恶性疟合并溶血尿毒综合征的诊疗探讨

发布时间：2018-01-13 18:15

本文关键词：恶性疟合并溶血尿毒综合征的诊疗探讨　出处：《中华实验和临床感染病杂志(电子版)》2016年01期 　论文类型：期刊论文

【摘要】：目的探讨恶性疟引起的溶血尿毒综合征(HUS)的诊断及治疗要点。方法对本院2008至2014年13例恶性疟引起的溶血尿毒综合征患者的临床特点、辅助检查及治疗情况进行回顾性分析。结果入组患者中男性12例,女性1例,年龄22~60岁,均符合恶性疟疾合并溶血尿毒综合征的诊断。其中10例合并脑型疟,1例合并消化道出血,2例出现呼吸循环衰竭。经抗疟原虫治疗、激素治疗、补液对症治疗以及呼吸机、血液透析滤过等,入组的13例患者中1例死亡,1例自动出院,11例治愈出院,其中5例因急性肾功能衰竭行血液透析滤过治疗肾功能恢复,随访11例治愈患者均未出现慢性肾功能损害,2例病例出现再燃。结论疟疾的早期诊断及治疗,对控制溶血及阻止脏器损害具有重要作用;大剂量长疗程使用蒿甲醚可增强抗疟原虫效果,早期应用激素可有效阻止溶血,减轻肾脏损害,对严重溶血、急性肾功能衰竭病例应及时采取血液透析滤过治疗,以降低病死率。
[Abstract]:Objective to investigate the main points of diagnosis and treatment of haemolytic uremic syndrome caused by falciparum malaria. Methods the clinical features of 13 patients with hemolytic uremic syndrome caused by falciparum malaria from 2008 to 2014 in our hospital were studied. Results there were 12 males and 1 female, aged 2260 years. All cases were in accordance with the diagnosis of falciparum malaria with hemolytic uremic syndrome, of which 10 cases were complicated with cerebral malaria and 1 case with digestive tract hemorrhage, 2 cases had respiratory and circulatory failure, which were treated with anti-malaria parasite and hormone therapy. Among the 13 patients, 1 case died and 1 case was discharged automatically. 11 cases were cured and discharged from hospital by resuscitation therapy, ventilator, hemodiafiltration and so on. Among them, 5 cases were treated with hemodiafiltration because of acute renal failure, 11 cases of cured patients were followed up, and 2 cases of chronic renal dysfunction were not rekindled. Conclusion the early diagnosis and treatment of malaria. It plays an important role in controlling hemolysis and preventing organ damage. Large dose of artemether can enhance the efficacy of anti-Plasmodium parasites, early use of hormones can effectively prevent hemolysis, reduce kidney damage, and serious hemolysis. Patients with acute renal failure should be treated with hemodiafiltration in time to reduce mortality.
【作者单位】：首都医科大学附属北京地坛医院感染性疾病诊疗中心、感染病科国家临床重点专科;
【分类号】：R531.3;R692.5
【正文快照】： 随着人员流动及劳务输出的不断增加,我国输入性疟疾呈上升趋势,且以恶性疟为主,而溶血尿毒综合征(hemolytic uremic syndrome,HUS)是恶性疟最为严重的并发症之一,病死率极高。目前,恶性疟所引起的HUS临床报道较少,为提高医护人员对此类疾病的认识及增加救治经验,现将本院2008

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