平阳霉素联合普萘洛尔治疗小儿血管瘤及血管畸形的疗效观察及安全性评价

发布时间：2018-06-15 10:45

  本文选题：血管瘤/治疗 + 平阳霉素　； 参考：《郑州大学》2014年硕士论文

【摘要】：背景和目的 血管瘤及血管畸形是一种先天性脉管发育异常，病理学属于错构瘤而非真性肿瘤，近20年来对血管瘤及血管畸形的病因、病理、分类及诊断进行深入研究，临床疗效显著提高。血管瘤是儿童常见病，发病率为2.5%-12%，新生儿期发病率为1.1%-2.6%，女性发病率高，男女之间比例约为1:2-1:5。出生体重小于1000g的超低出生体重儿发病率可高达30%。不同种族的血管瘤发病率差异不显著，血管瘤可发生在全身各个部位，15%-30%患儿为多发性。 我们通过临床向血管畸形及血管瘤内注射平阳霉素、地塞米松混合剂联合口服普萘洛尔，观察治疗小儿特殊部位血管瘤及血管畸形的临床疗效并对其安全性进行评价。 对象和方法 对我院2012年06月至2013年06月所收治的38例血管畸形及特殊部位难治性血管瘤进行临床和超声评估，住院后用平阳霉素、地塞米松混合剂采取全麻状态下瘤内注射治疗，一次未愈间隔6周后再次治疗，平阳霉素每次用量不超过8mg、每公斤体重不大于1mg；同时普萘洛尔1mg/kg次日早晨10：00顿服，于用药后1小时、3小时、6小时监测心率，6小时后每6小时监测心率。住院观察1周，出院后继续口服普萘洛尔3～6个月。每半月至我院门诊观察瘤体变化。总体随访3～８个月。 结果 所有患儿在完善相关检查后，行局部瘤体药物注射，注射后24小时后血管瘤颜色和质地显示出即时效果，口服普萘洛尔2月后复查超声提示血管瘤最大厚度平均缩小66.7％，，均未见严重不良反应。采用Achauer[1]分级标准评价疗效，I级1例（2.6％），Ⅱ级9例（23.7％），III级21例（55.3％），疗效IV级7例（18.4％）。 结论 平阳霉素、地塞米松混合剂联合口服普萘洛尔具有快速的治疗效果，部分血管畸形可得到缓解甚至治愈，能够较大程度缩短部分血管瘤自然进程，疗效确切、创伤小、不良反应轻微，可作为婴幼儿特殊部位血管瘤快速增长期及血管畸形的临床一线治疗方法。 数据处理 应用SPSS17.0统计软件进行结果统计分析，实验数据以x±s表示，采用非参数秩和检验（Kruskal-Wallis检验），两两比较Bonferroni法，P0.05为差异有显著性意义。
[Abstract]:Background and objective hemangioma and vascular malformation are congenital vascular dysplasia. Pathology is a hamartoma rather than a true tumor. The etiology and pathology of hemangioma and vascular malformation in recent 20 years. Classification and diagnosis of the in-depth study, the clinical efficacy significantly improved. Hemangioma is a common disease in children, the incidence is 2.5-12, the incidence of neonatal stage is 1.1-2.6, the incidence of female is high, the ratio between male and female is about 1: 2-1: 5. The incidence of ultra low birth weight infants with birth weight less than 1000 g can be as high as 30. There was no significant difference in the incidence of hemangioma among different races, and 15-30% of the children had multiple hemangiomas in all parts of the body. The clinical efficacy of pingyangmycin and dexamethasone combined with oral propranolol in the treatment of hemangioma and vascular malformation in children with special site was observed and the safety was evaluated through clinical injection of pingyangmycin and dexamethasone combined with oral propranolol. Participants and methods 38 cases of vascular malformation and refractory hemangioma in special position were evaluated by clinical and ultrasonic methods. Pingyangmycin was used after hospitalization. Dexamethasone mixture was treated by intratumoral injection under general anesthesia and was treated again at intervals of 6 weeks. The dosage of pingyangmycin was not more than 8 mg per kilogram, and the weight of propranolol 1mg/kg was taken at 10:00 the next morning. Heart rate was monitored every 6 hours after 1 hour, 3 hours and 6 hours. After 1 week of hospitalization, propranolol was given orally for 3 ~ 6 months. Tumor changes were observed every half month to our outpatient department. The follow-up was 3 ~ 8 months. Results all the children were given local tumor drug injection after improving the relevant examination. The color and texture of hemangioma showed immediate effect 24 hours after injection. After 2 months of oral propranolol, ultrasound examination showed that the maximum thickness of hemangioma decreased by 66.7 on average, and no serious adverse reactions were observed. Achauer [1] was used to evaluate the curative effect in 1 case with grade I and 2.6T, 9 cases with grade 鈪

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