关键词: 深层血管瘤, 阶梯治疗方案, 混合型血管瘤, 普萘洛尔

Abstract: Objective: To treat the mixed and deeper infantile hemangiomawith "ladder dosage"propranolol, and to explore its efficacy and safety.Methods: A total of 98 infants with hemangioma were treated by ladder treatment of propranolol. Before treatment,comprehensive assessments of electrocardiogram(ECG),heart color ultrasound, blood glucose,liver function,kidney function,myocardial enzymes and blood routine were conducted. After excluding contraindications,the dose of propranolol incrementally doubled from 0.5 mg·kg^-1·d^-1 to 4.0 mg·kg^-1·d^-1. Propranolol was taken 3 times a day. Before and after medication for 1 and 2 h,ECG was monitored. The changes of tumor size,texture,color and other changes or an onset of adverse reactions were dynamicly observed.The infants were visited every month.The efficacy was evaluated using Achauer system.Results: After medication,98 cases had different degrees of color changes or tumor consistency softening. After the dosage of propranolol was increased to 4.0 mg·kg^-1·d^-1,the change of tumor was the fastest. According to the 4-grade method, there were 84 cases(85.71%) as gradeⅣ (excellent),2 cases (2.04%) as grade Ⅲ (good),4 cases (4.08%) as gradeⅡ (medium)and 8 cases (8.16%) as gradeⅠ (poor).The curative effect of mixed hemangioma was better than that of deeper hemangioma(P<0.05). The recovery time of 74 cases of hemangiomas was 6 months. The major adverse reactions were heart rate decline(5/98,5.10%),drowsiness(3/98,3.06%),diarrhea(7/98,7.14%),loss of appetite (1/98,1.02%), and convulsions (2/98,2.04%).After treatment,all adverse reactions disappeared. Two months after drug withdrawal there were 4 cases of recurrence,and they were continously treated with propranolol.Conclusion: The efficacy of oral "ladder dosage" propranolol in treatment of mixed and deeper infantile hemangioma is increased significantly and there are no significant adverse reactions.

Key words: ladder dosage, mixed hemangioma, propranolol, deeper hemangioma