The Discussion Of Prevention And Treatment Of Infection Of The Patient In “5.7”¹⁹²Ir Radiation Accident In Nanjing

ObjectiveThis study aimed to explore the problems of infection prevention and treatment of the patients suffer from external exposed acute radiation disease with severe local radiation injury during clinical treatment. To provide a theoretical basis and treatment experience for the prevention and control of infection in similar patients with acute radiation injury in the future.Methods1. Accident investigation and dose estimation: Investigate the detail of the accident. Use the Monte Carlo method to estimate the physical dose. The biological dose was estimated by the analysis of chromosome aberration and the analysis of lymphocyte micronucleus.2. The protection of the environment and nursing management: Apply the methods such as restricting on the flow of ward staff, disinfection of the environment, environmental detection and good nursing measures for patients to provide clean room environment; take good nursing of the other parts of the skin and mucosa beside the wound surface.3. Hematopoietic and immune system monitoring: use the bone marrow biopsy and peripheral blood cell analysis and other methods to evaluate the ability of bone marrow hematopoietic and immune system of the patient. Apply granulocyte colony stimulating factor(G-CSF) to stimulate the ability of hematopoiesis.4. Wound treatment: Use the methods such as debridement, myocutaneous flap transfer to repair the wound. During the treatment, we use dressing, vacuum sealing drainage(VSD) and other measures to deal with the wound surface. At the same time, we detect the pathogenic changes of the wound.5. Antibiotic application: According to clinical manifestations and the pathogenic results of wound of the patient, we apply antibiotic and antifungal agents to prevent and treat the infection, evaluate the effect of the drugs afterwards.6. Nutritional therapy: Thepatient has poor nutrition during wound repairing,applyenteral and parenteral nutrition support, monitor the nutrition index.Result1. The result of the equivalent whole body dose estimation ofthepatient was 1.51 Gy(95% CI 1.40-1.61). According to the dose estimation results and clinical manifestations, the patientwas diagnosed as mild bone marrow form of acute radiation sickness from external exposure with severe local radiation injury.2. According to the operations of the wound, the treatment was divided into four stages.2.1 Stage I: After stimulated the hemopoietic system and other treatment, hematopoietic and immune system recovered well in the early period. During the course of disease, the wound gradually became necrotic. After the strengthened wound management and using of prophylactic antibiotics, the patient passed through the pole stage successfully.2.2 Stage II: At the 62 day after exposure, the expand debridement operation of the wound on the right thigh were carried out. After the combined treatment of the wound dressing and the usage of Vacuum sealing drainage(VSD), the inflammation of the wound is light, came up with no occurrence of systemic infection.2.3 Stage III: At the 171 day after exposure, we carried out the first transfer-transplantation operation of myocutaneous flap of latissimus dorsi. At the 9 day after operation, the wound appeared colonization infection of Bauman Acinetobacter. Through conventional dressing, continuous negative pressure closed to attract local treatment technology measures and systemic application of antibiotics. Effectively prevented the invasion of drug-resistant bacteria and avoided the occurrence of systemic infection.2.4 StageⅣ: At the 263 day after exposure, the second transfer-transplantation operation of myocutaneous flap of latissimus dorsi carried out successfully, postoperative flap healed well. At the 278 day after exposure, the patient came up with lung infection and developed to septic shock. After the combined application of antibiotics and antifungal agents, the infection was controlled effectively. At the 378 day after exposure,the patient was discharged with healed wound.ConclusionThe prevention and control of infection of acute radiation sickness from external exposure with severe local radiation injury is very complicated. Systemic and local treatment should be paid more attention, reasonable application of antibiotics and strengthen the external environment disinfection of the ward, comprehensive treatment measures should be applied.