南京“5．7”放射事故急性放射病患者局部损伤感染的防治

Prevention and treatment of a case with acute radiation sickness combined with severe local radiation injury infection at ＂5. 7＂ accident in Nanjing

目的 探讨轻度骨髓型急性放射病患者局部严重放射损伤的感染防治措施及策略。方法 观察1例急性放射病患者受照部位感染的发生、发展及转归,根据药物敏感性试验合理选用抗生素,同时增强患者免疫功能,改善营养状况,对症支持治疗,采取病房、物品表面消毒,常规换药及持续负压封闭引流术等手段防治感染,并评价疗效。结果 在病程早期,患者未出现发热,平稳地度过了极期;病程中期,创面持续存在多种细菌感染,清创、肌皮瓣移植过程中始终伴随鲍曼不动杆菌等耐药菌的定植感染;经综合治疗控制了感染。结论 急性放射病伴有局部严重放射损伤患者的感染防治要兼顾全身和局部处理,合理应用抗生素,采取综合措施。

Objective To explore the measures and treatment plans to be taken for infection prevention and control of mild bone marrow form of acute radiation sickness combined with severe local acute radiation damage.Methods Medical treatment of a patient suffering such a radiation sickness caused by 192Ir external exposure was based to observe the occurrence, development and prognosis of infection and clinical manifestations, analyse the etiology of the wound surface and other related laboratory indicators, and evaluate their curative effect of antibiotics and other comprehensive measures. Results In early phase, the patient had no fever and survived the critical phase. During the medical treatment, the wound surface was accompanied complicated bacterial infections, especially there always being by drug-resistant bacteria such as Acinetobacter baumannii, especially during debridement and myocutaneous flap transplantation. The infections were controlled effectively by the series of comprehensive treatment.Conclusions In order to prevent and control the infection of patient suffering acute radiation sickness combined with large area of severe local radiation injury, both systemic and local treatment should be considered together with reasonable application of antibiotics and other comprehensive measures.