三起放射事件中7例急性外照射人员及4例慢性外照射人员的医学处理及心理测评
发布时间：2018-08-30 09:43
【摘要】：目的： 通过对三起放射事件中3例192Ir急性外照射、4例60Co急性外照射和4例X射线慢性外照射的病史采集、医学处理及心理测评,探讨急性外照射及慢性外照射的生物学和心理学效应,为类似病例的医学应急救治提供资料和积累经验。 方法： 1、临床观察：采用“一对一”和“多对一”的方式对11例受照人员采集病史,密切观察和记录各自的临床表现,重点观察放射敏感组织的变化,如皮肤、胃肠道、眼晶体等。 2、辅助检查：分别对受照人员进行相应的实验室及器械检查,项目包括血细胞分析、尿粪常规、肝肾功能、精液常规、肿瘤标志物检测、免疫功能检测、甲状腺功能检测以及彩色B超、心电图、胸部X线检查等。 3、剂量估算：采用外周血淋巴细胞染色体畸变分析、G显带分析和微核分析(CB法)估算受照者的生物剂量；采用空气比释动能法及热释光剂量元件法估算急性外照射受照者的全身和局部吸收剂量。 4、心理测评：应用卡特尔十六种个性因素测验(16PF)、抑郁自评量表(SDS)、焦虑自评量表(SAS)对受照人员治疗前后的心理状况进行测评。 5、医学处理：根据人员的受照情况、严重程度及临床表现,予以对症支持治疗、中医中药调理及心理疏导等综合治疗措施。 结果： 1、病史采集： 成功采集了三起放射事件中7例急性外照射人员及4例慢性外照射人员较为详实的病史资料、受照剂量资料及心理学资料,为临床诊治奠定了基础。 2、临床观察： (1)7例急性外照射受人员均为意外照射,均有不同程度的乏力、睡眠障碍、食欲不振等植物神经紊乱症状。GSH受照后八天左手大鱼际皮肤出现红斑,十天后右手拇指及食指指腹、中指侧面出现数个针尖样红点；LGG右眼晶体有一点状轻度混浊,余未见明显异常体征。 (2)4例X射线慢性外照射受照者受照时间为3-5年,三年余前出现乏力、睡眠障碍、月经失调等症状。WY双手当地医院诊断为“雷诺征”。未见明显异常体征。 3、辅助检查： (1)血细胞分析7例急性外照射受照人员中SYG外周血白细胞高于正常值,余均在正常范围内。X射线放射事件中4例受照人员多次在当地医院检查,均发现白细胞低于正常值；脱离放射环境半年后,WY白细胞计数较前升高,但仍低于正常值,其余3人的白细胞计数在正常范围内,但接近正常值下限。 (2)骨髓象分析7例急性外照射受照人员骨髓象均未见异常。X射线放射事件中DYL骨髓象分析结果示红系增生活跃低水平,粒红比例增高；余受照人员均未见明显异常。 (3)免疫功能192Ir放射事件中YW、LGG受照后CD8+比率稍高于正常值,GSH、YW受照后NK细胞比率低于正常值,YW受照后B淋巴细胞比率稍高于正常值,GSH受照后IgM值略高于正常值。60Co放射事件中SYG受照后B淋巴细胞比率高于正常值,MXG受照后补体C3略低于正常值其他淋巴细胞比率在正常范围内。X射线放射事件中DYL、ZD的CD8+比率稍高于正常值,WY、DYL及ZD的NK细胞比率低于正常值,WY、LY、DYL及ZD的B淋巴细胞比率均低于正常值。余受照人员细胞免疫及体液免疫均在正常范围内。 (4)精液常规GSH精子活率较正常值减低,精子活力不正常。YZZ精子活率较正常值减低,精子活力正常。 (5)其它辅助检查11例受照者肝肾功能、心电图、胸部X线检查、腹部彩超、尿粪常规检查结果均未见明显异常。192Ir放射事件中GSH泌尿系彩超示前列腺轻度增生；YW泌尿系彩超示前列腺增生。 4、剂量估算： (1)生物剂量采用外周血淋巴细胞染色体畸变、G显带分析及微核分析(CB法)估算生物剂量,结果均在正常范围内,据回归方程无法估算生物剂量。 (2)物理剂量在192Ir放射事件中,空气比释动能法物理剂量估算GSH全身吸收剂量为310mGy,局部吸收剂量为8.12Gy, LGG、LW全身吸收剂量为3.1mGy o热释光剂量元件法估算GSH的全身吸收剂量为113.52～348.48mGy,手部吸收剂量为3.13～8.54Gy；LGG、LW的全身吸收剂量为18.72～32.76mGy。 5、心理测评： SAS测试结果提示,治疗前大部分受照人员处于焦虑抑郁状态；16PF测试结果提示,受试人员的各项心理学维度普遍低于普通人群均值。治疗后心理状况较前明显好转,但仍有部分受照人员表现抑郁焦虑等心理变化。 6、医学处理： 经过对症支持、中医中药调节免疫力等综合治疗措施后,受照人员的头晕乏力等症状减轻。7例急性照射人员中,GSH诊断为急性放射性皮肤损伤Ⅱ度,予全身抗炎及局部维生素B12处理后好转；余6例受照人员均诊断为过量照射。4例X射线慢性外照射受照者均诊断为观察对象,建议脱离可疑放射性工作环境,密切观察1年后再根据病情进行诊断和处理。 结论： 较为系统地对三起放射事件中7例急性外照射和4例慢性外照射受照者进行了病史采集、剂量估算、医学处理和心理测评,从应急管理角度分析总结了放射事故的经验教训,为类似病例的医学处理及随访提供了借鉴,为核事故医学应急提供了技术准备。
[Abstract]:Objective:
To explore the biological and psychological effects of acute external irradiation and chronic external irradiation on 3 cases of 192Ir, 4 cases of 60Co and 4 cases of X-ray chronic external irradiation.
Method:
1. Clinical observation: 11 cases of irradiation were collected by "one-to-one" and "many-to-one" methods, and their clinical manifestations were closely observed and recorded. The changes of radiosensitive tissues, such as skin, gastrointestinal tract and lens, were observed.
2. Auxiliary examination: Respectively carry out corresponding laboratory and instrumental examination for the irradiated personnel, including blood cell analysis, routine urine and feces, liver and kidney function, routine semen, tumor markers, immune function, thyroid function, color B-ultrasound, electrocardiogram, chest X-ray examination, etc.
3. Dose estimation: The biological doses were estimated by chromosome aberration analysis, G-banding analysis and micronucleus analysis (CB method) of peripheral blood lymphocytes, and systemic and local absorbed doses were estimated by air specific kinetic energy method and thermoluminescent dose element method.
4. Psychological Assessment: Sixteen Personality Factor Test (16PF), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to assess the psychological status of the subjects before and after treatment.
5. Medical treatment: According to the illumination, severity and clinical manifestations of the staff, symptomatic support treatment, traditional Chinese medicine and psychological counseling and other comprehensive treatment measures.
Result:
1, history collection:
Seven cases of acute external radiation exposure and four cases of chronic external radiation exposure were collected successfully. The dose data and psychological data were collected, which laid a foundation for clinical diagnosis and treatment.
2, clinical observation:
(1) Seven cases of acute external irradiation were accidentally irradiated, all of them had varying degrees of fatigue, sleep disorders, loss of appetite and other symptoms of autonomic nervous disorders. No obvious abnormal signs were found.
(2) Four X-ray chronic external irradiation recipients were irradiated for 3-5 years. Three years ago, they developed symptoms such as fatigue, sleep disorders, menstrual disorders, etc. WY was diagnosed as "Reynolds'sign" in the local hospital of both hands.
3, supplementary examinations:
(1) The white blood cell count of SYG in peripheral blood of 7 cases of acute external irradiation was higher than normal, the rest were within normal range. The remaining 3 white blood cells count in normal range, but close to the normal limit.
(2) Bone marrow analysis showed no abnormality in 7 cases of acute external irradiation. DYL bone marrow analysis in X-ray irradiation showed that erythroid hyperplasia was low in activity and the ratio of granulocyte red was high.
(3) The ratio of CD8 + in YW and LGG was slightly higher than the normal value, the ratio of NK cells in GSH and YW was lower than the normal value, the ratio of B lymphocytes in YW was slightly higher than the normal value, and the ratio of B lymphocytes in GSH was slightly higher than the normal value. In X-ray irradiation events, the ratio of DYL and ZD to CD8+ was slightly higher than normal. The ratio of NK cells in WY, DYL and ZD was lower than normal. The ratio of B lymphocytes in WY, LY, DYL and ZD was lower than normal.
(4) Routine GSH sperm motility was decreased and abnormal sperm motility was observed. YZZ sperm motility was decreased and sperm motility was normal.
(5) There were no significant abnormalities in liver and kidney function, electrocardiogram, chest X-ray, abdominal color Doppler ultrasonography and routine urine and stool examination in 11 cases of other auxiliary examinations.
4, dose estimation:
(1) The biological doses were estimated by chromosome aberration, G-banding and micronucleus analysis (CB) in peripheral blood lymphocytes. The results were within the normal range, and the biological doses could not be estimated by regression equation.
(2) In the 192Ir radiation event, the total absorbed dose of GSH was 310 mGy, 8.12 Gy, LGG, and 3.1 mGy, respectively. The total absorbed dose of GSH was 113.52-348.48 mGy, and the total absorbed dose of hand was 3.13-8.54 Gy, LGG and LW respectively. The body absorbed dose was 18.72 ~ 32.76mGy.
5, psychological assessment:
The results of SAS test showed that most of the subjects were in anxiety and depression state before treatment, and the results of 16PF test showed that the psychological dimensions of the subjects were generally lower than the average of the general population.
6, medical treatment:
The symptoms of dizziness and fatigue were alleviated after symptomatic support, immunity regulation by Chinese medicine and other comprehensive treatment measures. Among the 7 cases of acute radiation exposure, GSH was diagnosed as acute radiation skin injury of degree II, which was improved after systemic anti-inflammatory treatment and local vitamin B12 treatment; the remaining 6 cases were diagnosed as excessive irradiation. All the irradiated patients were diagnosed as the objects of observation. It is suggested that they should be separated from the suspicious radioactive working environment, closely observed for one year and then diagnosed and treated according to their condition.
Conclusion:
Seven cases of acute external irradiation and four cases of chronic external irradiation were collected for medical history, dose estimation, medical treatment and psychological assessment. The experiences and lessons of radiation accidents were analyzed and summarized from the perspective of emergency management, which provided a reference for the medical treatment and follow-up of similar cases, and provided emergency medical advice for nuclear accidents. For technical preparation.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R818.74
[Abstract]:Objective:
To explore the biological and psychological effects of acute external irradiation and chronic external irradiation on 3 cases of 192Ir, 4 cases of 60Co and 4 cases of X-ray chronic external irradiation.
Method:
1. Clinical observation: 11 cases of irradiation were collected by "one-to-one" and "many-to-one" methods, and their clinical manifestations were closely observed and recorded. The changes of radiosensitive tissues, such as skin, gastrointestinal tract and lens, were observed.
2. Auxiliary examination: Respectively carry out corresponding laboratory and instrumental examination for the irradiated personnel, including blood cell analysis, routine urine and feces, liver and kidney function, routine semen, tumor markers, immune function, thyroid function, color B-ultrasound, electrocardiogram, chest X-ray examination, etc.
3. Dose estimation: The biological doses were estimated by chromosome aberration analysis, G-banding analysis and micronucleus analysis (CB method) of peripheral blood lymphocytes, and systemic and local absorbed doses were estimated by air specific kinetic energy method and thermoluminescent dose element method.
4. Psychological Assessment: Sixteen Personality Factor Test (16PF), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to assess the psychological status of the subjects before and after treatment.
5. Medical treatment: According to the illumination, severity and clinical manifestations of the staff, symptomatic support treatment, traditional Chinese medicine and psychological counseling and other comprehensive treatment measures.
Result:
1, history collection:
Seven cases of acute external radiation exposure and four cases of chronic external radiation exposure were collected successfully. The dose data and psychological data were collected, which laid a foundation for clinical diagnosis and treatment.
2, clinical observation:
(1) Seven cases of acute external irradiation were accidentally irradiated, all of them had varying degrees of fatigue, sleep disorders, loss of appetite and other symptoms of autonomic nervous disorders. No obvious abnormal signs were found.
(2) Four X-ray chronic external irradiation recipients were irradiated for 3-5 years. Three years ago, they developed symptoms such as fatigue, sleep disorders, menstrual disorders, etc. WY was diagnosed as "Reynolds'sign" in the local hospital of both hands.
3, supplementary examinations:
(1) The white blood cell count of SYG in peripheral blood of 7 cases of acute external irradiation was higher than normal, the rest were within normal range. The remaining 3 white blood cells count in normal range, but close to the normal limit.
(2) Bone marrow analysis showed no abnormality in 7 cases of acute external irradiation. DYL bone marrow analysis in X-ray irradiation showed that erythroid hyperplasia was low in activity and the ratio of granulocyte red was high.
(3) The ratio of CD8 + in YW and LGG was slightly higher than the normal value, the ratio of NK cells in GSH and YW was lower than the normal value, the ratio of B lymphocytes in YW was slightly higher than the normal value, and the ratio of B lymphocytes in GSH was slightly higher than the normal value. In X-ray irradiation events, the ratio of DYL and ZD to CD8+ was slightly higher than normal. The ratio of NK cells in WY, DYL and ZD was lower than normal. The ratio of B lymphocytes in WY, LY, DYL and ZD was lower than normal.
(4) Routine GSH sperm motility was decreased and abnormal sperm motility was observed. YZZ sperm motility was decreased and sperm motility was normal.
(5) There were no significant abnormalities in liver and kidney function, electrocardiogram, chest X-ray, abdominal color Doppler ultrasonography and routine urine and stool examination in 11 cases of other auxiliary examinations.
4, dose estimation:
(1) The biological doses were estimated by chromosome aberration, G-banding and micronucleus analysis (CB) in peripheral blood lymphocytes. The results were within the normal range, and the biological doses could not be estimated by regression equation.
(2) In the 192Ir radiation event, the total absorbed dose of GSH was 310 mGy, 8.12 Gy, LGG, and 3.1 mGy, respectively. The total absorbed dose of GSH was 113.52-348.48 mGy, and the total absorbed dose of hand was 3.13-8.54 Gy, LGG and LW respectively. The body absorbed dose was 18.72 ~ 32.76mGy.
5, psychological assessment:
The results of SAS test showed that most of the subjects were in anxiety and depression state before treatment, and the results of 16PF test showed that the psychological dimensions of the subjects were generally lower than the average of the general population.
6, medical treatment:
The symptoms of dizziness and fatigue were alleviated after symptomatic support, immunity regulation by Chinese medicine and other comprehensive treatment measures. Among the 7 cases of acute radiation exposure, GSH was diagnosed as acute radiation skin injury of degree II, which was improved after systemic anti-inflammatory treatment and local vitamin B12 treatment; the remaining 6 cases were diagnosed as excessive irradiation. All the irradiated patients were diagnosed as the objects of observation. It is suggested that they should be separated from the suspicious radioactive working environment, closely observed for one year and then diagnosed and treated according to their condition.
Conclusion:
Seven cases of acute external irradiation and four cases of chronic external irradiation were collected for medical history, dose estimation, medical treatment and psychological assessment. The experiences and lessons of radiation accidents were analyzed and summarized from the perspective of emergency management, which provided a reference for the medical treatment and follow-up of similar cases, and provided emergency medical advice for nuclear accidents. For technical preparation.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R818.74
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