第一选择
普萘洛尔
:
2-3mg/kg/d，分2-3次口服
或
噻吗洛尔滴眼液
:
（0.5% 凝胶），在皮损部位涂一薄层，每日 2 次
普萘洛尔是婴幼儿血管瘤的首选全身治疗。[39]Izadpanah A, Izadpanah A, Kanevsky J, et al. Propranolol versus corticosteroids in the treatment of infantile hemangioma: a systematic review and meta-analysis. Plast Reconstr Surg. 2013 Mar;131(3):601-13.http://www.ncbi.nlm.nih.gov/pubmed/23142941?tool=bestpractice.com 已经证实该药对处于功能或外观重要位置的血管瘤有效，[43]Zaher H, Rasheed H, Hegazy RA, et al. Oral propranolol: an effective, safe treatment for infantile hemangiomas. Eur J Dermatol. 2011 Jul-Aug;21(4):558-63.http://www.ncbi.nlm.nih.gov/pubmed/21697036?tool=bestpractice.com[44]Fuchsmann C, Quintal MC, Giguere C, et al. Propranolol as first-line treatment of head and neck hemangiomas. Arch Otolaryngol Head Neck Surg. 2011 May;137(5):471-8.http://www.ncbi.nlm.nih.gov/pubmed/21576558?tool=bestpractice.com[45]Missoi TG, Lueder GT, Gilbertson K, et al. Oral propranolol for treatment of periocular infantile hemangiomas. Arch Ophthalmol. 2011 Jul;129(7):899-903.http://www.ncbi.nlm.nih.gov/pubmed/21402978?tool=bestpractice.com 气道血管瘤、[46]Peridis S, Pilgrim G, Athanasopoulos I, et al. A meta-analysis on the effectiveness of propranolol for the treatment of infantile airway haemangiomas. Int J Pediatr Otorhinolaryngol. 2011 Apr;75(4):455-60.http://www.ncbi.nlm.nih.gov/pubmed/21333364?tool=bestpractice.com 溃疡性血管瘤[47]Hong E, Fischer G. Propranolol for recalcitrant ulcerated hemangioma of infancy. Pediatr Dermatol. Pediatr Dermatol. 2012 Jan-Feb;29(1):64-7.http://www.ncbi.nlm.nih.gov/pubmed/21854419?tool=bestpractice.com 和内脏血管瘤。[48]Mazereeuw-Hautier J, Hoeger PH, Benlahrech S, et al. Efficacy of propranolol in hepatic infantile hemangiomas with diffuse neonatal hemangiomatosis. J Pediatr. 2010 Aug;157(2):340-2.http://www.ncbi.nlm.nih.gov/pubmed/20488455?tool=bestpractice.com
目前已经发现，停药后会出现病变反跳性生长，[49]Marqueling AL, Oza V, Frieden IJ, et al. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol. 2013 Mar-Apr;30(2):182-91.http://www.ncbi.nlm.nih.gov/pubmed/23405852?tool=bestpractice.com 所以治疗常常持续到理论消退时间或 12 个月左右。
普萘洛尔治疗的绝对禁忌证包括某些传导障碍，例如病窦综合征或二、三度房室 (AV) 传导阻滞。相对禁忌证包括心脏功能损伤、窦性心动过缓、低血压、一度房室传导阻滞、哮喘或支气管高反应性、糖尿病、慢性肾功能不全。[50]de Graaf M, Breur JM, Raphael MF, et al. Adverse effects of propranolol when used in the treatment of hemangiomas: A case series of 28 infants. J Am Acad Dermatol. 2011 Aug;65(2):320-7.http://www.ncbi.nlm.nih.gov/pubmed/21601311?tool=bestpractice.com 在患有 PHACES 综合征的情况下，慎用普萘洛尔，因为在理论上，普萘洛尔引起的低血压可以使已经微弱的脑灌注进一步下降。[52]Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009 Sep-Oct;26(5):610-4.http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1470.2009.00975.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19840322?tool=bestpractice.com
全身皮质类固醇治疗仍偶尔用来代替 β 受体阻滞剂，以治疗婴幼儿血管瘤。[56]Pope E, Krafchik BR, Macarthur C, et al. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics. 2007 Jun;119(6):e1239-47.http://www.ncbi.nlm.nih.gov/pubmed/17485449?tool=bestpractice.com血管瘤体积减小：一项包含75例患者的小型临床试验提供了中等质量的证据，该研究经全身性或病灶内给予皮质类固醇对婴幼儿血管瘤进行治疗；试验结果显示，与安慰剂相比，全身性或病灶内给予皮质类固醇治疗对缩小血管瘤体积的疗效显著且并发症极少。[57]Jalil S, Akhtar J, Ahmed S. Corticosteroids therapy in the management of infantile cutaneous hemangioma. J Coll Physicians Surg Pak. 2006 Oct;16(10):662-5.http://www.ncbi.nlm.nih.gov/pubmed/17007757?tool=bestpractice.com受试者＜200名的随机对照临床试验（RCT）、受试者＞200名且方法学存在缺陷的随机对照临床试验（RCT）、方法学存在缺陷的系统评价或者高质量的观察性（队列）研究。 根据患者的反应和年龄，预期治疗时间可能持续 6-12 个月。
除 β-受体阻滞剂之外，全身皮质类固醇治疗也可作为辅助治疗。[56]Pope E, Krafchik BR, Macarthur C, et al. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics. 2007 Jun;119(6):e1239-47.http://www.ncbi.nlm.nih.gov/pubmed/17485449?tool=bestpractice.com 同样，治疗的预期持续时间为 6-12 个月。
目前已发现减少口服皮质类固醇时，血管瘤会反跳性生长，因此需要密切的临床随访。[2]Garzon MC. Infantile hemangioma. In: Callen JP, Horn TD, Mancini AJ, et al, eds. Dermatology. Vol. 2. 2nd ed. St. Louis, MO: Elsevier; 2008:1565-80.[16]Bruckner AL, Friedan IJ. Hemangiomas of infancy. J Am Acad Dermatol. 2003 Apr;48(4):477-93.http://www.ncbi.nlm.nih.gov/pubmed/12664009?tool=bestpractice.com[58]Rossler J, Wehl G, Niemeyer CM. Evaluating systemic prednisone therapy for proliferating haemangioma in infancy. Eur J Pediatr. 2008 Jul;167(7):813-5.http://www.ncbi.nlm.nih.gov/pubmed/17676341?tool=bestpractice.com[59]Bennett ML, Fleischer AB Jr., Chamlin SL, et al. Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol. 2001 Sep;137(9):1208-13.http://www.ncbi.nlm.nih.gov/pubmed/11559219?tool=bestpractice.com
局部应用β-受体阻滞剂有助于治疗浅表婴幼儿血管瘤。[53]Ni N, Langer P, Wagner R, et al. Topical timolol for periocular hemangioma: report of further study. Arch Ophthalmol. 2011 Mar;129(3):377-9.http://www.ncbi.nlm.nih.gov/pubmed/21403002?tool=bestpractice.com[54]Pope E, Chakkittakandiyil A. Topical timolol gel for infantile hemangiomas: a pilot study. Arch Dermatol. 2010 May;146(5):564-5.http://jamanetwork.com/journals/jamadermatology/fullarticle/421304http://www.ncbi.nlm.nih.gov/pubmed/20479314?tool=bestpractice.com 当没有必要进行全身治疗或有禁忌时，可以考虑该治疗。
如果血管瘤较为局限且未扩展至深层组织，病灶内皮质类固醇则是一个额外的治疗选择。一般来说，病灶内治疗的间隔约 1 个月。虽然曲安西龙是典型用药，但是也有其他多种皮质类固醇用于治疗。[62]Chantharatanapiboon W. Intralesional corticosteroid therapy in hemangiomas: clinical outcome in 160 cases. J Med Assoc Thai. 2008 Oct;91(suppl 3):S90-6.http://www.ncbi.nlm.nih.gov/pubmed/19253502?tool=bestpractice.com 在大多数病例中，口服皮质类固醇的全身性不良反应是可以避免的。[63]Chen MT, Yeong EK, Horng SY. Intralesional corticosteroid therapy in proliferating head and neck hemangiomas: a review of 155 cases. J Pediatr Surg. 2000 Mar;35(3):420-3.http://www.ncbi.nlm.nih.gov/pubmed/10726680?tool=bestpractice.com[64]Buckmiller LM, Francis CL, Glade RS. Intralesional steroid injection for proliferative parotid hemangiomas. Int J Pediatr Otorhinolaryngol. 2008 Jan;72(1):81-7.http://www.ncbi.nlm.nih.gov/pubmed/18054392?tool=bestpractice.com
