| Ye Genyao,Wang Guilin,Luo Qingliang,Yang Zhixiang,Mao Bingzhi.[J].中华放射医学与防护杂志,1997,17(1):4-11 |
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| Joint Report of the Jilin 192 Ir Radiation Accident: A Clinical Study on A Case of Moderate Degree Bone Marrow Form of Acute Radiation Sickness with Extremely Severe Local Radiation Injury |
| 投稿时间：1996-05-04 修订日期：1996-09-03 |
| DOI： |
| 中文关键词: |
| 英文关键词:192Ir Radiation accident Acute radiation sickness Amputation Uneven irradiation |
| 基金项目: |
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| 英文摘要: |
| Objective After the medical handling of a patient exposed to extremely uneven total body irradiation from an 192Ir source (the activity was 2.765 TBq)on January 5,1996 in Jilin Province,we will provide new successful experience for medical support in future nuclear accident and to the security of peaceful uses of nuclear energy. Methods The dose distributions in the local tissues and the whole body were estimated by calculation.The biological doses were estimated by lymphocyte chromosome aberrations and micronuclei. In order to save the life,eradicate the focus of infection and avoid the impending acute renal failure(a lesson learned from the Estonia radiation accident),his right lower extremity was amputated at the level of about 23cm above the knee on day 8 and his left wrist amputated on the same day.145 days after the exposure he had the 2nd amputation of his reserved right leg because of intolerable pain and failure of healing.Pathological exmination of the amputated parts was made and dose (Gy) to the parts was estimated by electron spin resonance (ESR).The enzymes for muscle injury and HPRT gene mutation frequency(mf)were determined.The hemopoietic activity in the patient's sera was monitored.The treatment consisted of strict isolation in laminar air flow room(LAFR),antibiotics,radioprotective agent,measurcs improving the microcirculation and administration of rhG-CSF from day 4-23 with early recovery of leucocytopenia. Results The hematopoietic stem cell survival weighted whole body dose was 2.9Gy,and the maximal skin surface dose estimation at the right lower extremity was 3737.8Gy.The biological doses were consistent to the dose estimated by physical measurement.The local tissue absorbed dose estimated by ESR(Gy) at lst amputated sites of femur were 45.4Gy and 38.4Gy respectively and at the 2nd amputated sites of femur were 9.1Gy,8.7Gy,6.6Gy and 6.5Gy respectively.There were GM-CSF like,IL-3-like and Epo like activities in the plasma of the patient and were consistent with the changes of WBC,RBC and Hb in the patient's blood.The HPRT gene mf was determined to be 30×10-8 ,comparable to that of 3Gy60Co γ-rays in vitro and also consistent with the physical dose of 2.9Gy.Masssive necrosis of the cells of the epidermis,appendages of the skin,hypodermis,skeletal muscles were seen microscopically in the heavily irradiated part of the right shank. Conclusion The authors emphysize the early amputation as the key to success,the importance of rhG-CSF effect and the significance of rational nutrition for the support of the patient,who had total body irradiation,massive local radiation injury and extensive surgical intervention to sustain. |
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