医源性急性放射病的临床探讨

目的 通过观察医源性急性放射病的临床和治疗经验，为事故性放射病的救治提供依据。方法 观察41例经过大剂量照射预处理的自体外周血造血干细胞移植患者的外周血象、体温和症状，并作统计学比较与相关分析。结果 照射后患者外周血白细胞、血小板逐渐下降，平均于照后第10天、第13天至最低值，分别于第18天、第17天恢复，血红蛋白仅有轻至中度降低。移植后使用rhG-CSF与未使用rhG-CSF患者造血重建时间差异有统计学意义。移植前采集的单个核细胞数与骨髓重建时间呈负相关。照射副作用除常见呕吐、乏力、腮腺肿大、口腔溃疡、肝功异常及皮肤损伤外，25．6％患者照射后体温升高。粒细胞减少或缺乏期感染发生率为63．4％，多为轻度，心脏功能及肾脏功能基本不受影响。患者均能平稳渡过骨髓抑制期。结论 rhG-CSF的应用可明显缩短粒细胞缺乏期，促进骨髓重建；而移植前采集足够数量的单个核细胞是治疗医源性放射病、缩短造血恢复时间的关键；严格实行全环境保护和及时、联合、足量应用抗生素的原则为医源性急性放射病患者能够顺利渡过极期、减少感染等合并症提供了保证。

Clinical investigation of iatrogenic acute radiation sickness

Objective To accumulate clinical experience for treatment of accidental acute radiation sickness(ARS) by observation of ARS induced by medical treatment. Methods To observe the changes of peripheral blood indexes,body temperature and clinical symptoms of 41 cases who were clinically irradiated with high dose irradiation(TBI or TLI) before autologous peripheral blood stem cell transplantation(auto-PBSCT).All data were statistically analyzed. Results After irradiation,peripheral WBC and PLT counts began to decrease,and reached their lowest levels at days 10 and 13 separately.They returned to the normal levels at days 18 and 17,respectively.Hb only decreased mildly.The hematopoietic reconstruction time was significantly different between the group of using G-CSF and the group without using it.The number of MNC infused and the time of hematopoietic reconstitution bore negative correlation.The side effects of high dose irradiation included vomiting,debilitation,parotid gland megaly,dental ulcer,hepatic injury and skin injury.In addition,25.6% of the cases got fever after irradiation.The incidence of infection at neutropenia phase was 63.7%,but most of them were mild.There was no significant injury of cardiac and renal functions.Most cases could tide over the myelosuppression phase smoothly without crisis of ARS. Conclusion Treatment with G-CSF can reduce the time span for bone marrow reconstruction significantly.Infusion of sufficient number of MNC is critical for bone marrow reconstruction.Comprehensive environmental protection and combined antibiotics treatment are the key points for patients to overcome neutropenia successfully during PBSCT.