飞行员重症恶性疟疾伴并发症一例并文献复习

One case of pilot＇s severe subtertian malaria with complications and literatures review

目的探讨飞行员重症恶性疟疾的临床诊治及航空医学鉴定。方法结合1例飞行员重症恶性疟疾的临床诊断、抢救治疗、康复情况及健康鉴定情况，复习相关文献，对飞行员重症恶性疟疾的临床诊治及医学鉴定进行探讨。结果该飞行员有到非洲出访史，临床表现为发热、肝功能不全、急性肾功能衰竭、低血糖、急性溶血性贫血及溶血性尿毒综合征等多系统损害和并发症，经检验外周血发现大量恶性疟原虫环状体，诊断为恶性疟疾。鉴定结论：暂时飞行不合格。地面观察两个月，经临床检查未见疟疾复发，血红蛋白及肝肾功能检查全部正常，结论为飞行合格。结论恶性疟疾病情危重，可合并多系统损害，及时明确的诊断，及早抗疟原虫和对症治疗是患者得以生存的关键。飞行员患重症恶性疟疾后应视病情恢复情况个别评定，恢复良好无后遗症者，可飞行合格。

Objective To explore the clinical diagnosis, treatment and aeromedical evaluation of the pilots with severe subtertian malaria. Methods Based on the reviews of clinical diagnosis, treatment, recovery, aeromedical evaluation of a male pilot with severe subtertian malaria, and literatures, we explored the clinical diagnosis, treatment and medical evaluation of the pilot. Results The pilot showed injuries on many systems and presence of multiple complications, including fever, hepatic dysfunction, acute renal failure hypoglycemia, acute hemolytic anemia and hemolytic uremicsyndrome due to he had been in Africa. Subteftian malaria was diagnosed based on the examination of peripheral smear, which showed the protozoal ring form of subtertian malaria. The pilot was assessed as temporary grounding. By two months medical observation, there was no evidence to show the recurrence of malaria and his hepatorenal function and haematochrome were normal. He was qualified for flying then. Conclusions Severe subtertian malaria may cause multi-system injuries and presence of multiple compilations. Timely diagnosis, early prevention and intervention by appropriate anti- malarial therapy are critical for survival. Pilot with severe subtertian malaria should be individually evaluated. If no sequel or malaria recurs, the pilot can be qualified for flying.