Mbale Regional Referral Hospital, Mbale, Uganda.
Adv Exp Med Biol. 2013;764:241-50. doi: 10.1007/978-1-4614-4726-9_20.
Globally, malaria remains a substantial public health burden with an estimated 349-552 million clinical cases of P. falciparum malaria each year--leading to 780,000 deaths directly attributable to the disease. Whilst the outcome from severe malaria in Africa children remains poor, recent developments in the management of malaria have come from two key sources--the introduction of new, safe and rapidly-effective anti-malarials and high quality evidence from two of the largest clinical trials ever conducted in African children with severe malaria. As a result, the time-honoured anti-malarial treatment for severe malaria, quinine, will now be replaced by artesunate, a water-soluble artemisinin derivative. Supportive care, specifically the management of shock, has been informed by a large late phase clinical trial which concluded that bolus resuscitation is harmful and therefore should be avoided in children with severe malaria, including the high risk group with severe metabolic acidosis and advanced shock.
全球范围内，疟疾仍然是一个重大的公共卫生负担，每年估计有 3.49 亿至 5.52 亿例疟疾病例，其中 78 万人直接死于该病。虽然非洲儿童的重症疟疾结局仍然较差，但疟疾管理的最新进展来自两个关键来源--新型、安全且快速有效的抗疟药物的引入，以及两项有史以来在非洲重症疟疾儿童中开展的最大型临床试验提供的高质量证据。因此，作为传统的重症疟疾抗疟治疗药物的奎宁，现在将被水溶性青蒿素衍生物青蒿琥酯所取代。支持性治疗，特别是休克的管理，受到一项大型后期临床试验的影响，该试验得出结论，推注复苏是有害的，因此应避免在重症疟疾儿童中使用，包括伴有严重代谢性酸中毒和晚期休克的高危人群。
