1例输入性危重恶性疟病例的救治

Treatment of an imported case of severe falciparum malaria

2017年2月14日大理州人民医院接诊1例输入性危重恶性疟疾病例。该病例为在非洲加蓬务工感染,在加蓬未得到疟疾诊断和抗疟治疗,病程达55 d才回国。回国后已发展为危重病例,虫密度高达170万/μl,脾肿大达脐平面,并伴有重度昏迷、不能自主呼吸、重度贫血、急性肾功能衰竭、高乳酸血症等多项严重并发症。给予抗疟治疗、支持治疗、对症处理、并发症治疗、加强护理以及防止合并感染等治疗措施;抗疟治疗首选了作用最快的青蒿琥酯静脉推注;虽加大抗疟药物使用剂量,延长疗程,病例仍发生2次疟疾再燃;除常规的对症治疗外,还给予气管插管、呼吸机辅助呼吸、血浆置换、胆红素吸附等特殊措施,最终病例救治成功,未发生死亡。

A case of severe falciparum malaria was admitted to Dali Prefecture People's Hospital on February 14,2017.The case was infected with malaria while working in Gabon,Africa,where the disease was not diagnosed and the treatment was not available.The illness lasted for 55 days before his returning to China.After returning to China,it had developed into a severe case,with a plasmodium density up to 1.7 million/μl.Splenomegaly reached the umbilical level,accompanied by severe coma,inability to breathe spontaneously,severe anemia,acute renal failure,hyperlactic acidemia and other serious complications.Antimalarial treatment,supportive treatment,symptomatic treatment,treatment of complications,enhanced nursing care,prevention of co-infection and other treatments were given.The fastest acting intravenous bolus of artesunate was first chosen for antimalarial treatment.Although the dosage of antimalarial drugs was increased and the course of treatment was prolonged,the case still had recurrence e twice.In additiontoconventional symptomatic treatment,special measures such as tracheal intubation,ventilator assisted breathing,plasma exchange and bilirubin adsorption were also given.The case was successfully treated and no death occurred.