摘要
目的通过对１９９６年１月５日吉林市发生的一起辐射事故病人“文”的救治，对急性放射病合并局部极重度放射性损伤诊断与救治提供新经验。方法通过物理模拟试验、染色体畸变分析、淋巴细胞微核率及局部组织ＥＳＲ的检测，估算全身受照射剂量及局部不同部位受照射剂量，并通过临床症状、造血系统等临床资料综合分析，确定了损伤程度。结果全身受照后吸收剂量（红骨髓干细胞存活计权等效剂量）为２．９±０．３Ｇｙ，右下肢最大吸收剂量达３７３７．８Ｇｙ。照后２小时５０分出现频繁的恶心呕吐。照后第１～２天淋巴细胞计数为０．９～０．４×１０９／Ｌ，为保全生命，于照后第８天行右大腿及左手腕截肢术。白细胞、血小板计数于照后第１７天降至最低值（分别为０．６５×１０９／Ｌ及１９×１０９／Ｌ）。照后４～２３天应用ｒｈＧ－ＣＳＦ，极期仅持续５天便进入恢复期。结论本例为中度骨髓型急性放射病合并局部极重度放射损伤，后者又会加重全身急性放射病的病理改变，在治疗中不能忽视对局部损伤的及时处理，早期应用ｒｈＧ－ＣＳＦ有助于造血功能的恢复，心肌酶的检测有助于局部严重放射损伤的判定。
Objective This paper presents the clinical diagnosis and treatment of a patient “Wen”subjected to an accidental 192 Ir exposure in January 5,1996 in Jilin City.It is our hope to afford new experience and information for similar cases in the future.Methods After physical dose estimation,biological dosimetry from chromosome aberrations and micronuclei of lymphocytes and ESR estimation of bone samples were conducted.In addition to the dose estimation,the degree of whole body and local radiation damage was also judged by the clinical symptoms and signs,and changes in hemopoietic system.rhG CSF was given on days 4-23.Results The hemopoietic stem cell survival weighted whole body dose was 2.9±0.3Gy and the maximal dose was 3737.8Gy in right leg.Frequent episodes of nausea and vomiting were observed about 3 hours after exposure.The lymphocyte counts were 0.9-0.4×10 9/L on day 1 to day 2.In order to save life,his right lower extremity and left wrist had to be amputated on day 8.The nadir of white blood cells and platelets were 0.65×10 9/L and 19×10 9 on day 17 post exposure,respectively.rhG CSF was used for accelerating hematopoietic restoration,so that his critical stage lasted only for five days,followed by rapid recovery.Conclusion The study suggests that the local radiation damage might aggravate the total body condition so that the rational treatment of local damage should not be neglected in clinical practice.This is a case of moderate degree bone marrow form of acute radiation sickness associated with extremely severe local radiation damage.The early use of rhG CSF is beneficial to hematopoietic restoration,while the myocardiac enzymes can be used in assessment of local radiation damage.The early amputation of extremely severe damaged limbs is the key to success.
出处
《中华放射医学与防护杂志》
CAS
CSCD
北大核心
1997年第1期12-18,共7页
Chinese Journal of Radiological Medicine and Protection
关键词
骨髓型
急性
放射病
皮肤损伤
截肢术
局部损伤
Acute radiation sickness Local radiation damage rhG CSF Myocardiac enzyme Amputaion
