一例^(192)Ir极不均匀外照射局部极重度放射损伤的临床观察

Clinical observation of extremely severe local radiation injury by extremely heterogeneous 192 Ir irradiation:report of a case

目的对１例１９２Ｉｒ极不均匀外照射局部极重度放射损伤病人进行临床观察。方法系统观察了病变的临床过程和应用红外线热成像技术测定了损伤部位的温度变化。结果照射后２小时出现肢体麻木、抽搐，最早照后４小时出现红斑、肿胀，５４小时出现水疱，第５天出现坏死和剧痛，最晚出现红斑、肿胀是照射后４１天，４７天出现水疱和糜烂创面。红外线热成像显示：损伤早期温度升高，水疱、坏死区和损伤后期温度降低，温度升高越早，损伤越重，温度改变区域与损伤范围相一致。结论大剂量极不均匀外照射放射损伤的初期反应早，放射病与局部损伤相互加重病情，症状先后不一，轻重不等，致残率高和疼痛剧烈，红外线热成像温度变化可以作为临床诊断的指标之一。

Objective The clinical observation of a case of extremely severe local radiation injury by extremely heterogeneous external irradiation of 192 Ir is reported.Method The clinical pathologic change was systematically observed,and the temperature changes in the radiation injured parts were examined by infra red thermoimaging.Results Numbness and convulsion occurred 2h after irradiation,the earliest erythema and swelling were found 4h after irradiation.Blistering took place 54h after irradiation,necrosis and severe pain occurred at the 5th day,the latest erythema and swelling were found 41days after irradiation,and blistering and erosive surface of wound took place at the 47th day.Infra red thermoimaging examination showed that temperature increased in the early stage of injury,while it decreased in blisters,necrotic regions and in the late stage of injury.The earlier the temperature increased,the severer the injury was.The region of temperature change was consistent with injury extent.Conclusion Incipient reaction occurred early,injury was exacerbated by radiation sickness and local injury,symptoms were different in early and late stages and varied in severity,the disability was high and pain was severe.The temperature change during infra red thermoimaging can be used as one of the objective indices for the diagnosis of injury extent and degree.