A reflection on medical treatment of radionuclide-contaminated wounds during medical response to nuclear emergencies
LYU Xiaofan, LU Binghui, RAN Xinze, WANG Junping, WANG Tao
State Key Laboratory of Trauma, Burns and Combined Injury, Department of Anti-radiation Medicine, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing 400038 China
吕晓凡, 卢丙慧, 冉新泽, 王军平, 王涛. 核应急医学救援中放射性核素污染伤口的医学处理思考[J]. 中国辐射卫生, 2023, 32(4): 402-407,412.
LYU Xiaofan, LU Binghui, RAN Xinze, WANG Junping, WANG Tao. A reflection on medical treatment of radionuclide-contaminated wounds during medical response to nuclear emergencies. Chinese Journal of Radiological Health, 2023, 32(4): 402-407,412.
[1] 中华人民共和国国务院新闻办公室. 中国的核安全[N]. 人民日报, 2019-09-04(17). The State Council Information Office of the People's Republic of China. China's nuclear security[N]. People's Daily, 2019-09-04(17). [2] International Atomic Energy Agency. IAEA Safety Reports Series No. 101. Medical management of radiation injuries[R]. Vienna: IAEA, 2020. [3] Rump A, Becker B, Eder S, et al. Medical management of victims contaminated with radionuclides after a “dirty bomb” attack[J]. Mil Med Res, 2018, 5(1): 27. DOI: 10.1186/s40779-018-0174-5 [4] Radiation Emergency Assistance Center/Training Site. T. R. E. A. C. T. Site. The medical aspects of radiation incidents[M]. The Oak Ridge Institute for Science and Education, 2012. [5] National Council on Radiation Protection. NCRP Report No. 156. Development of a biokinetic model for radionuclide-contaminated wounds and procedures for their assessment, dosimetry and treatment[R]. Bethesda: NCRP, 2007. [6] Williams G, O’Malley M. Surgical considerations in the management of combined radiation blast injury casualties caused by a radiological dirty bomb[J]. Injury, 2010, 41(9): 943-947. DOI: 10.1016/j.injury.2010.01.103 [7] 闫铁成, 鱼敏. 地铁脏弹恐怖袭击医学救援的难点和对策探讨[J]. 中国辐射卫生,2020,29(3):292-294. DOI: 10.13491/j.issn.1004-714X.2020.03.023 Yan TC, Yu M. The discussion on the difficulties and countermeasures of medical rescue in terrorist attack of dirty bomb in subway[J]. Chin J Radiol Health, 2020, 29(3): 292-294. DOI: 10.13491/j.issn.1004-714X.2020.03.023 [8] Bazhin AG, Khokhriakov VF, Shevkunov VA. Wounds and burns of the skin polluted by alpha irradiation in personnel of radiochemistry enterprises[J]. Gig Sanit, 1994,(9): 27-29 [9] 袁志强, 孙金锴, 张仲仁, 等. 3例钚污染伤口的医学处理[J]. 中华放射医学与防护杂志,1982,2(6):23-26. DOI: 10.3760/cma.j.issn.0254-5098.1982.06.108 Yuan ZQ, Sun JK, Zhang ZR, et al. Medical treatment for plutonium contaminated wounds in three cases[J]. Chin J Radiol Med Prot, 1982, 2(6): 23-26. DOI: 10.3760/cma.j.issn.0254-5098.1982.06.108 [10] Avtandilashvili M, Tolmachev SY. Four-decade follow-up of a plutonium-contaminated puncture wound treated with Ca-DTPA[J]. J Radiol Prot, 2021, 41(4): 1122-1144. DOI: 10.1088/1361-6498/ac04b8 [11] 王薇, 邬蒙蒙, 汪传高, 等. 伤口摄入超铀核素的内照射剂量估算[J]. 中国辐射卫生,2018,27(6):523-527. DOI: 10.13491/j.issn.1004-714X.2018.06.001 Wang W, Wu MM, Wang CG, et al. The internal dose evaluation for transuranic nuclide-contaminated wounds[J]. Chin J Radiol Health, 2018, 27(6): 523-527. DOI: 10.13491/j.issn.1004-714X.2018.06.001 [12] Mcdiarmid MA, Gaitens JM, Hines S, et al. Surveillance of depleted uranium-exposed gulf war veterans: more evidence for bone effects[J]. Health Phys, 2021, 120(6): 671-682. DOI: 10.1097/HP.0000000000001395 [13] Surdyk S, Itani M, AlLobaidy M, et al. Weaponised uranium and adverse health outcomes in Iraq: a systematic review [J]. BMJ Glob Health, 2021, 6(2): e004166. [14] Guilmette RA, Durbin PW. Scientific basis for the development of biokinetic models for radionuclide-contaminated wounds[J]. Radiat Prot Dosim, 2003, 105(1/4): 213-218. DOI: 10.1093/oxfordjournals.rpd.a006225 [15] Guilmette RA, Durbin PW, Toohey RE, et al. The NCRP wound model: development and application[J]. Radiat Prot Dosimetry, 2007, 127(1/4): 103-107. DOI: 10.1093/rpd/ncm342 [16] Poudel D, Bertelli L, Klumpp JA, et al. Some considerations for chelation treatment and surgical excision following incorporation of plutonium in wounds[J]. Health Phys, 2018, 114(3): 307-318. DOI: 10.1097/HP.0000000000000772 [17] 刘波, 苏璞, 陈忠民, 等. 核应急医学救援任务中辐射防护措施运用及优化探讨[J]. 职业卫生与应急救援,2021,39(4):476-479. DOI: 10.16369/j.oher.issn.1007-1326.2021.04.026 Liu B, Su P, Chen ZM, et al. Discussion on optimization of radiation protection measures in nuclear emergency and medical rescue[J]. Occup Health Emerg Rescue, 2021, 39(4): 476-479. DOI: 10.16369/j.oher.issn.1007-1326.2021.04.026 [18] National Council on Radiation Protection. NCRP Report No. 161. Management of persons contaminated with radionuclides[R]. Bethesda:NCRP, 2008. [19] 中华人民共和国国家卫生和计划生育委员会. GBZ/T 255—2014 核和辐射事故伤员分类方法和标识[S]. 北京: 中国标准出版社, 2014. National Health and Family Planning Commission of the People's Republic of China. GBZ/T 255—2014 Classification methods and triage tag of wounded personnels in nuclear and radiation accidents[S]. Beijing: Standards Press of China, 2014. [20] 苏旭. 核和辐射突发事件处置 [M]. 北京: 人民卫生出版社, 2013: 173-182. Su X. Management of nuclear and radiological emergencies [M]. Beijing: People's Medical Publishing House, 2013: 173-182. [21] 王汝杰, 王磊, 王兴华, 等. 核泄露事故现场医学救援洗消实践初探[J]. 中华灾害救援医学,2021,9(3):896-900. DOI: 10.13919/j.issn.2095-6274.2021.03.015 Wang RJ, Wang L, Wang XH, et al. A discussion on emergency medical rescue and decontamination after nuclear leak accidents[J]. Chin J Dis Med, 2021, 9(3): 896-900. DOI: 10.13919/j.issn.2095-6274.2021.03.015 [22] 徐孝华, 秦宏冉. 核与辐射突发事件放射性体表污染的去污洗消流程及场所[J]. 辐射防护通讯,2020,40(4):43-47. DOI: 10.3969/j.issn.1004-6356.2020.04.011 Xu XH, Qin HR. Decontamination of body surface in nuclear and radiation emergencies[J]. Radiat Prot Bull, 2020, 40(4): 43-47. DOI: 10.3969/j.issn.1004-6356.2020.04.011 [23] 朱茂祥, 刘超, 陈肖华, 等. 核与辐射突发事件现场医学救援技术要点[J]. 灾害医学与救援(电子版),2012,1(2):125-127 Zhu MX, Liu C, Chen XH, et al. Technical key points of on-site medical rescue in nuclear and radiation emergencies[J]. Dis Med Rescue (Electron Ed), 2012, 1(2): 125-127 [24] 罗莹莹, 姚叶豹, 殷爱民, 等. 疑似放射性废水伤口沾染医学应急处置1例[J]. 中国辐射卫生,2022,31(3):340-343. DOI: 10.13491/j.issn.1004-714X.2022.03.016 Luo YY, Yao YB, Yin AM, et al. Emergency medical disposal for a case with the wound suspected of radioactive waste water contamination[J]. Chin J Radiol Health, 2022, 31(3): 340-343. DOI: 10.13491/j.issn.1004-714X.2022.03.016 [25] 刘雁玲. 钚污染伤口的医学处理[J]. 辐射防护,1988,(6):443-446, 454 Liu YL. The medical treatment of the plutonium-contaminated wound[J]. Radiat Prot, 1988,(6): 443-446, 454 [26] 中华人民共和国国家卫生和计划生育委员会. WS/T 583—2017 放射性核素内污染人员医学处理规范[S]. 北京: 中国标准出版社, 2017. National Health and Family Planning Commission of the People's Republic of China. WS/T 583—2017 Medical management of standard for internal contamination of radionuclides [S]. Beijing: Standards Press of China, 2017. [27] Rump A, Stricklin D, Lamkowski A, et al. Reconsidering current decorporation strategies after incorporation of radionuclides[J]. Health Phys, 2016, 111(2): 204-211. DOI: 10.1097/HP.0000000000000473 [28] World Health Organization. National stockpiles for radiological and nuclear emergencies: policy advice[M]. Geneva: World Health Organization, 2023.