的，而不是接受皮质类固醇治疗的。如果在理论退化（年龄12个月）后延长治疗，则可避免复发。关于最佳剂量和停止治疗时的年龄仍存在问题。
Objectives: To report the efficacy of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas.Design: Multi-institutional retrospective study.Setting: Two tertiary care referral pediatric centers.Patients: Thirty-nine children with head and neck infantile hemangiomas were treated.Main Outcome Measures: Review of clinical records.Results: Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of beta-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping.Conclusions: Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patients whom we previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation.