辐射损伤的分类及诊断——介绍美国国家战略储备辐射工作组关于急性放射病治疗的建议之一

Triage and diagnosis of radiation injuries——Introduction of a suggestion on acute radiation sickness therapy made by strategic national stockpile radiation working group of USA. Part 1

美国国家战略储备辐射工作组根据可能遭受到的放射性恐怖袭击,制定了不同急性照射剂量范围、出现不同数量伤员的救治方案,为内科和相关医疗专业的医生提供评估和处理大规模辐射损伤伤员的基本临床指南。该建议以恶心、呕吐发生的时间和严重性,照射后数小时及数日内淋巴细胞下降绝对值,以及外周血淋巴细胞染色体畸变率(包括双着丝粒和染色体环)来评估个体受照射剂量。各个时期出现的造血、胃肠道、脑血管和皮肤系统的临床征兆和症状等是病人分类、选择治疗和预后的重要信息。

Strategic National Stockpile Radiation Working Group developed a consensus document to provide a framework for physicians in internal medicine and the medical subspecialties to evaluate and manage large-scale radiation injuries for aiding individuals injured by a terrorist act involving radioactive material. Scenarios have been developed for such acts that include a range of exposures resulting in few to many casualties. Individual radiation dose is assessed by determining the time to onset and severity of nausea and vomiting, decline in absolute lymphocyte count over several hours or days after exposure, and appearance of chromosome aberrations （including dicentrics and ring forms） in peripheral blood lymphocytes. Documentation of clinical signs and symptoms （affecting the hematopoietic, gastrointestinal, cerebrovascular, and cutaneous systems） over time is essential for triage of victims, selection of therapy, and assignment of prognosis.