Timing Artesunate Treatment To Reduce The Study Of Cerebral Malaria Mortality

According to professor Li Guoqiao's experience about the cerebral malaria, The cerebral malaria are divided into T coma.R coma . non R and non T coma, Lethal cases mainly distributed to the T coma cerebral malaria, which is induced by pyperparasitemia of late stage of trophozoite (T) and early stage of schizont (Se), There is high mortality in T coma cerebral malaria, and now it is also difficult to reduce the mortality in the world, when a great number of trophozoites and schizonts sequestered in the tissues of brain and kidney and so on in most fatal cases If the parasites of late stage of trophozoite and early stage of schizont are killed by the anti-malaria drug at this time, There is still sequestration in the microblood vessels, and the results is: the parasites have been killed, the patients will be died0 It is hopeful to lower down the high mortality by means of choice the optimal time to give Artesunate is given to I comatose patients when trophozoite and schizont fully matured and ruptured instead of medicated with antimalaria on admission , The circulation and functions of the major organs can be recovery rapidly because of the rupture of trophozoite and schizont sequestration in the microvessels0 The identified I coma should have parasitemia that late stage trophozoite and early stage schizont count reaches 300/ Li 1 in intradermal film According to the T + Se count in peripheral blood film, patients are distributed into two group , i.e, The group of choosing the optimal time (treated at once on admission)0 The regimen of 420mg of Artesunate over 5 days and supplement treatment are available for both groups0 89 identified patients were recruited into the study with 36 cases in choosing time group and the other 53 ones in non-choosing time group 0 Antimalarial treatment is postponed at an average of 17.9 ?8.1 hours, The results are : (1) mortality is 8.3% in the choosing time group and 24.1% in non-choicing time group a (x24.04 P0. 044); (2) comatose duration is 37.0?35.7 hours in the choicing time group and 67.2?3.2 hours in no-choicing time group 0 (t=2.78 P0. 007): (3) Although the incidence of complication of acute renal failure is similar in two groups, Auria type acute renal failure needing dralysis occurs in 37.5% patients in the Choicing time group,being significantly lower than that(85.7%)in non-chicing group (P=0.032) 32 cases of R coma cerebral malaria are treated with the method of antimalaria on time (treated at once on admission), the results are: (1) All of 32 patients was cured, (2)The mean parasite clearance times (PCT)were 39.7?0.1 hours, (3) The mean parasite clearance times (FCT) were 35.8 ?1.1 hours, (4) The comatose duration was 22.9?2.2 hours, R coma cerebral malaria patient's prognosis were better than T coma, and significantly shorter than I coma in FCT. PCT. comatose duration0 We have tested the serum of adhesion molecules and cytokines of the cerebral malaria patients The result are : (1) The concentration of serum sICAM-1, sE-selectin in I coma patients is significantly higher than that in R coma patients This means that the mechanism of T coma is the sequestration of late stage of trophozoit and early stage of schizont in the microvessles0 (2) The concentration of serum TNF-a.. IL-6 is significantly highly in all of the cerebral malaria patients In a word, The method of choosing the optimal time to antimalaria can lower down the mortilaty of T coma patients0 Th...