青蒿琥酯联合血液净化治疗凶险型恶性疟二例并文献复习

doi:10.3877/cma.j.issn.1674-1358.2016.06.022

中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (06) : 746 -748. doi: 10.3877/cma.j.issn.1674-1358.2016.06.022

病例报告

青蒿琥酯联合血液净化治疗凶险型恶性疟二例并文献复习

许晓兰¹, 邵俊¹, 林华¹, 郑瑞强¹^,^†(

)

^1. 225001　扬州市，江苏省苏北人民医院重症医学科

收稿日期:2015-07-27 出版日期:2016-12-15
通信作者: 郑瑞强

Artesunate combined with blood purification therapy for two cases of severe falciparum malaria

Xiaolan Xu¹, Jun Shao¹, Hua Lin¹, Ruiqiang Zheng¹^,^†()

^1. Department of Intensive Care Medicine, Subei People’s Hospital, Yangzhou 225001, China

Received:2015-07-27 Published:2016-12-15
Corresponding author: Ruiqiang Zheng

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目的

探讨凶险型恶性疟的临床特征及青蒿琥酯联合血液净化治疗凶险型恶性疟的疗效。

方法

对本院收治的2例凶险型恶性疟患者的临床资料、治疗经过及预后进行回顾性分析。

结果

2例凶险型恶性疟患者均为境外输入，均有明确的疫区生活居住史，均为中年男性，主要临床症状为发热，病情进展迅速，快速出现神志改变，并伴随急性肝、肾功能衰竭及休克等。经给予青蒿琥酯联合血液净化并积极对症治疗，2例患者均治愈，其中1例间断使用血液净化治疗患者遗留肾功能不全，另1例患者出院时各指标均在正常范围；长期随访2例患者均未见再燃现象。

结论

尽早诊断凶险型恶性疟，及时予以青蒿琥酯抗疟治疗的同时，早期、持续行血液净化治疗，并及时予以对症治疗，有利于凶险型恶性疟的预后。

关键词: 青蒿琥酯, 血液净化, 凶险型恶性疟, 急性肾功能衰竭

Objective

To investigate the characteristics of severe falciparum malaria and the effect of artesunate combined with blood purification for severe falciparum malaria.

Methods

The clinical data, treatment and prognosis of 2 cases with severe falciparum malaria were analyzed, retrospectively.

Results

Both cases with severe falciparum malaria cases were overseas input, and both had a clear life history of endemic falciparum malaria area. Both cases were middle-aged men, the main clinical symptom was fever. The conditions of both patients developed rapidly. They occurred consciousness soon, and accompanied by acute liver function, renal function failure and shock. Both cases with severe falciparum malaria were cured by artesunate combined with blood purification. Long-term follow-up indicated that neither of them recrudesced with malaria.

Conclusions

Early diagnosis of severe falciparum malaria, timely artesunate antimalarial treatment, early and continuous blood purification, and timely symptomatic treatment, may improve the prognosis for severe falciparum malaria.

Key words: Artesunate, Blood purification, Severe falciparum malaria, Acute renal failure

1	杨绍基，任红主编. 传染病学[M]. 7版. 北京: 人民卫生出版社,2008,267-274.
2	World Health Organization. Guidelines for the Treatment of Malaria. 3rd edition[EB/OL]. Geneva,2015. URL
3	Krisher LK, Krisher J, Ambuludi M, et al. Successful malaria elimination in the Ecuador-Peru border region: epidemiology and lessons learned[J]. Malar J,2016,15(1):573.
4	张锁才，邵幼林，陈国春, 等. 恶性疟疾40例临床表现和血液生化学分析[J]. 中华临床感染病杂志,2012,5(6):371-372.
5	Dondorp AM, Fairhurst RM, Slutsker L, et al. The threat of artemisinin-resistant malaria[J]. N Engl J Med,2011,365(12):1073-1075.
6	Askling HH, Bruneel F, Burchard G, et al. Management of imported malaria in Europe[J]. Malar J,2012,11(1):328.
7	Noor AM, Kinyoki DK, Mundia CW, et al. The changing risk of Plasmodium falciparum malaria infection in Africa: 2000-10: a spatial and temporal analysis of transmission intensity[J]. Lancet,2014,383(9930):1739-1747.
8	黄兰智. 注射用青蒿琥酯治疗疟疾的疗效观察[J/CD]. 中华实验和临床感染病杂志:电子版,2015,9(1):77-79.
9	World Health Organization. Guidelines for the Treatment of Malaria. 2rd edition[EB/OL]. Geneva,2010. URL
10	邱海波主编. ICU监测与治疗技术[M], 上海:科学技术出版社,2009:248-263.
11	Stępniewska J, Dołęgowska B, Cecerska-Heryć E, et al. The activity of antioxidant enzymes in blood platelets in different types of renal replacement therapy: a cross-sectional study[J]. Int Urol Nephrol,2016,48(4):593-599.
12	Tolwani A. Continuous renal-replacement therapy for acute kidney injury[J]. N Engl J Med,2013,368(12):1160-1161.
13	兰玲鲜. 青蒿琥酯联合血液净化救治脑型疟疾合并多器官功能衰竭一例[J]. 中华临床感染病杂志,2012,5(2):116-117.
14	Gaudry S, Hajage D, Schortgen F, et al. Initiation Strategies for renal-replacement therapy in the intensive care unit[J]. N Engl J Med,2016,375(2):122-133.
15	Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically Ⅲ patients with acute kidney injury: the ELAIN randomized clinical trial[J]. JAMA,2016,315(20):2190-2199.

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Artesunate combined with blood purification therapy for two cases of severe falciparum malaria

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Artesunate combined with blood purification therapy for two cases of severe falciparum malaria