南京“5．7”^192Ir源放射事故患者的营养治疗

Nutrition treatment scheme for a patient exposed to Nanjing ＂5.7＂ ^192 Ir source accident

目的 通过对南京＂5.7＂192Ir源放射事故患者全程救治中的营养治疗,探讨放射损伤患者的营养治疗方案。方法 在不同救治阶段,对患者进行膳食调查和监测相关营养指标包括体重、体质量指数（BMI）、血常规、血生化指标等,并使用代谢车测定患者静息能量消耗值,为患者制订不同的营养治疗方案。结果 患者入院时（受照后第5天）体重42.5 kg,受照后第172天（首次植皮术后）下降至最低为36 kg,此后逐渐回升,出院时（受照后第383天）体重基本恢复。血红蛋白入院时正常为135 g/L,受照后第172天降至最低为54 g/L,出院时恢复正常;淋巴细胞入院时偏低为0.5×10^9/L,受照后第58天恢复正常,受照后第172天降至最低为0.4×10^9/L,出院时恢复正常。血清白蛋白入院时正常为41.2 g/L,受照后第172天降到最低为25.3 g/L,出院时恢复正常;血清前白蛋白入院时正常为0.22 g/L,受照第248天降至最低为0.04 g/L,出院时基本恢复正常为0.17 g/L。肝功能指标入院时正常,胆红素指标略偏高,进行＂全合一＂肠外营养后约2.5个月后,肝功能指标和胆红素指标均逐渐升高,经调整营养治疗方案及保肝利胆等治疗后逐渐恢复正常。受照后第294、308和342天使用代谢车测得患者的静息能量消耗值,据此确定患者当日热能需要量。结论合理营养治疗可以有效改善放射损伤患者的全身营养状况及临床疗效,是放射损伤临床救治的关键手段之一。

Objective To provide nutritional supportive scheme for patients with radiation injury through the treatment of the one exposed to Nanjing 192Ir source accident.Methods The reasonable nutrition treatment scheme was made on the basis of dietary survey and nutritional index monitoring during clinical stages of the patient, including body weight, body mass index（BMI）, biochemical indexes, electrolyte, etc., as well as metabolic cart determination of resting energy expenditure （REE）. Results Patient on admission （days 5 post-irradiated） weighing 42.5 kg, 172 days after the first irradiated （the first skin grafting） fell to a minimum of 36 kg, then gradually rise, hen rose back to normal range on days 383 before discharge. Normal admission hemoglobin was 135 g/L, 172 d after irradiated to a minimum of 54 g/L, normal discharge; when lymphocytes admission low as 0.5×10^9/L, 58 days back to normal after exposure, 172 days after irradiated down to 0.4×10^9/L. Serum albumin was normal admission 41.2 g/L, 172 days after irradiated down to 25.3 g/L. The normal level of serum prealbumin was 0.22 g/L, 248 days to a minimum of 0.04 g/L, the basic return to normal at discharge was 0.17 g/L. Admission normal liver function, bilirubin index slightly higher, the ＂all in one＂ parenteral nutrition after about 2.5 months later, bilirubin and liver function indicators were gradually increased, the adjusted treatment and nutrition liver and gallbladder and other gradually returned to normal after treatment. REE and the body weight were determined by metabolic cart on days 294, 308 and 342 for the energy requirements. Conclusions For patient with radiation injury, appropriate nutrition therapy is a key method for the clinical treatment and rehabilitation, which can maintain the nutritional status of patients and improve clinical treatment.