婴幼儿血管瘤患者口服小剂量普萘洛尔前后动态心电图的比较

Changes in ambulatory electrocardiographic findings after oral administration of low-dose propranolol in infants with hemangioma

摘要:

目的 探讨口服小剂量普萘洛尔在治疗婴幼儿血管瘤过程中对患儿心率变异性(HRV)、心率加速力(AC)、心率减速力(DC)以及心脏传导功能等方面的影响.方法 对118 例1 岁以内血管瘤患儿口服小剂量普萘洛尔[1 mg/(kg · d)] 治疗前及治疗1 个月后行24 h 动态心电图检查,观察治疗后HRV 时域指标[RR间期总体标准差(SDNN)、RR 间期平均值的标准差(SDANN)、相邻RR 间期差值的均方根(RMSSD)、NN50 占所有NN 间期个数的百分数(PNN50)] 与频域指标[ 低频功率(LF)、高频功率(HF)]、AC、DC 的变化,同时观察治疗后有无心脏传导功能及其他方面的异常.结果 普萘洛尔治疗后SDNN、RMSSD、LF、HF、PNN50 均大于治疗前(P<0.01);治疗后AC、平均心率(HR)、最慢心率均小于治疗前(P<0.01).治疗后24 h 动态心电图结果异常比例高于治疗前,但差异无统计学意义.结论 普萘洛尔治疗婴幼儿血管瘤可抑制交感神经活性,使心脏传导功能受阻,但不会造成严重不良后果.

Abstract:

Objective To investigate the effects of oral administration of low-dose propranolol on heart rate variability (HRV), acceleration capacity (AC), deceleration capacity (DC), and cardiac conduction in the treatment of infantile hemangioma. Methods A total of 118 infants with hemangioma (≤1 year) were enrolled, and 24-hour ambulatory electrocardiography was performed before oral administration of low-dose propranolol and after one month of administration. The changes in time-domain indices [standard deviation of all normal sinus RR intervals (SDNN), standard deviation of all mean 5-minute RR intervals (SDANN), root mean squared successive difference (RMSSD), and percentage of successive normal sinus RR intervals >50 ms (PNN50)] and frequency-domain indices [low frequency (LF) and high frequency (HF)] for HRV, AC, and DC were observed, as well as abnormalities in cardiac conduction and other aspects after administration of propranolol. Results After administration of propranolol, the infants had significantly increased SDNN, RMSSD, LF, HF, and PNN50 (P<0.01), and significantly reduced AC, mean heart rate (HR) and minimum HR (P<0.01). The 24-hour ambulatory electrocardiographic findings showed a nonsignificantly higher abnormal rate after administration of propranolol. Conclusions In the treatment of infantile hemangioma, propranolol can inhibit the activity of sympathetic nerve and block cardiac conduction, but without any serious adverse effect.