van der Torn M, Thuma P E, Mabeza G F, Biemba G, Moyo V M, McLaren C E, Brittenham G M, Gordeuk V R
Division of Hematology and Oncology, George Washington University Medical Center, Washington, DC, USA.
Trans R Soc Trop Med Hyg. 1998 May-Jun;92(3):325-31. doi: 10.1016/s0035-9203(98)91032-x.
The majority of deaths from cerebral malaria occur within 48 h after admission to hospital. Because of the possibility of inadequate treatment within this period, the use of a loading dose of quinine has been proposed. We reviewed clinical and laboratory data for 113 children with cerebral malaria, who were treated with intravenous quinine, 10 mg/kg every 8 h, at Macha Mission Hospital in rural Zambia. In 1990-1991, 39 children were not given a loading dose of quinine while, in 1992-1993, 74 children received a loading dose of 20 mg/kg. Elevated serum iron levels, as reflected in transferrin saturation, were strongly associated with higher mortality. A loading dose of quinine was associated with faster recovery from coma and enhanced clearance of parasitaemia and fever. The loading dose was also associated with trends to lower mortality and higher haemoglobin levels, but these differences were not statistically significant.
大多数脑型疟死亡病例发生在入院后48小时内。鉴于在此期间可能存在治疗不足的情况，有人提议使用负荷剂量的奎宁。我们回顾了赞比亚农村地区马查传教医院113例接受静脉注射奎宁（每8小时10mg/kg）治疗的脑型疟患儿的临床和实验室数据。在1990 - 1991年，39名儿童未使用负荷剂量的奎宁，而在1992 - 1993年，74名儿童接受了20mg/kg的负荷剂量。转铁蛋白饱和度所反映的血清铁水平升高与较高的死亡率密切相关。负荷剂量的奎宁与昏迷恢复更快、疟原虫血症清除加快及发热缓解有关。负荷剂量还与死亡率降低趋势和血红蛋白水平升高有关，但这些差异无统计学意义。
