What Is Radiation Sickness?

Radiation disease is a systemic disease caused by the body being exposed to large doses of ionizing radiation in a short time. External radiation and internal radiation may cause acute radiation sickness, but external radiation is the predominant. Radiation that causes acute radiation sickness includes gamma rays, neutrons, and X-rays.

Basic Information

English name

radiation sickness

Visiting department

Chemotherapy Department

Common causes

Ionizing radiation exposure

Common symptoms

Nausea and loss of appetite, vomiting, severe diarrhea, disorientation, ataxia, limb tremor, etc.

Causes of radiation sickness

It is a systemic disease caused by large doses (> 1Gy) of ionizing radiation in a short time. Radiation that causes acute radiation sickness includes gamma rays, neutrons, and X-rays.

Clinical manifestations of radiation sickness

1. Nausea and loss of appetite in the early post-photograph period. The dose may be greater than 1Gy; those with vomiting may be greater than 2Gy. If multiple vomiting occurs, it may be greater than 4Gy. If vomiting and diarrhea occur early, it may be exposed to more than 6Gy.

2. Multiple vomiting within a few hours after the photo, and severe diarrhea soon occur, but those without neurological symptoms can be considered as intestinal radiation sickness.

3. Frequent vomiting, disorientation, ataxia, limb tremor, and increased muscle tone within 1 hour after the photo can be basically diagnosed as cerebral radiation sickness. If twitches occur when the trauma factor is ruled out, they can be confirmed as cerebral radiation sickness.

Attention should be paid to comprehensive analysis of the initial symptoms, and psychological factors must be excluded.

Radiation examination

The correct determination of the patient's exposure dose is the main basis for judging the condition. Physical conditions and biological doses can be measured separately when conditions permit, and the two can complement each other to obtain more accurate values.

Radiation diagnosis

Detailed inquiry of past history, the diagnosis of radiation sickness must determine whether the patient has radiation sickness, but also early to determine the extent of the disease and the stage of the disease at the time of diagnosis, which is very important to guide the timely and effective treatment measures.

Radiation Therapy

1. Principles of treatment of bone marrow radiation sickness

(1) The main contradiction for comprehensive treatment of bone marrow-type radiation disease with hematopoietic injury as the center is hematopoietic tissue injury. Therefore, around this center, on the one hand, we must try to reduce and delay the development of hematopoietic organ injury and promote the recovery of injury; on the other hand, we must vigorously prevent complications such as infection and bleeding caused by hematopoietic injury. In addition, since the damage of radiation disease involves various organs in the whole body, comprehensive treatment is still the main method to maintain the balance of the internal environment of the body and survive the extreme period safely.

(2) Graduated and staged treatment of mild radiation sickness can be observed in a short-term hospitalization, symptomatic treatment, symptomatic treatment during wartime, and observation in the team. Hospitalization is required for moderate-to-moderate radiation sickness. However, moderate early treatment can be simplified. Serious and extremely severe patients should not only be hospitalized immediately, but also take early preventive treatment measures to achieve the so-called "grasping the early stages, focusing on hematopoiesis, focusing on the extreme stage", which will help improve the cure rate. . In addition, it is necessary to treat different contradictions in each period. In the early stage, symptomatic treatment is mainly aimed at the initial symptoms, and measures to reduce injuries are taken according to the characteristics of the lesion. Keep patients quiet and restful and emotionally stable; early anti-radiotherapy; sedative and antiemetic symptomatic treatments, such as diazepam and metronidazole; those who have symptoms such as conjunctival hyperemia and skin flushing, give diphenhydramine, Desensitization drugs such as promethazine; improve microcirculation; sterilize the intestines early in patients with severe severity and disinfect and isolate them. Hematopoietic stem cell transplantation is performed early in severe and very severe patients. The focus of the false healing period is to protect hematopoietic function, prevent infection and prevent bleeding. Intensive care, pay attention to observe changes in the condition. Encourage patients to eat more, give high-calorie, high-protein, high-vitamin and easy-to-digest foods. Very severe patients can use intravenous retention catheters to supplement nutrition; protect hematopoietic function, delay and reduce hematopoietic damage. Multiple vitamins can be taken orally, and a small amount of blood can be transfused in severe patients; prevention of infection and bleeding prevention; very severe patients who need to transplant hematopoietic stem cells, if not initially, should be transplanted as soon as possible after entering this period. Extreme anti-infection and anti-bleeding are the key issues in this stage of treatment. At the same time, strong supportive treatment should be adopted to provide adequate nutrition, maintain water and electrolyte balance, correct acidosis, and promote the recovery of hematopoietic function. The patient is absolutely bed rest, control the infusion rate, prevent aggravation of pulmonary edema, pay attention to observe changes in the condition; anti-infection, anti-bleeding; promote the recovery of hematopoietic function, give vitamin B ₄ , B ₆ , B ₁₂ , folic acid and DNA preparations, hematopoietic factors can be applied As well as traditional Chinese medicines for replenishing and regulating qi and blood; while supplying sufficient nutrition (including intravenous replenishment), potassium ions and alkaline medicines can be supplemented as needed, and energy mixtures such as coenzyme A and ATP can be given at the same time. The recovery period mainly prevents recurrence of the disease and treats the remaining lesions. Strengthen nursing to prevent patients from overwork, prevent colds and re-infection, pay attention to nutrition intake and observe the occurrence of various complications; continue to promote the recovery of hematopoietic function, iron patients, can take iron medicine, take Chinese medicine tonic and conditioning blood, or A small amount of blood transfusion; symptomatic treatment for those with indigestion and other symptoms; after the clinical recovery period, you should continue to rest, recuperate for a period of time, work away from radiation. After physical examination, proper work can resume.

2. Main treatment measures

(1) Early administration of anti -radiotherapy Anti-radiotherapy refers to a class of drugs that can reduce radiation sickness when administered before and early after irradiation, and has a better effect on moderate and severe radiation sickness.

(2) Improving early microcirculation disorders after microcirculation irradiation can aggravate tissue cell damage, especially for severe radiation sickness. In the first 3 days after irradiation, low-molecular-weight dextran can be intravenously added, and an appropriate amount of dexamethasone and compound salvia injection can be added to improve microcirculation, increase tissue blood flow and reduce tissue damage.

(3) Prevention and treatment of infections Prevention and treatment of infections occupy a very important position in the treatment. Especially in the extreme period, the control of infection should be given priority. Admission to the hospital for cleansing or bathing with 1: 5000 chlorhexidine medicinal bath. Segment isolation during war and disinfection , that is, separate rooms or hospitalizations with other wounded and sick to avoid cross infection. Wards are often wiped with UV disinfection and disinfectant. Usually, patients with severe severity should be admitted to a laminar clean ward. Pay attention to the hygiene of the skin and mucous membranes . Strengthen oral care, disable toothbrushes, rinse with disinfectant. Rinse your mouth with disinfectant and wipe your mouth, genitals and anus with a cotton ball containing disinfectant after each meal. Apply intestinal antibacterial drugs to patients with severe intestinal sterilization drugs orally to reduce intestinal infections. Can take oral berberine, compound Xinnuoming, neotoxin, gentamicin and so on. Due to the inhibition of intestinal bacteria, VitB ₄ and B ₂ should be supplemented appropriately. Application of antibacterials throughout the body This is an important measure to control infection, and it is better to use it for preventive use. The indications were: bleeding from the skin and mucous membranes; infections were found; erythrocyte sedimentation was significantly accelerated; leukocytes fell below 3 × 10 ⁹ / L; It should be used whenever one of them appears. The order of medication can be sulfa drugs, penicillin, streptomycin, ampicillin, neopenicillin II, gentamicin, kanamycin, tobramycin, vanguardmycin and the like. The dosage should be large, mainly for intravenous administration. And according to the results of blood or throat swab culture and bacterial drug sensitivity test, adjust the drug types in time, pay attention to compatibility and prevent toxic and side effects. Enhance the immune function of patients with moderate and severe lightness, the body's immune function has not been lost, and active immune measures can be appropriately adopted, such as stimulating the body's immune function with Corynebacterium Brevibacterium vaccine, BCG vaccine and some plant polysaccharides. For severe and severe patients, passive immunity is better, and large doses of human blood gamma globulin or placental globulin can be injected intravenously. Pay attention to the prevention and treatment of local infections , such as caries, stomatitis, edema of the skin, hemorrhoids, athlete s foot, or newly-occurring radiation skin and mucous membrane damage, etc., and they must be promptly detected and treated and treated. Reduce the chance of infection. Pay attention to the prevention and treatment of double infection. Antimycotic drugs such as oral nystatin or aerosol inhalation and mouthwash can be used to prevent mold infection. Or you can take the new antimycotic ketoconazole tablet. Acyclovir and propoxyguanosine can be used to prevent and treat viral infections. Interstitial pneumonia and prevention and treatment mainly use oxygen or assisted ventilation to improve respiratory function and prevent heart failure. Corticosteroids can improve dyspnea and control symptoms. Large doses of gamma globulin, antiviral drugs, and anti-cytomegalovirus serum can prevent and treat viral infections.

(4) Prevention and treatment of bleeding Radiation sickness is mainly caused by thrombocytopenia, followed by microvascular and coagulopathy. Replenishing platelets and promoting platelet production to patients with severe bleeding are the most effective anti-bleeding measures at present. Hemostasis has the effect of promoting platelet production, and can also be used in the treatment of radiation sickness. Improve blood vessel function During the false healing period, drugs that improve and strengthen capillary function can be applied. Such as: adrenaline semicarbazone, serotonin, VitC, P, etc. 6-aminocaproic acid (EACA), VitK _3, etc. can be used to correct coagulopathy .

(5) Blood transfusion and blood formation are important measures for the treatment of severe radiation sickness and above. Blood transfusion can supplement blood cells, nutrients and immune factors, stimulate and protect hematopoietic function; timing of hemostasis and anti-infection transfusion; leukocytes below 1 × 10 ⁹ / L, or granulocytes below 0.5 × 10 ⁹ / L, or low platelets (30 50) × 10 ⁹ / L; hemoglobin less than 80g / L; severe bleeding or severe illness and failure. Enter 200 ~ 300ml each time, once or twice a week. After white blood cells are transfused into white blood cells, the number of white blood cells in the patient's blood can temporarily increase, reaching a peak 4 to 6 hours after the blood transfusion, and then gradually decrease. Therefore, transfusion of white blood cells can not increase the number of white blood cells in peripheral blood, and can achieve the effects of improving the body's resistance, delaying and reducing infection. The timing of platelet transfusion is: leukocytes less than 1 × 10 ⁹ / L or platelets less than 20 × 10 ⁹ / L; bleeding on the skin and mucous membranes; microscopic hematuria or fundus bleeding. The number of platelets to be input at one time is 10 ¹¹ to 10 ^{12. The} severe platelet reduction stage requires daily transfusion. Generally, the effect of inputting fresh platelets is good. Cryopreserved allogeneic platelets can also be applied. Chernobyl accident treatment experience, the platelet count of patients with moderate and severe radiation decreased to 20 × 10 ⁹ / L, about 14-18 days after irradiation. In this type of patients, about 5 to 6 platelet suspensions need to be input during the thrombocytopenia, and 300 ml of plasma containing 3 × 10 ¹¹ platelets is input each time.

For blood transfusion and blood formation, we must pay attention to the infusion rate to avoid aggravating pulmonary edema and cerebral edema. To ensure the effect of infusion, it is best to choose HLA-consistent or semi-consistent donors to reduce the immune response caused by infusion. Before infusion of blood or formed suspensions, they need to be irradiated with 15-25Gy rays before infusion to remove the immune-active cells and reduce the post-infusion reaction.

(6) Hematopoietic stem cell transplantation There are three sources of hematopoietic stem cell transplantation, namely bone marrow, embryonic liver and peripheral blood.

(7) Application of Hematopoietic Factors At present, the research on cytokines is getting deeper, and many recombinant cytokines have come out one after another. In normal radiation accidents, relevant hematopoietic factors have been applied to the treatment of radiation sickness. Treatment of intestinal radiation sickness. Intestinal radiation sickness mostly dies from dehydration, acidosis, sepsis, toxic shock, etc. in 1 to 2 weeks. Therefore, first, comprehensive symptomatic treatment should be taken for intestinal injury, and bone marrow transplantation should be implemented early. After the intestinal death phase, the focus is on treating hematopoietic disorders. Cerebral radiation sickness treatment Cerebral radiation sickness mostly died within 1 to 2 days. Essentials of first aid sedation, antispasmodic, anti-shock and comprehensive symptomatic treatment. When convulsions occur, use phenobarbital and chlorpromazine to control them. For vomiting and diarrhea, antiemetics and diarrhea should be controlled. For shock, fluid replacement and plasma transfusion should be used. Pressure-sensitive drugs such as booster.