本文關(guān)鍵詞： 青蒿琥酯 阿奇霉素 瘧疾 間日 惡性 療效　出處：《大理學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 1.觀察青蒿琥酯與阿奇霉素伍用治療瘧疾的療效； 2.觀察標(biāo)準(zhǔn)的間日瘧(惡性瘧)治療方法治療當(dāng)?shù)亻g日瘧(惡性瘧)的療效； 3與標(biāo)準(zhǔn)的間日瘧、惡性瘧疾療法比較，評(píng)價(jià)青蒿琥酯與阿奇霉素伍用治療瘧疾的療效； 方法:在云南省中緬邊境西部地區(qū)拉咱和瑞麗市弄島鎮(zhèn)兩地設(shè)立觀察點(diǎn)，主要觀察青蒿琥酯與阿奇霉素伍用殺滅人體紅內(nèi)期瘧原蟲作用。對(duì)涂片鏡檢確診的單一感染間日瘧或惡性瘧的患者嚴(yán)格按照篩選條件入選。間日瘧分A組（青蒿琥酯與阿奇霉素觀察組）和B組（標(biāo)準(zhǔn)的氯伯8d療法作對(duì)照組）；惡性瘧分C組（青蒿琥酯與阿奇霉素觀察組）和D組（標(biāo)準(zhǔn)的雙氫青蒿素哌喹療法作對(duì)照組）。按照患者就診順序1:1隨機(jī)編號(hào)入組，A組和C組用青蒿琥酯與阿奇霉素伍用3d治療，B組用磷酸氯喹片3d磷酸伯氨喹8天治療，D組用雙氫青蒿素哌喹片3d治療。間日瘧用藥后24h、48h，觀察/計(jì)數(shù)瘧原蟲減少率、1周臨床治愈率，根治率持續(xù)觀察3個(gè)月，且觀察病人體溫恢復(fù)正常時(shí)間；惡性瘧觀察用藥后24h、48h，觀察/計(jì)數(shù)瘧原蟲減少率、1周臨床治愈率、28d治愈率。觀察結(jié)果用SPSS16.0軟件分析，綜合評(píng)價(jià)青蒿琥酯與阿奇霉素伍用的療效。 結(jié)果：間日瘧A組（青蒿琥酯與阿奇霉素）共52例，服藥前平均體溫38.50.11℃，平均原蟲密度5320個(gè)/ul。完成全療程治療（3天）52例，有效52例，有效率100%；完成7d臨床觀察51例（1例退出），平均退熱時(shí)間31.691.73h，平均原蟲轉(zhuǎn)陰時(shí)間30.311.71h。臨床治愈率100%，，282d根治率78.3%(36/46)，602d根治率70.7%(29/41)，902d根治率68.4%(26/38)。間日瘧B(tài)組(標(biāo)準(zhǔn)的氯伯8d療法)共39例，服藥前平均體溫38.90.13℃，平均原蟲密度4507個(gè)/ul。完成全療程治療（氯喹片3天，伯氨喹8天）39例，有效39例，有效率100%，平均退熱時(shí)間32.42.02h，平均原蟲轉(zhuǎn)陰時(shí)間30.821.98h，臨床治愈39例，臨床治愈率100%。282d根治率97.4%(38/39)，602d根2014屆碩士學(xué)位論文青蒿琥酯與阿奇霉素伍用治療瘧疾的臨床研究治率89.7%(35/39)，902d根治率87.2%(34/39)。A、B組間比較平均退熱時(shí)間、原蟲轉(zhuǎn)陰時(shí)間，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.01）。A、B組間比較282d、602d、902d，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 惡性瘧C組（青蒿琥酯與阿奇霉素）共23例，服藥前平均體溫39.00.19℃；平均原蟲密度19462個(gè)/ul。完成全療程治療（青蒿琥酯與阿奇霉素伍用3天）23例，有效率95.7%（22/23），平均退熱時(shí)間42.573.74h；平均原蟲轉(zhuǎn)陰時(shí)間41.133.63h，完成28天隨訪的20例中13例治愈，治愈率65%（13/20）。惡性瘧D組(雙氫青蒿素哌喹)共22例，服藥前平均體溫38.60.2℃；平均原蟲密度14923個(gè)/ul。完成全療程治療22例，有效率100%；平均退熱時(shí)間37.094.67h；原蟲轉(zhuǎn)陰時(shí)間35.554.66h。完成28天隨訪的17例中全部治愈，治愈率100%。 C、D組間比較平均退熱時(shí)間、原蟲轉(zhuǎn)陰時(shí)間，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.01）。C、D組間比較28天治愈率差異有統(tǒng)計(jì)學(xué)意義（P0.05）。4組病人對(duì)藥物均有較好的耐受性,個(gè)別病人在服藥過(guò)程中出現(xiàn)腹瀉、惡心、腹痛等癥狀,均較輕微且有自限性。 結(jié)論： 1.標(biāo)準(zhǔn)的氯/伯喹8d療法治療當(dāng)?shù)亻g日瘧是安全有效的，3個(gè)月的根治率為87.1%；與標(biāo)準(zhǔn)的間日瘧療法比較，青蒿琥酯與阿奇霉素伍用治療間日瘧有速效和不良反應(yīng)少等優(yōu)點(diǎn)，但對(duì)間日瘧的根治率不如前者。 2.標(biāo)準(zhǔn)的雙氫青蒿素哌喹片療法治療當(dāng)?shù)貝盒辕懯前踩行У模?8d治愈率100%；青蒿琥酯與阿奇霉素伍用治療惡性瘧近期療效和不良反應(yīng)二者相似，但治愈率不如前者。
[Abstract]:Objective:
1. the efficacy of artesunate and azithromycin in the treatment of malaria was observed.
2. the efficacy of the standard treatment of Plasmodium vivax (falciparum malaria) in the treatment of Plasmodium vivax (falciparum malaria) was observed.
3 compared with the standard Plasmodium vivax and the treatment of malarial malaria, the efficacy of artesunate and azithromycin in the treatment of malaria was evaluated.
Methods: in the western region of Yunnan province and Ruili border in Laiza Nongdao town set up two observation points, mainly to observe the effect of artesunate and Azithromycin combined with function of killing human blood stage Plasmodium. The smear were single infection of Plasmodium falciparum or vivax malaria patients strictly according to the screening conditions selected. Group A (vivax malaria artesunate and azithromycin in the observation group) and group B (primary 8D chlorine standard therapy as the control group); group C (falciparum artesunate and azithromycin in the observation group) and group D (standard dihydroartemisinin piperaquine therapy as the control group). According to the sequence of 1:1 random number in the patient group, A group and C group was treated with artesunate and Azithromycin combined with 3D treatment, B group with Chloroquine Phosphate Tablets 3D primaquine phosphate 8 days of treatment, group D with Dihydroartemisinin and Piperaquine Phosphate Tablets 3D in the treatment of vivax malaria. After administration of 24h, 48h, observation / counting Plasmodium reduced rate, 1 weeks of treatment The rate of cure rate, continuous observation of 3 months, and observe the patient body temperature returned to normal time; falciparum malaria were observed after 24h, 48h, observation / counting Plasmodium reduction rate of 1 weeks, the clinical cure rate, the cure rate of 28d. The results were analyzed by SPSS16.0 software, a comprehensive evaluation of efficacy of artesunate and Azithromycin combined with the.
Results: A group (vivax artesunate and azithromycin) a total of 52 cases, before taking the average temperature of 38.50.11 DEG C, the mean parasite density of 5320 /ul. completed the treatment course (3 days) in 52 cases, effective 52 cases, efficiency of 100%; the completion of 7D clinical observation of 51 cases (1 cases, the average cooling time of 31.691.73h exit). The mean parasite clearance time 30.311.71h. clinical cure rate was 100%, the cure rate of 282D 78.3% (36/46), the cure rate of 602d 70.7% (29/41), the cure rate of 902d 68.4% (26/38). Group B (primary vivax chloride standard therapy for 8D) a total of 39 cases, before taking the average temperature of 38.90.13 DEG C, the mean parasite density 4507 /ul. complete the whole treatment (chloroquine primaquine for 3 days, 8 days) in 39 cases, 39 cases were effective, the efficiency is 100%, the average cooling time 32.42.02h, the mean parasite clearance time of 30.821.98h, 39 cases were cured, the cure rate of clinical cure rate of 100%.282d 97.4% (38/39), 602d root 2014 master's degree thesis and artesunate Azithromycin in the treatment of malaria was 89.7% (35/39), the cure rate of 902d was 87.2% (34/39).A, the average fever time of B group, and the time of protozoan conversion were not statistically significant (P > 0.01).A, B group comparison 282D, 602d, 902d, the difference was statistically significant (P0.05).
Plasmodium falciparum C group (artesunate and azithromycin) a total of 23 cases, before taking the average temperature of 39.00.19 DEG C; the mean parasite density of 19462 /ul. finished the whole treatment (artesunate and Azithromycin combined with 3 days) in 23 cases, efficiency of 95.7% (22/23), the average cooling time of 42.573.74h; the mean parasite clearance time 41.133.63h, complete 28 days of follow-up in 20 cases 13 cases were cured, the cure rate was 65% (13/20). Group D (falciparum dihydroartemisinin piperaquine) a total of 22 cases, before taking the average temperature of 38.60.2 DEG C; the mean parasite density of 14923 /ul. finished the whole treatment in 22 cases, the effective rate was 100%; the average cooling time 37.094.67h; parasite clearance time 35.554.66h. 28 days of follow-up of 17 cases were cured, the cure rate of 100%., C, D group compared to the average defervescence time, parasite clearance time, there was no statistically significant difference (P > 0.01).C, D between two groups 28 day cure rate difference was statistically significant (P0.05.4) The patients in the group had better tolerance to the drugs. Some patients had symptoms such as diarrhea, nausea and abdominal pain in the course of taking medicine, all of which were mild and self limiting.
Conclusion:
1. standard chlorine / primaquine 8D therapy in the treatment of local vivax malaria is safe and effective, 3 months of the cure rate was 87.1%; compared with the standard treatment of vivax malaria, artesunate and Azithromycin combined treatment of vivax malaria has the advantages of quick and adverse reactions, but the vivax malaria cure rate is not as the former.
The 2. standard Dihydroartemisinin and Piperaquine Phosphate Tablets therapy is safe and effective for the treatment of local falciparum malaria. The cure rate of 28d is 100%. The artemisinin and azithromycin are similar in treating two cases, but the cure rate is not as good as the former.

【學(xué)位授予單位】：大理學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R531.3

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