四川省黑热病复发和死亡原因分析

Analysis on Recurrence and Death of Leishmaniasis Cases in Sichuan Province

目的对黑热病病例复发和死亡进行临床分折,探讨复发与死亡的主要原因。方法收集和整理全省历年黑热病疫情报告、各级卫生医疗机构诊治复发与死亡病例的病历记录资料,进行核对、整理和统计。结果全省1985-1991年采用传统锑剂用法,诊治423例,平均复发率和死亡率分别为14.66%、5.67%;1992-2009年增加锑剂用量,诊治638例,平均复发率和死亡率分别降为6.58%、1.88%。结论黑热病复发与发病地区、职业、年龄、病程长短、并发症和锑剂用量及用法等有关;对病例加大锑剂用量,改传统用药为按不同公斤体重增大锑剂总剂量给药可降低复发率。复发病例加大锑剂剂量治疗仍有效,对复发1次的治愈率可达79.81%。死亡与复发次数、并发症多少和误诊以及患者经济困难有关。

Objective To analyze the recurrence and death of leishmaniasis cases clinically and identify the causes. Methods The analysis on the epidemic data of leishmaniasis and the medical records of the recurrence and death in hospitals at all levels in Sichuan from 1985 to 2009 were analyzed. Results From 1985 to 1991,423 leishmaniasis cases were diagnosed and treated by using traditional doage of antimonials. The average recurrence and case fatality rates were 14.66% and 5.67% respectively. From 1992 to 2009,638 leishmaniasis cases were diagnosed and treated by using increased dosage of antimonials. The average recurrence and case fatality rates were 6.58% and 1.88% respectively. Conclusion The recurrence of leishmaniasis was related with patients＇ residential area,occupation,age,length of the illness course,complications,dosage of antimonials. The recurrence rate could be reduced by increasing the dosage of antimonials according to patients＇ body weight. Increasing the dosage of antimonials is still effective to recurring cases. For the cases with the first recurrence,the curative rate could reach up to 79.81%. Case fatality,recurrence and complication are related to economic status of the patients.