Medical management of the victim exposed to 192Ir source at"5.7"accident in Nanjing

Objective To explore the treatment technique, occurrence and development patterns of such radiation injuries as in a major radiological accident that occurred in Nanjing on 7th May in 2014, in which a victim suffered mild bone marrow radiation sickness combined with Degree Ⅳ acute radiation-induced skin injury, based on his dose estimation, clinical manifestations and disease treatments. Methods History inquiry in detail, earlier physical dose estimation and biological dose estimation were conducted in conjunction with examination of temperature changes in radiation injured parts by using infra-red thermoimaging. A comprehensive analysis was made on the basis of estimated dose, clinical manifestation, laboratory examination and imaging examination results with a view to preparing the diagnosis and treatment plan. Comprehensive treatment measures were taken for systemic and topical treatments along with synchronous physical- and psycho-therapy. Systemic treatments included microcirculation improvement, immunity enhancement, nutrition support, anti-infection, application of granulocyte colony stimulating factor (G-CSF) and symptomatic treatment, etc. Topical treatments included analgesia, dressing, debridement and twice myocutaneous flap transplantations, umbilical cord mesenchymal stem cells (MSCs) infusion, vacuum sealing drainage (VSD), etc. Results The biological dose of whole body was estimated to be 1.51 Gy, while the physical dose in right lower limb was about 4 100 Gy. Dose estimates were consistent with clinical manifestations. After 40 d the patient transited smoothly into the recovery period. After 378 d of active treatment, the wound in right lower limb had healed completely but with dysfunction. Conclusions The biological dose estimates made in the early stage after non-uniform local radiation exposure was consistent with the clinical diagnosis. The treatment plan was made after systemic medical examination. There had not been significant staging courses in mild bone marrow form of acute radiation sickness, but had a better prognosis. Severe local radiation injury had a protracted course. The key of treatment lied in myocutaneous flap transplantations, and microsurgery operation, VSD technique and MSCs infusion guaranteed the success of the surgery treatment. Moreover, anti-infection, nutrition support, and psychological intervention also contributed to the recovery the patient. Key words: 192Ir; Mild bone marrow form of acute radiation sickness; Degree Ⅳ acute radiation-induced skin injury; Clinical treatment