| Objective:To introduce medical treatment and psychological evaluation of three cases about three192Ir acute external irradiation persons, four60Co acute external exposure persons and four X-ray chronic irradiation persons. To explore the biological and psychological effects with acute or chronic irradiation and provide information and experience for medical emergency treatment of similar cases.Methods:1. Medical history collection:Clinical observation:Histories was taken by the "one to one" and "many-to-one" way. The clinical symptoms were observed and recorded. The priority is about radiation sensitive organizational change, such as skin, gastrointestinal tract, eye lens, etc.2. Laboratory:examinations:Irradiated persons were respectively carry out the corresponding auxiliary examination, the project including the blood cell analysis, urine stool routine, liver and kidney function, tumor designated object, immune function, thyroid function testing and ultrasonography B, ECG, X-ray,etal.3. Dose estimation:Biological dose was estimated by analysis of peripheral blood lymphocyte chromosome aberration, G-banding analysis, micronucleus assay. The acute external exposure illuminated systemic and local absorbed dose was estimated by air kerma method and thermoluminescence dose component method;4. Psychological assessment:The cattell sixteen personality factor test (16PF), depression self rating scale (SDS), self rating anxiety scale (SAS) used to evaluate the psychological status of victims.5. Medical treatment:According to the researchers illuminated situation, severity and clinical manifestation, the comprehensive treatment measures were taken to cure persons, such as support symptomatic treatment, Chinese medicine, psychological counseling.Results:1. We successfully obtained eleven persons’ detailed medical history material, radiation dose data and psychology information of three radiation accidents, which laid a foundation for further diagnosis and treatment.2. Clinical observation:(1) Seven persons with acute external irradiation all have different degrees of fatigue, sleep disorders, loss of appetite and other plant nerve disorder. GSH found left thenar skin appears erythema after eight days, the fingers of the right hand thumb and index finger, middle finger side appeared a number of red tip sample point after ten days; LGG has a point slightly cloudy crystal in right eye crystal. Others are no obvious abnormal signs.(2) Four X-ray chronic irradiation persons were illuminated for3to5years, and has shown symptoms such as fatigue sleep disorders and menstrual disorders for three years. WY’s hands diagnosed as "Renault" appearance in local hospital. Four person are no obvious abnormal signs.3.Laboratory examination:(1) Blood cell analysis:SYG results in a higher than normal amount of white blood cells, other persons with acute external irradiation were normal. Four X-ray chronic irradiation persons results in a lower than normal amount of white blood cells for several times check at the local hospital; Outside the radiation environment after six months, WY elevated white blood cells, but still below normal; LY, DYL and ZD white blood cells within the normal range, close to the normal limit.(2) Bone marrow analysis:The bone marrow of acute external exposure staff did not see abnormalities. DYL’s bone marrow hyperplasia of the results showed low active in red, grain increased proportion of red; No obvious abnormal was found in all illuminated staff.(3) Immune function:The rate CD8+of YW, LGG is a bit higher than normal; The rate of NK cells of GSH, YW is lower than normal; The rate of CD8+of YW, SYG is a bit higher than normal; The IgM of GSH is higher than the normal. C3of MXG is slightly lower than normal. The rate CD8+of DYL, ZD is slightly higher than normal; The rate of NK cells of WY, DYL, ZD is below normal; The rate of B lymphocyte of WY, LY, DYL is lower than normal. The illuminated cellular immunity and moral immunity of others are within the normal range.(4) Semen routine:GSH’s live sperm rate was lower than normal, abnormal sperm viability. YZZ’s live sperm rate was lower than normal, normal sperm vitality.(5) Other examination:There were no obvious abnormal results about the liver and kidney function, ultrasonography B, ECG, X-ray. The urinary exceed of GSH showed mild hyperplasia of prostate; The urinary exceed of YW prostate hyperplasia.4. Dose estimation(1)Biological dose:Used the circumference blood lymphocyte chromosome aberration, G banding analysis and micro nuclear analysis method (CB) of Illuminated staff to estimate the biological dose, all people were in the normal range, were unable to estimate the biological dose finally.(2) Physical dose:Air kerma physical dose estimation method of GSH body absorbed dose is310mGy, local absorbed dose is8.12Gy, LGG, LW body absorbed dose is3.1mGy. Thermoluminescence dose element method is used to estimate the systemic absorption of GSH dose was113.52～348.48mGy, absorbed dose is3.13～8.54Gy hands; LGG, LW body absorbed dose is18.72～32.76mGy.5. Psychological evaluation:SDS and SAS evaluation results shown before the treatment most illuminated staff is in a state of anxiety depression;16PF comprehensive all kinds of personality factors, mental health factors evaluation and environmental adaptation ability, the result shows the mean is generally lower than the general population. General psychological status after treatment compared with the previous improved significantly, but there are still some illuminated staff performance depression anxiety and psychological changes.6. Medical treatment:Illuminated staff were given comprehensive treatment measures such as the support symptomatic, traditional Chinese medicine. GSH diagnosed as acute radiation skin injury Ⅱ degrees, anti-inflammatory and topical vitamin B12treatment after systemic improvement; Other illuminated staff were diagnosed with excessive exposure. Chronic irradiation illuminated staff are diagnosed as observation objects.We advice them from radioactive working environment and take observation, and to diagnosis and treatment the disease after one year.Conclusions:It is a systematical work which contained taking history, estimating dose, medical treatment and psychological assessment with three192Ir acute external irradiation persons, four60Co acute external exposure persons, four X-ray chronic irradiation persons in three radiation accidents. From the angle of emergency,We can summarize the experience and lesson in the radiation accidents. It provides references for medical treatment and follow-up in similar cases. It also provides technical preparations for medical emergencies of nuclear accident。... |
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