本文選題：血管瘤/治療 + 平陽霉素��； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景和目的 血管瘤及血管畸形是一種先天性脈管發(fā)育異常，病理學(xué)屬于錯構(gòu)瘤而非真性腫瘤，近20年來對血管瘤及血管畸形的病因、病理、分類及診斷進(jìn)行深入研究，臨床療效顯著提高。血管瘤是兒童常見病，發(fā)病率為2.5%-12%，新生兒期發(fā)病率為1.1%-2.6%，女性發(fā)病率高，男女之間比例約為1:2-1:5。出生體重小于1000g的超低出生體重兒發(fā)病率可高達(dá)30%。不同種族的血管瘤發(fā)病率差異不顯著，血管瘤可發(fā)生在全身各個部位，15%-30%患兒為多發(fā)性。 我們通過臨床向血管畸形及血管瘤內(nèi)注射平陽霉素、地塞米松混合劑聯(lián)合口服普萘洛爾，觀察治療小兒特殊部位血管瘤及血管畸形的臨床療效并對其安全性進(jìn)行評價。 對象和方法 對我院2012年06月至2013年06月所收治的38例血管畸形及特殊部位難治性血管瘤進(jìn)行臨床和超聲評估，住院后用平陽霉素、地塞米松混合劑采取全麻狀態(tài)下瘤內(nèi)注射治療，一次未愈間隔6周后再次治療，平陽霉素每次用量不超過8mg、每公斤體重不大于1mg；同時普萘洛爾1mg/kg次日早晨10：00頓服，于用藥后1小時、3小時、6小時監(jiān)測心率，6小時后每6小時監(jiān)測心率。住院觀察1周，出院后繼續(xù)口服普萘洛爾3～6個月。每半月至我院門診觀察瘤體變化�？傮w隨訪3～８個月。 結(jié)果 所有患兒在完善相關(guān)檢查后，行局部瘤體藥物注射，注射后24小時后血管瘤顏色和質(zhì)地顯示出即時效果，口服普萘洛爾2月后復(fù)查超聲提示血管瘤最大厚度平均縮小66.7％，，均未見嚴(yán)重不良反應(yīng)。采用Achauer[1]分級標(biāo)準(zhǔn)評價療效，I級1例（2.6％），Ⅱ級9例（23.7％），III級21例（55.3％），療效IV級7例（18.4％）。 結(jié)論 平陽霉素、地塞米松混合劑聯(lián)合口服普萘洛爾具有快速的治療效果，部分血管畸形可得到緩解甚至治愈，能夠較大程度縮短部分血管瘤自然進(jìn)程，療效確切、創(chuàng)傷小、不良反應(yīng)輕微，可作為嬰幼兒特殊部位血管瘤快速增長期及血管畸形的臨床一線治療方法。 數(shù)據(jù)處理 應(yīng)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行結(jié)果統(tǒng)計(jì)分析，實(shí)驗(yàn)數(shù)據(jù)以x±s表示，采用非參數(shù)秩和檢驗(yàn)（Kruskal-Wallis檢驗(yàn)），兩兩比較Bonferroni法，P0.05為差異有顯著性意義。
[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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