【摘要】 目的探讨"阶梯加量"口服普萘洛尔治疗婴幼儿血管瘤的疗效及安全性。方法2013年12月至2014年12月,共56例血管瘤婴幼儿（共计72枚瘤体）在本院接受住院"阶梯加量"口服普萘洛尔治疗;治疗前全面评估,并行心电图、血糖、肝功能、心肌酶及血常规检查,排除禁忌症后,均给予"阶梯加量"口服普萘洛尔,剂量从0.5 mg·^-1·d^-1逐渐增加至1.5² mg·kg^-1·d^-1,每日一次性顿服,服药后予心电监测2³ h,动态观察瘤体大小、质地、颜色等变化,以及患儿有无相关不良反应,出院后定期随访,按4级评分法进行疗效评价。结果 56例患儿服药72 h内,50例出现瘤体不同程度颜色变浅或质地变软,剂量增加至1¹.5 mg·kg^-1·d^-1后的前3 d内瘤体性质变化最快。服药后随访1³个月者12例,3⁶个月者16例,6¹2个月者26例,超过12个月者2例;疗效评价:Ⅳ级（优）10例（10/56,17.86%）,Ⅲ级（好）30例（30/56,53.57%）,Ⅱ级（中）14例（14/56,25%）,Ⅰ级（差）2例（2/56,3.57%）。草莓状血管瘤的疗效优于海绵状及混合型血管瘤（P<0.05）。主要不良反应为心率减慢56例（56/56,100%）,嗜睡6例（6/56,10.7%）,腹泻3例（3/56,5.4%）,低血糖1例（1/56,1.8%）,肝功能轻度异常1例（1/56,1.8%）,给予对症处理后均恢复正常。结论 "阶梯加量"口服普萘洛尔治疗婴幼儿血管瘤疗效确切,用药时应密切注意不良反应。更多还原

【Abstract】 Objective To explore the efficacy and safety of " ladder dosage" propranolol for infantile hemangioma.Methods From December 2013 to December 2014,a total of 56 infants with hemangioma（72tumors） were treated by taking a gradually incremental dose of propranolol.Prior to treatment,comprehensive assessments of electrocardiogram（ECG）,blood glucose,liver function,myocardial enzymes and blood routine were conducted.After excluding contraindications,the dose of propranolol gradually increased from 0.5 mg·kg^-1 · d^-1 to 1.5 2 mg · kg^-1 · d^-1.Propranolol was taken once daily.After medication,ECG was monitored for 2 3 hours.Dynamic observations were made of tumor size,texture,color and other changes or an onset of adverse reactions.After discharge,regular follow-ups were performed with a 4-grade method.Results Within 72 hours after dosing,50 cases had different degrees of color change or tumor consistency softening.During the first three days after 1¹.5 mg/（kg· d）,the change of tumor was the fastest.After medications,12 cases were followed up for 1 3 months,16 for 3 6 months,26 for 6 12 months and 2 for > 12 months.According to the 4-grade method,（n = 10,17.86%） were evaluated as grade Ⅳ（excellent）,（n = 30,53.57%） grade Ⅲ（good）,（n = 14,25%） grade Ⅱ（medium） and（n = 2,3.57%） grade ⅠI（poor）.The curative effect of strawberry hemangioma was better than that of spongy/mixed type hemangioma（P < 0.05）.According to the statistics of major adverse reactions,56 cases developed bradycardia（100%）,drowsiness（n= 6,10.7%）,diarrhea（n = 3,5.4%）,glucopenia（n = 1,1.8%） and mild liver dysfunction（n = 1,1.8%）.After treatment,all adverse reactions disappeared.Conclusions The efficacy of oral "ladder dosage " propranolol is definite for infantile haemangioma.During medication,close attention should be paid to the occurrences of adverse reactions.更多还原