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目的分析恶性疟疾并发脓毒症的临床特征。方法对我院近8年来收治的32例确诊为恶性疟疾的患者进行病例资料分析。结果出现脓毒症者26例(81.25%),其中严重脓毒症19例(59.38%),脓毒症休克2例(6.25%)。26例脓毒症常见表现为发热26例(100%)、心率大于90次/min25例(96.15%)以及白细胞数改变23例(88.46%),其他依次为气促、高血糖、C反应蛋白增高。严重脓毒症合并器官功能障碍依次为血液系统损害、肾功能损害、高胆红素血症、意识状态改变、低氧血症、腹胀以及低血压。31例(96.88%)患者治愈或好转出院,1例死亡(3.13%),死亡病例为脓毒症休克患者。结论恶性疟疾原虫感染较易发生脓毒症,并极易发展为严重脓毒症,疟疾所致的严重脓毒症以血液系统损害、肾脏损害、高胆红素血症以及意识状态改变多见,如果发展为脓毒症休克则预后差。该病对青蒿琥酯的治疗效果好,及时使用青蒿琥酯清除疟原虫是预防脓毒症发生的关键。
Objective To analyze the clinical features of sepsis associated with malignant malaria. Methods The data of 32 cases diagnosed as malignant malaria in our hospital in the recent 8 years were analyzed. Results Sepsis occurred in 26 patients (81.25%), of which 19 were severe sepsis (59.38%) and 2 were septic shock (6.25%). Twenty-six cases of sepsis showed fever (26%), heart rate more than 90 beats / min (96.15%) and leukocyte count change (88.46%). The others were shortness of breath, hyperglycemia, C-reactive protein Increase. Serious sepsis with organ dysfunction followed by blood system damage, renal dysfunction, hyperbilirubinemia, changes in consciousness, hypoxemia, bloating and hypotension. Thirty-one patients (96.88%) were cured or discharged, one died (3.13%) and the death was septic shock. CONCLUSIONS: Plasmodium falciparum infection is more likely to develop sepsis and is highly susceptible to severe sepsis. Serious sepsis caused by malaria is associated with hematological, renal, hyperbilirubinemia and changes in the state of consciousness , If the development of septic shock, the prognosis is poor. The disease treatment of artesunate good effect, the timely use of artesunate clear malaria parasites is the key to preventing the occurrence of sepsis.