本文選題：瘧疾 + 臨床研究　； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：通過回顧性分析湖南省某大型綜合醫(yī)院近30年的瘧疾臨床資料,以了解瘧疾的流行病學(xué)變遷及其臨床表現(xiàn)、實驗室檢查、病原學(xué)、治療四個方面的變化,旨在以新的認(rèn)識和理念指導(dǎo)當(dāng)前瘧疾臨床診治實踐,提高瘧疾的診治水平,并為當(dāng)?shù)赝晟菩滦蝿菹碌寞懠卜揽夭呗蕴峁┯袃r值的參考。 方法：1.收集某大型綜合醫(yī)院1984-2013年的瘧疾臨床資料。 2.比較近30年三個時段瘧疾的流行病學(xué)變遷。 3.比較境內(nèi)外病例臨床表現(xiàn)、實驗室檢查、病原學(xué)、治療四個方面的變化。 4.統(tǒng)計學(xué)方法：計量資料采用兩獨立樣本的t檢驗、Wilcoxon檢驗,計數(shù)資料采用卡方檢驗。 結(jié)果：1.共收集111份瘧疾病例。 2.1984年-1993年組共有14例,境外病例占14.3%(2/14)；1994年-2003年組共有29例,境外病例占17.2%(5/29)；2004年-2013年組共有68例,境外病例占97.1%(66/68)。2004年-2013年組境外病例所占比例顯著高于1984年-1993年組和1994年-2003年組,差異有統(tǒng)計學(xué)意義,P0.001。 3.瘧原蟲分型明確的有80例。1984年-1993年組有14例,其中間日瘧占78.6%(11/14),惡性瘧占21.4%(3/14)；1994年-2003年組有20例,其中間日瘧占55.0%(11/20),惡性瘧占45.0%(9/20)；2004年-2013年組有46例,其中間日瘧占15.2%(7/46),惡性瘧占69.6%(32/46),混合感染占15.2%(7/46)。三組病例的蟲種構(gòu)成比比較差異有統(tǒng)計學(xué)意義,P0.001。 4.境內(nèi)病例共38例,境外病例共73例。在臨床表現(xiàn)中,境外病例組間歇熱、大汗發(fā)生率顯著低于境內(nèi)病例組(P0.01),境外病例組寒戰(zhàn)發(fā)生率顯著低于境內(nèi)病例組(P0.001),而境外病例組醬油色尿、少尿、黃疸、神志改變發(fā)生率均顯著高于境內(nèi)病例組(P0.05)。 5.實驗室檢查中,境外病例組白細(xì)胞計數(shù)顯著高于境內(nèi)病例組(P0.01),而境外病例組血小板計數(shù)顯著低于境內(nèi)病例組(P0.05)；境外病例組白蛋白顯著低于境內(nèi)病例組(P0.001),境外病例組總膽紅素、直接膽紅素、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶均顯著高于境內(nèi)病例組(P0.001)；境外病例組尿素氮、肌酐均高于境內(nèi)病例組(P0.05)。 6.血片檢出率和骨髓片檢出率比較差異無統(tǒng)計學(xué)意義。 7.境外病例中惡性瘧和混合感染所占比例顯著高于境內(nèi),差異有統(tǒng)計學(xué)意義,P0.001。8.在治療上,以青蒿素類藥物為主,境外病例的退熱時間和住院時間與境內(nèi)相比差異無統(tǒng)計學(xué)意義。 結(jié)論：近十年來湖南省瘧疾境外輸入性病例顯著增多,臨床表現(xiàn)不典型、重癥病例增多,其病原學(xué)分類以惡性瘧原蟲為主。雖然目前瘧疾病例在諸多方面較前有所改變,但是臨床常用抗瘧藥物仍然有效。
[Abstract]:Objective: to analyze retrospectively the clinical data of malaria in a large general hospital in Hunan Province in recent 30 years, in order to understand the changes of malaria epidemiology and its clinical manifestations, laboratory examination, etiology and treatment. The aim of this paper is to guide the current clinical practice of malaria diagnosis and treatment, to improve the level of malaria diagnosis and treatment, and to provide a valuable reference for the local improvement of malaria control strategy under the new situation. Method 1: 1. The clinical data of malaria in a large general hospital from 1984 to 2013 were collected. 2. To compare the epidemiological changes of malaria in three periods in the last 30 years. 3. The changes of clinical manifestation, laboratory examination, etiology and treatment were compared. 4. Statistical method: two independent samples of t test and Wilcoxon test were used to measure the data and chi-square test was used to measure the data. The result is 1: 1. A total of 111 malaria cases were collected. 2. In the 1984-1993 group, there were 14 cases, with foreign cases accounting for 14.33 / 14 / 14; in the 1994-2003 group, there were 29 cases and there were 17. 2 / 29 cases abroad; in the 2004-2013 group, there were 68 cases, and the overseas cases accounted for 97. 1 / 66 / 68. The proportion of overseas cases in the 2004-2013 group was significantly higher than that in the 1984-1993 and 1994-2003 groups. The difference was statistically significant (P 0.001). 3. In the 1984-1993 group, there were 14 cases of Plasmodium falciparum, which accounted for 78.6% / 14%, and falciparum malaria accounted for 21.440% / 14%; in the 1994-2003 group, there were 20 cases, with 55.0% / 20% malaria and 45.0% / 20% falciparum malaria; and 46 cases in the 2004-2013 group. The proportion of Plasmodium falciparum malaria is 15. 2% of 46%, falciparum malaria is 69. 6% 32 / 46, and mixed infection is 15. 2% of 46%. There was significant difference in the proportion of insect species in the three groups (P 0.001). 4. There were 38 cases in China and 73 cases abroad. In the clinical manifestations, the incidence of intermittent fever and sweating in the overseas case group was significantly lower than that in the domestic case group (P 0.01), the incidence of shivering in the overseas case group was significantly lower than that in the domestic case group (P 0.001), while the soy sauce color urine, oliguria and jaundice in the overseas case group were significantly lower than those in the domestic case group. The incidence of mental changes was significantly higher than that of patients in China (P 0.05). 5. In laboratory examination, the white blood cell count in the overseas case group was significantly higher than that in the domestic case group, while the platelet count in the overseas case group was significantly lower than that in the domestic case group, while the albumin in the overseas case group was significantly lower than that in the domestic case group, and the total bilirubin in the overseas case group was significantly lower than that in the domestic case group. Direct bilirubin, alanine aminotransferase and alanine aminotransferase were significantly higher than those in domestic case group (P 0.001), and urea nitrogen and creatinine in overseas case group were higher than that in domestic case group (P 0.05). 6. There was no significant difference between the detection rate of blood smear and that of bone marrow film. 7. The proportion of falciparum malaria and mixed infection in overseas cases was significantly higher than that in China, and the difference was statistically significant (P 0.001.8). In treatment, artemisinin was the main drug, and the time of antipyretic and hospital stay was not significantly different from that in China. Conclusion: in the last ten years, the imported malaria cases in Hunan Province increased significantly, the clinical manifestations were atypical and the severe cases increased. The main pathogenic classification of malaria was Plasmodium falciparum. Although malaria cases have changed in many ways, antimalarial drugs are still effective.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R531.3

【共引文獻(xiàn)】

相關(guān)期刊論文 前7條

1 張毅民;王娜;黃德超;白家瑞;;乙氧羰基化-β-環(huán)糊精的合成工藝優(yōu)化[J];高�；瘜W(xué)工程學(xué)報;2014年02期

2 高春燕;許凡;馬紅燕;劉瓊;;β-環(huán)糊精和青霉素V鉀包絡(luò)物熒光性能的研究[J];分子科學(xué)學(xué)報;2014年04期

3 全先高;王慧云;丁林;孫珊珊;宋雪艷;徐娜;;甲氨蝶呤/蒙脫土納米插層化合物的制備及緩釋作用研究[J];濟寧醫(yī)學(xué)院學(xué)報;2014年04期

4 張博;趙永亮;;羥丙基-β-環(huán)糊精對積雪草酸增溶作用的研究[J];天津醫(yī)科大學(xué)學(xué)報;2014年06期

5 夏海建;張振海;姚冬冬;賈曉斌;;改善中藥口服生物利用度的劑型設(shè)計的研究[J];中國中藥雜志;2013年17期

6 高源源;谷福根;;非諾貝特-羥丙基-β-環(huán)糊精包合物在大鼠體內(nèi)的藥動學(xué)及生物利用度研究[J];中南藥學(xué);2014年05期

7 汪菊芬;吳旭日;陳依軍;;注射用難溶藥物增溶技術(shù)的研究進展[J];藥物生物技術(shù);2014年03期

相關(guān)博士學(xué)位論文 前2條

1 孫樂;基于BCS系統(tǒng)的in silico/in vitro模型評價藥物及制劑的BA/BE[D];沈陽藥科大學(xué);2013年

2 熊青青;β-環(huán)糊精聚合物的合成、自組裝及作為藥物/基因載體的應(yīng)用研究[D];北京協(xié)和醫(yī)學(xué)院;2014年

相關(guān)碩士學(xué)位論文 前10條

1 李媛;新型噻吩類希夫堿大環(huán)及分子鉗化合物的合成與離子識別研究[D];西北大學(xué);2013年

2 王芳;環(huán)糊精及其衍生物對藥物溶出的影響[D];河北大學(xué);2013年

3 封小玲;不同處理方式對恩諾沙星體外溶出及抑菌性的影響[D];重慶大學(xué);2013年

4 孔蕊;光敏性環(huán)糊精聚合物的制備與性能研究[D];江南大學(xué);2013年

5 黃源銳;難溶性藥物固體自乳化釋藥系統(tǒng)的研究[D];重慶醫(yī)科大學(xué);2013年

6 陳靜靜;環(huán)糊精與有機小分子間相互作用的理論研究[D];湘潭大學(xué);2013年

7 何海云;伊潘立酮—羥丙基-β-環(huán)糊精包合物注射劑的研究[D];重慶醫(yī)科大學(xué);2012年

8 孫萍;醇凝膠對難水溶藥物的緩釋作用研究[D];仲愷農(nóng)業(yè)工程學(xué)院;2013年

9 徐陽光;分枝桿菌降解植物甾醇側(cè)鏈過程基礎(chǔ)研究[D];浙江大學(xué);2014年

10 李明陽;重組腈水解酶催化反應(yīng)體系改進及固定化研究[D];華東理工大學(xué);2014年

，

本文編號：1779217