Medical Treatment Of The Patient With "5.7" Radiation Accident In Nanjing And Medical Follow-up Of 2 Years After Irradiation

ObjectiveTo discusse the medical treatment and investigate the late effects of ionizing radiation by retrospective study of medical treatment of the patient with "5.7" radiation accident in Nanjing and medical follow-up of 2 years after irradiation,and provide more experience for the treatments in the medical nuclear accident.Methods1.Review of medical treatment after the exposure of the patient Wang1)Review the process of the radiation accident in Nanjing in 2014,dose estimation and diagnosis.2)medical treatment during the period of hospitalization.2.Medical follow-up of 2 years after irradiation1)Carefully inquiry the medical history,observe and record of the Wang's symptoms and signs;focus on the main injury sites and radiation-sensitive organ changes,such as the right lower extremity local injury,gonads and so on.2)Laboratory tests: hematopoietic system,immune system,thyroid hormone,sex hormones and other related laboratory tests.3)Equipment examination: MRI,thyroid color Doppler ultrasound,ophthalmic examination,chest X-ray and ECG examination.4)Psychological evaluation: The use of Cattell's 16 personality factor,self-rating depression scale,self-rating anxiety scale on Wang to implement psychological evaluation.5)To get the information of Wang's right lower limb dysfunction rehabilitation and analgesic treatment.Result1.Review of medical treatment after exposure1)Process of the accident,dose estimation and diagnosisWang picks up a chain of ¹⁹²Ir source metal items standing outside the right thigh when it stood for about 3 hours and 15 minutes,the equivalent of a whole body dose equivalent to 1.51 Gy of acute whole body irradiation,right thigh skin The maximum dose was about 4100 Gy.It was diagnosed as mild radiation-induced acute myeloid leukemia,IV degree acute radiation-induced skin injury in the right lower extremity,and severe radioactive gonadal injury.2)Medical treatment during the period of hospitalizationSystemic treatment and local treatment are equally important.Systemic treatment is mainly for anti infection,improving microcirculation,promoting hematopoiesis,enhancing immunity and symptomatic treatment.Local treatment includes debridement,dressing,myocutaneous flap transplantation,vacuum sealing drainage,umbilical cord mesenchymal stem cell infusion and so on.2.Medical follow-up results of two years after exposure1)Wang was significantly better than normal after discharge,good appetite,sleep,and two will be normal,right lower extremity radiation wounds at the wound healing,but the right lower extremity still some dysfunction and pain,the need to walk on crutches And analgesic treatment.2)Laboratory examination: blood routine examination showed mild anemia;indexes of immune system normal;bone marrow puncture indicates that right iliac bone hyperplasia is low;thyroid hormone tests indicate the presence of subclinical hypothyroidism;sex hormone levels were increased in varying degrees,suggesting that testicular injury;semen examination showed that the sperm survival rate was 0.3)Equipment examination results: MRI examination showed right femur marrow cavity edema,soft tissue swelling of the right thigh subcutaneous,were relieved than discharged,muscle abnormalities can be seen in the signal foci,but the range was reduced when discharged;a small amount of bilateral testis Fluid.Ophthalmology examination revealed right eye vision damage,the ophthalmic lens appears turbid point,the retina and fundus appear radioactive injury.Thyroid color Doppler ultrasound,chest X-ray and ECG were no obvious abnormalities.4)Psychological evaluation: Wang slightly less stable psychological state,prone to worry,emotional,no obvious depression,anxiety performance.5)Right lower extremity dysfunction rehabilitation and analgesic therapy: rehabilitation treatment is mainly for local ultrasound treatment,Chinese medicine smoked drug treatment with joint loose training and isokinetic strength training.Analgesic treatment for the combination of physical analgesia and analgesic drugs,analgesic analgesics for oral oxycodone hydrochloride sustained-release tablets,gabapentin;physical analgesia to adopt transcutaneous electrical nerve stimulation.ConclusionThe process of the accident,dose estimation and medical treatment of "5.7" radiation accident in Nanjing were reviewed comprehensively.The systematic follow-up of various organs and systems of this patient was reviewed,which provided important experience for medical treatment and medical follow-up observation of similar cases;Further evaluation of the late effects of radiation damage needs further medical follow-up.