血液滤过透析治疗重症疟疾致死性内环境紊乱的疗效分析

目的 分析血液滤过透析（CHDF）治疗重症恶性疟的疟疾早期致死性内环境紊乱的效果与安全性。方法 回顾性分析2006年1月—2017年12月南京市第二医院21例重症疟疾患者,比较在青蒿琥酯治疗基础上,连续性肾脏替代治疗（CRRT）与否对重症疟疾高热、昏迷、低钠、高钾、高乳酸血症等内环境紊乱及抗疟效果的影响。结果 2006年1月—2009年12月单纯内科治疗（对照组）的9例,2006年1月—2017年12月内科治疗基础加用CHDF治疗12例（CHDF组）;两组患者入ICU时器官损伤程度、APACHE Ⅱ评分和预期死亡率差异无统计学意义（P>0.05）;治疗72 h后,CHDF组预期死亡风险下降为（28.0±9.0）%,与本组入院时的（47.1±10.4）%比较明显降低,与对照组治疗72 h后的（41.0±15.2）%比较也明显降低;CHDF组的平均住ICU时间为（9.16±3.21） d,对照组为（9.67±2.06） d,两组差异无统计学意义（P>0.05）;CHDF组患者的乳酸水平为（1.52±0.36） mg/L,对照组为（4.89±2.75） mg/L;两组患者的血Na、血K浓度差异无统计学意义（P>0.05）;两组中CHDF组患者的意识恢复高于对照组,CHDF组与对照组GCS评分分别是11.3±0.7、8.7±2.7,两组差异有统计学意义（P<0.05）。CHDF组与对照组患者的疟原虫转阴时间分别是（64.67±9.39）d、（59.00±7.73）d,两组差异无统计学意义（P>0.05）。结论 在青蒿琥酯治疗基础上联合CHDF治疗,可以改善重症疟疾早期致死性内环境紊乱,缩短昏迷时间,提高抢救成功率与治愈率。

Effect evaluation of hemodiafiltration rebuilding homeostasis while fatal dysregulation of homeostasis in severe malaria

Objective To study the effect and safety of continuous hemodiafiltration (CHDF) in the treatment of early fatal dysregulation of homeostasis in severe malaria.Methods The clinical data of 21 patients with severe malaria, who admitted to Second Hospital of Nanjing from January 2006 to December 2017, were retrospectively analyzed. The efficacy of the treatment of whether continuous renal replacement therapy (CRRT) was conducted on the basis of artesunate on antimalarial effect and dysregulation of homeostasis such as hyperthermia, coma, hyponatremia, hyperkalemia, hyperlactatemiain severe malaria were compared.Results From January 2006 to December 2009, 9 cases were treated with medical therapy (the control group), 12 cases were treated with medical therapy combined with CHDF from January 2006 to December 2017 (CHDF group). There was no significant difference in the degree of organ injury evaluated by APACHE Ⅱ score on admission between the two groups (P>0.05). After 72 hours of treatment, the risk of death in CHDF group was reduced to (28.0±9.0)%, which was significantly lower than (47.1±10.4) % on admission. The mean time in ICU in the CHDF group was (9.16±3.21) days versus (9.67 ±2.06) days in the control group (P>0.05). The LAC level of the CHDF group was (1.52±0.36) mg/L versus (4.89±2.75) mg/L of in the control group. There was no significant difference in blood Na and potassium concentration between the two groups （P>0.05）. The recovery of consciousness in the treatment group was significantly higher than that in the control group and the control group, the Glasgow′s coma scale (GCS) scores of the two groups were (11.3±0.7) versus (8.7±2.7), with statistical difference and clinical significance （P>0.05）. The conversion time of Plasmodium falciparum in the CHDF-treated group was (64.67±9.39) d versus (59.00±7.73 ) d in the control group (P>0.05).Conclusion sThe combination of artesunate and CHDF can improve the fatal dysregulation of homeostasis, shorten the time of coma, and improve the success rate and cure rate of severe malaria.