青岛市1例输入性恶性疟死亡病例分析

目的 对2016年青岛市1例脑型恶性疟死亡病例的发病、就诊、治疗等情况进行调查分析,杜绝恶性疟死亡病例的再次发生。方法 查阅患者就诊的医疗机构对患者的诊治资料,对患者家属及诊治医务人员进行了流行病学调查,对患者的诊治过程进行了分析研究。结果 患者柳某某,男,26岁,农民,现住山东省青岛市莱西市农村。患者于2014年1月6日由某公司外派前往坦桑尼亚经商,主要工作环境在野外。2016年1月30日回国休假、探亲。患者在坦桑尼亚期间患疟情况不详。2016年1月27日,患者在坦桑尼亚开始出现发热、发冷、全身肌肉关节酸痛的症状,体温最高40 ℃。2016年1月30日回到北京,直接转机到青岛,随后到莱西市人民医院就诊,血常规检查结果血小板明显减少,但具体病因不明,住院1 d,病情未见好转。2016年2月2日上午,患者到青岛市海慈医疗集团门诊就诊,抽血化验血常规,结果显示血小板明显降低,但未查到具体病因。2016年2月3日14:00青岛市第六人民医院电话反馈青岛市海慈医疗集团血液科,该患者的血检结果为恶性疟。16:00患者转至青岛市第六人民医院住院治疗。22:30出现昏迷状态,并逐渐出现多种并发症,经医护人员全力抢救,但终因病情严重,抢救无效,于2月4日24:00死亡。患者死于脑型疟疾与多器官功能衰竭,死亡原因主要是延误治疗,其次,治疗措施也有待进一步提高。结论 应加强重点人群出境前防护与入境后防治的健康教育,提高综合医院医务人员对疟疾的敏感性、鉴别能力与救治水平,设置由防治人员、多方诊治人员组成的专家救治组（包括ICU专家）,抢救危重病例时,将抗疟药剂量增加,疗程延长,多措并举,减少死亡病例的发生。

Survey of one death case of imported falciparum malaria in Qingdao

Objective To investigate the diagnosis and treatment of 1 death case of cerebral falciparum malaria in Qingdao City in 2016, so as to prevent the recurrence of falciparum malaria deaths.Methods The data of diagnosis and treatment of the cerebral falciparum malaria case were reviewed in the medical institution. An epidemiological investigation was conducted on the family members of the patient and medical staff, and all the information was analyzed.Results The patient Liu, male, 26 years old, farmer, lived in the village of Laixi City, Qingdao City, Shandong Province. On January 6, 2014, he was sent to Tanzania for business by Beijing Sunshine Insurance Company. His worked mainly in wild environments. On January 27, 2016, in Tanzania, he suffered from fever and chill, with a body temperature of up to 40 ℃. On January 30, 2016, he returned to Beijing, then to Qingdao, and then visited the People's Hospital of Laixi City. The blood routine examination showed that platelets were significantly decreased, but the specific etiology was unknown. On February 2, 2016, the patient visited the clinic of Haizi Medical Group in Qingdao City, and the blood routine examination showed that the platelets were significantly decreased, but the specific etiology was not found too. At the afternoon (14 p. m.) of February 3, 2016, the Sixth People's Hospital of Qingdao City gave a feedback to the clinic of Haizi Medical Group in Qingdao City by telephone that the blood test found Plasmodium falciparum. The patient was transferred to the Sixth People's Hospital of Qingdao City. The patient appeared comatose state and gradually developed multiple complications. Although the medical staff tried their best to rescue him, he died of serious illness at the midnight, February 4. The patient died of cerebral malaria and multiple organ failure, and the main cause of death was delayed treatment, but the treatment measures may be further improved.Conclusion The health education for focus groups should be strengthened before departure and after turning back. The medical staff also should improve the levels of diagnosis and treatment of malaria, especially falciparum malaria.