忻州^(60)Co源放射事故主要8例受照者临床报告

Clinical report of eight chief victims in 60~Co radiation

目的通过对诊断不明病人“芳”的诊断和治疗，探索在放射源不明情况下，如何进行放射病的诊断；探索采用简易隔离和ＧＭ－ＣＳＦ治疗效果；同时回顾性介绍同组其他病人发病经过。方法通过详细询问病史，排除传染病和中毒，在高度怀疑放射病时，经对外周血淋巴细胞染色体畸变分析，确诊急性放射病；复习文献，提出放射源不明、放射病诊断线索。结果经作淋巴细胞染色体畸变分析，估算受照剂量为２．３０（２．０７～２．５０）Ｇｙ，确诊为骨髓型急性（中度）放射病，同时推断家中死亡３例也为放射病。结论如遇到难以解析的皮肤烧伤病变（红斑，水疱），排除热或化学烧伤后，应考虑放射烧伤，对有恶心，呕吐，脱发，口腔溃疡，外周血细胞减少者，更支持诊断；如家中成员中相继发生上述同类症状者更应高度怀疑，并作相关检查确诊；简易隔离可为一般医院所采用；细胞因子可促进造血功能恢复。

Objective\ This paper presents the clinical diagnosis and treatment of one patient (Fang) with acute radiation sickness(ARS) without obvious history of radiation exposure,the therapeutic effect of simple isolation and administration of GM CSF and the condition of other seven patients in this group.Methods \ After collecting detailed history and chromosome aberration analysis of lymphocytes,a definite diagnosis of ARS was made and infectious diseases and poisoning were ruled out.Results \ When Fang was recovered using GM CSF and simple isolation,143 rings plus dicentric aberrations were found in 300 lymphocytes at intermitotic phase,0.4368 “R+Dic” averagedly exist in every cell,the whole body dose was estimated to be 23Gy.Thus,acute radiation sickness of moderate degree was ascertained.It was deduced that 3 other members in Fang's family died of ARS.Altogether about 100 victims were found.Conclusion\ When a patient suffers suspicious burn(erythema,blistering) but without a history of contact of heat or fire and caustic chemicals and the patient has nausea,vomiting,epilation and decrease in white blood cells,the possibility of radiation exposure exists.If some patients with above manifestations are found in a same family, the radiation exposure may be more probable.A simple isolation ward can be set in an ordinary hospital and GMCSF should be used to reduce the course.