GB 8280-2000 Diagnostic criteria and treatment principles for acute radiation sickness caused by external exposure
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principlesof management for external acute radiation sickness
UDC 616-07/-08
: 616 001.26
GB 8280—B7
Acute radiation sickness refers to a systemic disease caused by a large dose of radiation to the human body once or in batches within a short period of time (several days). According to its clinical characteristics and basic pathological changes, it is divided into three types: bone marrow type, intestinal type and brain type. Its course is generally divided into four stages: initial stage, pseudo-healing stage, critical stage and recovery stage.
This standard is mainly used for occupational radiation workers who are exposed to large doses of radiation in accidental irradiation, emergency irradiation, medical irradiation and nuclear war. Non-radiation workers who are accidentally exposed to acute radiation sickness can also be diagnosed and treated according to this standard. 1 Diagnostic principles
It is necessary to make an accurate judgment on whether the exposed individual has suffered radiation damage and the severity of his injury based on the exposure history, the estimated results of the exposure dose (with individual dose records), clinical manifestations and laboratory examination findings, and combine them with health records for comprehensive analysis. 2 Diagnosis and classification and grading standards
2.1 Uniform or relatively uniform whole-body irradiation of more than 1Gy in two or short periods of time (several days). 2.2 The main clinical symptoms and laboratory test findings caused by irradiation are the main basis for judging the condition, and its severity is related to the dose size, the irradiated site and range, and the individual situation. For cases of whole-body irradiation with multiple fractions and high unevenness, certain characteristics of its clinical manifestations should be noted. 2.2.1 In the early stage, you can refer to Table 1 and the figure below to make a preliminary classification and grading diagnosis. Table: Initial reactions and lower limits of radiation dose for various types of acute radiation sickness
Extremely severe
Initial manifestations
Fatigue, discomfort, loss of appetite
Dizziness, fatigue, loss of appetite, nausea, vomiting, white blood cell count rises for a short time and then decreases
Polydipsia and vomiting, diarrhea may occur, and the number of white and red blood cells decreases significantly. Multiple vomiting and abdominal distension, shock, and a sharp decrease in white blood cell count were approved by the Ministry of Health of the People's Republic of China on December 10, 1987. 1 to 2 days after the radiation sickness is approved The lowest absolute lymphocyte count per day is 109/L. The lower limit of the irradiated dose is implemented on July 1, 1988. GB8280-87 is continued in Table 1. Initial manifestations: vomiting and diarrhea, abdominal pain, shock, elevated hemoglobin, abdominal pain, shock, dysregulation, increased tension, convulsions, lethargy, decreased concentration and judgment. Absolute lymphocyte count (10*) Radiation observation: Symptoms within 1 hour: Early diagnosis of acute radiation sickness
1-2 days after exposure
The lowest value of the cell logarithm, 10°/
The lower limit of the exposure dose
Note: According to the absolute value of the cell volume 12h, 2-48h after exposure and the most serious symptom that the patient has experienced during this period (the lower edge of the solid line inside the figure column), a line is drawn through the small column. The degree of the mark in the column is the possible diagnosis of the patient: if the patient is diagnosed 6h after exposure, it is recommended to draw a line from the most serious symptom of the patient (the upper edge of the solid line inside the figure column) to the central column, and the judgment can be made according to the degree of the mark in the column, but it is greater than the judgment made 24-48h after exposure.
2.2.2 During the surface examination and close observation of the disease development process, a comprehensive analysis can be made with reference to Table 2 to further determine the clinical classification and degree diagnosis.
Radiation sickness
Maoji disorder
Extension, judgment
Decrease in strength
Start time
Highest body temperature,
Asphalt side
Self-cell maximum preservation
Irradiated agent
Lower limit, Gy
Not obvious
GB 8280-87
Clinical diagnosis basis of various types of acute radiation sickness TypewwW.bzxz.Net
1.0 ~3.13.
+ respectively represent mild, moderate and severe.
Extremely severe
15 ~ 25
3 Treatment principles
GB 8280—87
According to the severity of the disease and the different characteristics of each stage, take comprehensive treatment measures of Chinese and Western medicine as soon as possible. 3.1 Mild: Generally no special treatment is required. Symptomatic treatment can be adopted, nutrition can be strengthened, and rest can be taken. 3.2 Degree and severe: Take appropriate protective isolation measures according to the condition, and formulate corresponding treatment plans according to the different clinical manifestations of each stage.
3.2.1 Initial stage: Sedation, desensitization and anti-vomiting, regulation of nerve function, improvement of microcirculation and platelet aggregation function, and use of anti-radiation drugs as early as possible.
3.2.2 Pseudo-healing period: Prophylactic use of antibacterial drugs should be targeted at Gram-positive bacteria when there are indications (total white blood cell count is less than 3.0×10°/L, skin and mucous membrane bleeding). Prevent bleeding and protect hematopoietic function. When the total white blood cell count is less than 2.0×10/L and the platelet count is less than 5.0×1010/L, fresh whole blood can be transfused. 3.2.3 Extreme stage: Actively take effective anti-infection measures according to bacteriological examination or estimation of the source of infection (pay special attention to Gram-negative bacteria). The quarantine measures should be strict, and laminar clean air should be used as needed and possible. Control bleeding, reduce hematopoietic damage, and infuse white blood cell and platelet suspension irradiated by 1500 roentgens through the Y line. Correct water and electrolyte disorders. Pay attention to prevent pulmonary edema. 3.2.4 Recovery period: Strengthen treatment to promote recovery. 3.3 For extremely severe, intestinal and cerebral types, refer to the treatment principles of moderate and severe types. However, special attention should be paid to taking anti-infection and anti-bleeding measures as soon as possible. Pay attention to correcting water and electrolyte disorders, retain Hickman catheter intubation, continue infusion, actively relieve gastrointestinal and nervous system symptoms, and pay attention to prevent intussusception. When using antibacterial drugs at human doses, pay attention to the prevention and treatment of fungal and viral infections. For extremely severe bone marrow and mild intestinal types, fetal liver cell transplantation can be performed: Generally, for patients with irradiation of more than 8Gy, allogeneic bone marrow transplantation can be considered when there is a suitable donor, and pay attention to the prevention and treatment of host-vs-host disease.
4 Principles of treatment of acute radiation sickness
After the condition stabilizes, conduct strict medical follow-up observation and regular health assessment, pay attention to possible long-term effects, and give corresponding treatment. Depending on the recovery situation, patients can recuperate, rest or arrange appropriate work. GB·8280--87
Appendix A
Explanation of terms and terms
(Supplement)
A.1 Bone marrow form of acute radiation sickness (hematupoietic form of acute radiation sickness) is an acute radiation sickness with damage to hematopoietic tissues such as bone marrow as the basic lesion, leukopenia, infection, bleeding as the main clinical manifestations, and a typical staged course. According to the severity of the disease, it is divided into four degrees: mild, moderate, severe and extremely severe. A.2 Intestinal form of acute radiation sickness is a serious acute radiation sickness with gastrointestinal damage as the basic lesion, frequent vomiting, severe diarrhea and water and electrolyte metabolism disorder as the main clinical manifestations, and a two-stage course of initial, pseudo-healing and terminal stage. Aa Cerebral form of acute radiation sickness is a very serious acute radiation sickness with brain tissue damage as the basic lesion, with special clinical manifestations of central nervous system symptoms such as impaired consciousness, loss of orientation, ataxia, increased muscle tone, convulsions, and palpitations, and a two-stage course of initial and terminal stage. A.4 Prodromal phase
The first stage of the course of acute radiation sickness. It starts from a few hours to 1 or 2 days after exposure and can last from one to several days. It is mainly manifested by changes in nervous system and gastrointestinal function, especially symptoms of autonomic dysfunction. The time and severity of the initial reaction are helpful to judge the condition and estimate the prognosis to a certain extent. A.5 Latent phase (period of “apparent” well-being) is the second stage of the course of acute radiation sickness. During this period, the initial symptoms are relieved or basically disappear, and there are no obvious clinical manifestations, but the pathological process inside the body continues to develop. The presence or length of the latent phase is one of the important indicators for judging the severity of acute radiation sickness. A.6 Main phase (critical phase) The fourth stage of the acute radiation sickness course. It is the period when the clinical manifestations of acute radiation sickness are the most serious and the critical moment for the patient's survival or death.
A.?Convalescent period (phaseotrecovery, convalescent period) The fourth stage of the acute radiation sickness course for patients with mild symptoms or who have passed the critical period after treatment. During this period, the infection is controlled, the body temperature returns to normal, the bleeding stops, the blood picture gradually recovers, and the general condition gradually improves. A,8 Accidental exposure (accidental exposure) Unexpected exposure in the event of an accident where the radiation source is out of control. A.9 Emergency exposure (emergency exposure) Exposure received in the event of an accident in order to save lives, prevent injuries or control the expansion of the accident. A.to Medical exposure (medical exposture) Exposure received for the purpose of diagnosing or treating a certain disease of the individual. A.11 Relatively uniform and non-uniform radiation (relatively iniform radiation and non-uniform radiation) After the human body is irradiated with the whole body, the distribution of the absorbed dose in each part of the body cannot be completely uniform, so there is only a distinction between relatively uniform and non-uniform radiation. The boundary between the two is not very clear, but only relative. The degree of non-uniformity is generally expressed by the difference between the maximum and minimum doses of different parts of the body (non-uniformity coefficient). The non-uniformity coefficient is less than 3 and is called relatively uniform radiation, while the non-uniformity coefficient is greater than 3 and is called non-uniform radiation.
A.12 Absorbed dose (absorbed dose) dE
dm. In the formula, dE is the energy of any ionizing radiation absorbed by a unit mass of matter, represented by D, that is, the energy given to a volume unit of matter by radiation, and dm is the mass of the volume unit of matter. The current practical unit of absorbed dose D is Gray (Gy), which is equal to 1J/kg. A.13 Chromosome
GB 8280—87
It is the carrier of genetic genes. It exists in the cell nucleus and is darker in color under the action of alkaline dyes. It is composed of deoxyribonucleic acid (DNA), protein and a small amount of ribonucleic acid (RNA). A, 14 Chromosome aberration (chromosome aberration) The structural and quantitative abnormalities of normal chromosomes under the action of physical (such as ionizing radiation) or chemical factors. Chromosome aberration is one of the sensitive indicators of radiation effects. When the human body is acutely irradiated, it can be used to estimate the dose received by the individual. A.15 Micronucleus (micronucleus)
It is a small body composed of chromosome fragments, one or more chromosomes produced in the late stage of cell division, which can be used as an indicator for estimating biological agent load in genetic toxicology research or radiation sickness diagnosis. A.16 Allogeneic bone marrow transplantation (Alla-BMT) refers to the transplantation of bamboo marrow between two individuals with different genotypes within the same species. The source of homologous bone marrow is convenient and easy to obtain, but it is easy to cause immune reaction and difficult to transplant successfully. Only by infusing the bone marrow cells of HLA-matched siblings can the transplantation be successful, and its secondary diseases are less. The bone marrow transplantation from identical twins is called isogenic bone marrow transplantation. A,17 Fetal liver transplantation (FLT) refers to the infusion of homologous fetal liver cells. This measure is considered a new way to treat patients with hematopoietic system failure or immune deficiency. The liver is the main hematopoietic organ in the first stage of embryonic development. It has a low content of lymphocytes, and most of them have not yet differentiated into mature T lymphocytes. Therefore, fetal liver transplantation can reconstruct hematopoietic tissue on the one hand, and produce less host-versus-host disease on the other hand, but the engraftment rate is generally low. A.18 Graft versus host disease (GVHD) is a somatic disease that occurs in the recipient after transplantation of hematopoietic cells such as bone marrow, peripheral blood or fetal cells. Due to the immunogenetic differences between the donor and the recipient, the immune active cells (mainly T cells) in the transplanted bone marrow, peripheral blood or fetal liver are stimulated by the receptor antigens to proliferate and differentiate, and then directly or indirectly attack the recipient cells (the target organs are mainly the skin, liver and intestines). T cells are effector cells that cause GVHD.
A.19 Early effect
Harmful effects that occur in the near future (for example, within weeks or months) after a single or multiple exposures to a large dose of radiation in a short period of time. A.20 Late effect
Harmful effects that occur in the late stage after a single exposure to a large dose or multiple exposures to a small dose of radiation, generally refers to effects that appear several years after exposure, such as leukemia and related diseases.
GB B280—87
Appendix B
Instructions for the correct use of this standard
(reference)
B1 Acute radiation sickness is a non-random effect of ionizing radiation and has a dose threshold. However, due to the different radiation sensitivity of individuals, the frequency of acute radiation sickness is related to the size of the irradiated agent disk. As reported in domestic and foreign literature, a single whole-body irradiation of more than 1Gy can often cause acute radiation sickness, while the irradiation dose is only 0.6～D.8Gy, and there are also a few people who suffer from mild acute radiation sickness. Therefore, those who have an irradiation dose of less than 1Gy and more than 0.5Gy should still be closely observed and should not be taken lightly to avoid missed diagnosis and missed treatment opportunities. Regarding the classification of acute radiation sickness, some scholars at home and abroad have proposed in recent years that there may be a special type between intestinal and cerebral acute radiation sickness, namely cardiovascular or toxemic form of acute radiation sickness. The dose range for this type of acute radiation sickness is 20 to 50 Gy, but the diagnostic criteria for this type need further research and discussion.
B.2 In addition to the determination and estimation based on physical methods (including simulation tests when necessary), the determination of the irradiated agent disk should also refer to the results of biological methods. Among them, in addition to the initial symptoms and peripheral blood picture (total white blood cell count and absolute lymphocyte count), the analysis of lymphocyte chromosome aberration rate is currently a commonly used indicator, and its effective dose range is 0.25 to 5.0 Gy. In addition, the results of lymphocyte micronucleus rate (culture method), lymphocyte acid phosphatase, lymphocyte conversion rate (\H-TdR incorporation method) and neutrophil alkaline phosphatase can also be used to estimate the exposure dose. B, 3 The figure in the text (early diagnosis of acute radiation sickness) was drawn based on the analysis of 231 people exposed to small doses in my country, 8 cases of acute radiation sickness of varying degrees, and 44 cases of nuclear accident exposure abroad. Practice has proved that the accuracy of diagnosis using this chart is high and the method is simple. Before there is a better early classification diagnosis method, this chart can be used in practice. In use, attention should be paid to the effect of adrenocortical hormone drugs on lymphocytes.
B, The lower limit of the irradiation dose in Tables 1 and 2 refers to a relatively uniform whole-body irradiation of X-rays and Y-rays with a radiation quality factor of 1. When referring to the physical dose estimation and judging the condition, the influence caused by the different relative biological effects (RBE) of different rays must be fully considered. If the whole body is uneven and (or) multiple fractionated irradiation, the influencing factors such as different irradiated parts, ranges, unevenness, fractionation time and number should be considered, and the equivalent dose calculated by the average dose of red bone marrow or the weighted survival of red bone marrow hematopoiesis cells and the equivalent dose of "one" irradiation corrected by the time factor shall prevail. B, 5. Compared with the same dose of whole-body irradiation, the damage caused by multiple fractionated highly uneven whole-body irradiation has the following main characteristics: the initial reaction is generally more severe and lasts longer, and the degree of local damage is often more severe than that of systemic damage Injury, the degree of decrease in the number of neutrophils and platelets is less than that of the total number of white blood cells, and the cumulative dose required to cause the same degree of radiation effect is higher. In order to estimate the degree of injury, it is often necessary to convert multiple cumulative doses to the effective dose equivalent to a single whole-body uniform irradiation. It is recommended that the following formula can be used for conversion before a better conversion formula is available: Whole-body irradiation mainly to the neck:
IgY=1.9060-0.5911)gX..
Whole-body irradiation mainly to the abdomen:
lgY=1.9811-0.4409lgX
wherein; Y is the effective dose to the cumulative dose: X is the number of days of irradiation.
(2)
This formula is based on the relationship between the actual biological effects (clinical and blood picture changes) and the cumulative dose of 16 cancer patients who were irradiated with multiple uneven fractions mainly on the head or abdomen during "°C0" radiotherapy. Although it has its own special conditions and limitations of use, it is human material after all, so it can be used as an auxiliary means to estimate the effective dose under similar irradiation conditions. Its applicable conditions are:
Y-line external irradiation; the average whole body dose of each irradiation is 0.6 ～2.6Gy, the interval time is 24h, and the unevenness is 25～10f times. GB8280-87
B, 6 The early use of anti-radiation drugs for acute radiation sickness is of great significance in that it can reduce radiation damage, simplify comprehensive treatment measures, and improve treatment effects. Therefore, for moderate or above acute coagulopathy, effective anti-radiation drugs should be used as soon as possible without losing time. B.? In the process of comprehensive treatment, according to the clinical characteristics and treatment principles of acute radiation sickness and the specific conditions of the patient, refer to the relevant treatment experience of general clinical medicine, and flexibly grasp the For patients with acute radiation skin damage, the diagnosis and treatment can refer to GB8282-87 "Diagnostic Standards and Treatment Principles for Radiation Skin Diseases". In addition, nursing work plays an important role in the treatment of patients, especially for patients with acute radiation sickness of severe or above. B, B Clinical practice has proved that the treatment principles and measures currently adopted can cure most or all of the acute radiation sickness of severe and below severe. Therefore, for cases that have been clinically confirmed to be cured, the diagnosis of acute radiation sickness should be revoked, but regular follow-up observation should be carried out to detect possible long-term harmful effects as early as possible, and to give a clear diagnosis and proper treatment in time. Additional remarks:
This standard was proposed by the National Health Standard Technical Committee and reviewed and approved by the Radioactive Disease Diagnostic Standard Subcommittee. This standard was drafted by the Academy of Military Medical Sciences and the Industrial Hygiene Laboratory of the Ministry of Health. This standard is interpreted by the Industrial Hygiene Laboratory of the Ministry of Health, the technical unit entrusted by the Ministry of Health. From the date of implementation of this standard, the section on acute radiation sickness caused by external irradiation in the original diagnostic standards and treatment principles for radiation sickness (GBW1-80) will be invalidated.
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.