一例双手严重放射性皮肤损伤合并过量照射患者的临床救治

辐射防护通讯 ›› 2026, Vol. 46 ›› Issue (2): 1-5.

一例双手严重放射性皮肤损伤合并过量照射患者的临床救治

王优优, 卞华慧, 陈炜博, 冯骏超, 刘玉龙

核工业总医院,江苏苏州 215004

收稿日期:2025-09-30 出版日期:2026-04-20 发布日期:2026-05-07
通讯作者: 刘玉龙。E-mail:yulongliu2002@126.com
作者简介:王优优(1986—),女,2013年毕业于苏州大学肿瘤学专业,获硕士学位,副主任医师,主要从事放射损伤临床救治及肿瘤诊疗。E-mail:wangyy0315@163.com
基金资助:
国家自然科学基金项目(U2267220) ;核工业总医院学科建设托举工程(二期)核医疗科研项目(核应急救治XKTJ-HTD2025002);国家自然科学基金项目(12405392);江苏省自然科学基金青年项目(BK20240358);中核集团“青年英才”科研项目(启明星);省部共建放射医学与辐射防护国家重点实验室开放课题(GZK12020042);河南省辐射生物与流行病学医学重点实验室课题(HNRBEKF202401);省部共建放射医学与辐射防护国家重点实验室内部协作课题(GZN1202201);苏大附二院科研预研基金项目(SDFEYBS2304)。

Medical management of a case suffered from severe finger skin radiation injurycombined with overexposure caused by external irradiation

WANG Youyou, BIAN Huahui, CHEN Weibo, FENG Junchao, LIU Yulong

Nuclear Industry General Hospital,Jiangsu Suzhou 215004

Received:2025-09-30 Online:2026-04-20 Published:2026-05-07

摘要/Abstract

摘要： 通过对1起¹⁹²Ir源辐射事故中1例轻度骨髓型外照射急性放射病合并双手手指IV度急性放射性皮肤损伤患者的剂量估算、临床表现和综合救治的总结,探讨此类放射损伤的救治技术。详细询问受照者的事故经过,系统地观察其临床表现,尤其是手指皮肤放射性损伤的变化;通过外周血淋巴细胞染色体畸变分析估算生物剂量;利用蒙特卡罗模拟软件估算物理剂量;并结合系统的实验室及影像学检查结果评估病情,进而综合分析,确定诊断和治疗方案。患者生物剂量估算结果为0.76 Gy(95% CI:0.6~0.92);物理剂量估算双手各手指皮肤剂量在2.2~11.2 Gy之间。于受照射后25 d行手指切开减压术,并取其大腿及腹部脂肪提取血管基质组份(SVF)注射至其双手手指损伤处。经过3个月治疗,患者双手手指皮肤伤口均愈合,疼痛明显减轻,指关节活动基本正常。患者救治过程中需注重生理与心理相结合,局部应用自体SVF移植及皮片移植可在放射性皮肤损伤中取得良好的效果。该双手IV度急性放射性皮肤损伤合并过量照射患者救治案例,可为核和辐射损伤医学救治提供临床资料和积累经验。

关键词: ¹⁹²Ir, 放射性皮肤损伤, 临床救治, 剂量估算

Abstract: To explore the treatment technique of such radiation injuries as in a major radiological accident in which a victim suffered mild bone marrow radiation sickness combined wiht heavy acute radiation induced skin injury, based on his dose estimation, clinical manifestations and disease treatments. History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with analyzing the chromosome aberration of peripheral blood lymphocytes. The physical dose was estimated by Monte Carlo method. The systematic laboratory and imaging examination was performed to evaluate the condition.The comprehensive analysis was conducted to determine the diagnosis and treatment plan. During the treatment of patients with radiation injury, we should pay attention to the combination of physiology and psychology. Local application of autologous SVF transplantation and skin transplantation can achieve good results in radioactive skin injuries.

Key words: ¹⁹²Ir, radiation skin injury, medical management, dose estimation

中图分类号:

R818

王优优, 卞华慧, 陈炜博, 冯骏超, 刘玉龙. 一例双手严重放射性皮肤损伤合并过量照射患者的临床救治[J]. 辐射防护通讯, 2026, 46(2): 1-5.

WANG Youyou, BIAN Huahui, CHEN Weibo, FENG Junchao, LIU Yulong. Medical management of a case suffered from severe finger skin radiation injurycombined with overexposure caused by external irradiation[J]. RADIATION PROTECTION BULLETIN, 2026, 46(2): 1-5.

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