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目的探讨恶性疟引起的溶血尿毒综合征(HUS)的诊断及治疗要点。方法对本院2008至2014年13例恶性疟引起的溶血尿毒综合征患者的临床特点、辅助检查及治疗情况进行回顾性分析。结果入组患者中男性12例,女性1例,年龄22~60岁,均符合恶性疟疾合并溶血尿毒综合征的诊断。其中10例合并脑型疟,1例合并消化道出血,2例出现呼吸循环衰竭。经抗疟原虫治疗、激素治疗、补液对症治疗以及呼吸机、血液透析滤过等,入组的13例患者中1例死亡,1例自动出院,11例治愈出院,其中5例因急性肾功能衰竭行血液透析滤过治疗肾功能恢复,随访11例治愈患者均未出现慢性肾功能损害,2例病例出现再燃。结论疟疾的早期诊断及治疗,对控制溶血及阻止脏器损害具有重要作用;大剂量长疗程使用蒿甲醚可增强抗疟原虫效果,早期应用激素可有效阻止溶血,减轻肾脏损害,对严重溶血、急性肾功能衰竭病例应及时采取血液透析滤过治疗,以降低病死率。
Objective To investigate the diagnosis and treatment of hemolytic uremic syndrome (HUS) caused by falciparum malaria. Methods A retrospective analysis was performed on the clinical features, auxiliary examinations and treatment of 13 patients with hemolytic uremic syndrome caused by falciparum malaria from 2008 to 2014 in our hospital. Results Among the patients enrolled, there were 12 males and 1 females aged from 22 to 60 years. All of them were in line with the diagnosis of falciparum malaria complicated with hemolytic uremic syndrome. 10 cases of cerebral malaria with merger, 1 case of gastrointestinal bleeding, 2 cases of respiratory failure. After anti-malaria treatment, hormone therapy, rehydration symptomatic treatment and ventilator, hemodiafiltration and so on, 1 out of 13 patients died, 1 patient was discharged automatically and 11 patients were discharged. Among them, 5 patients were discharged due to acute renal function Failure of hemodialysis filtration treatment of renal function recovery, follow-up of 11 cases were cured patients without chronic renal damage, and 2 cases of rebound. Conclusion The early diagnosis and treatment of malaria play an important role in the control of hemolysis and the prevention of organ damage. The use of artemether at high doses and long courses can enhance the anti-malarial effect. Early application of hormones can effectively prevent hemolysis and reduce renal damage. Severe hemolysis Acute renal failure cases should promptly take hemodialysis filtration treatment to reduce mortality.