| 侯雨含,刘玉龙,王优优,卞华慧,陈炜博,戴宏,冯骏超,崔冉,王睿昊,杜云,王敏,姚振.一例192 Ir源外照射致右手指急性放射损伤的临床综合处理[J].中华放射医学与防护杂志,2019,39(11):852-858 |
| 一例192 Ir源外照射致右手指急性放射损伤的临床综合处理 |
| A case of acute radiation injury of right finger caused by 192Ir external irradiation |
| 投稿时间：2019-07-01 |
| DOI：10.3760/cma.j.issn.0254-5098.2019.11.010 |
| 中文关键词: 192Ir 急性放射性皮肤损伤 过量照射 |
| 英文关键词:192Ir Acute radiation induced skin iniury Excessive external exposure |
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| 中文摘要: |
| 目的 通过对一起192Ir源辐射事故中一例过量照射合并右手指Ⅲ度急性放射性皮肤损伤患者的剂量估算、临床观察和医学处理的总结，探讨同类放射损伤的救治技术和疾病的发生、发展规律。方法 2016年11月15日，苏州大学附属第二医院收治一名放射损伤患者，入院后详细询问受照者"任"的受照经过，并系统地观察其临床表现；通过外周血淋巴细胞染色体畸变分析估算全身生物剂量；通过蒙特卡罗计算估算物理剂量；进行系统的实验室及影像学检查，评估病情；进行综合分析，确定诊断和治疗方案。结果 "任"在受照后3 d感右手食指皮肤发红，轻度疼痛不适。受照后21 d右手食指远端指节及第2指节掌面、桡侧面及背面均被水疱覆盖。生物剂量估算结果为0.43 Gy （95%CI：0.31~0.58 Gy）；物理剂量估算右手手指各部位剂量36~164 Gy。造血系统、免疫系统及内分泌生殖系统均正常；肝功能指标值一过性升高，结合患者既往病史及入院检查结果，考虑为使用抗生素引起的一过性药物性肝损伤，予停用相关抗生素及保肝治疗后好转。于受照射后22 d行右手指切开减压术，并取其大腹部脂肪，提取干细胞植入其右手食指损伤处。经过59 d住院治疗，"任"全身无明显不适，右手食指恢复状况良好，疼痛较前明显减轻，指关节活动基本正常。结论 成功地处置了一名192Ir过量外照射合并Ⅲ度急性放射性皮肤损伤患者，局部应用自体脂肪干细胞移植取得了良好的效果。 |
| 英文摘要: |
| Objective To explore the treatment technique, occurrence and development patterns of such radiation injuries as in a major radiological accident in which a victim suffered mild bone marrow radiation sickness combined grade degree Ⅲ acute radiation induced skin injury, based on his dose estimation, clinical manifestations and disease treatments. Methods History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with analyzing the chromosome aberration of peripheral blood lymphocytes. The physical dose was estimated by Monte Carlo method.The systematic laboratory and imaging examination was performed to evaluate the condition. The comprehensive analysis was conducted to determine the diagnosis and treatment plan. Results At 3d after the exposure, "Ren" felt mild pain and discomfortable on the skin of the right index finger. The body of the right hand index finger was covered with blister at 21 d after exposure.The estimation of biological dose was 0.43 Gy (95%CI:0.31-0.58 Gy), and the physical dose was estimated to be 36-164 Gy for each part of the right hand finger. The hematopoietic system, immune system and endocrine system were normal. The liver function index value was transiently increased. The liver damage resulted from the use of antibiotic-induced combined with the patient's past medical history and admission examination result, and the relevant antibiotics were discontinued. The liver function returned to normal after liver protection treatment. At 22 d after irradiation, a right finger incision and decompression surgery were performed. The stem cells were extracted and implanted into the right index finger. After 59 days of hospitalization, there was no obvious discomfort in the body, and the right index finger recovered well, as well as the pain significantly relieved, and the knuckle activity was basically normal. Conclusions The patient with excessive radiation and grade Ⅲ acute radiation skin injury was successfully treated, and local application of autologous adipose-derived stem cell transplantation achieved good result. |
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