极重度骨髓型和肠型急性放射病细菌感染的防治  

Prevention and treatment of severe acute radiation sickness complicated by bacteria infection

作　　者：王丹红[1] 艾辉胜[1] 乔建辉[1] 余长林[1] 郭梅[1] 孙琪云[1] 张石[1] 张锡刚[2] 牛文凯[2] 李光[2] 葛飞娇[3] 

机构地区：[1]解放军第307医院血液科,北京100071 [2]解放军第307医院ICU,北京100071 [3]解放军第307医院肿瘤科,北京100071

出　　处：《解放军医学杂志》2007年第5期430-431,448,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家863计划资助项目(2002AA216081)

摘　　要：目的探讨极重度骨髓型和肠型急性放射病细菌感染的防治经验,为今后急性放射病的治疗提供治疗经验。方法2例急性放射病患者整个病程中均合并不同菌种的感染,通过观察患者的临床症状、影像学检查及相关的病原体检测而给予不同强度的抗细菌和真菌治疗,通过观察临床症状、影像学检查及病原学检测评价疗效。结果2例急性放射病患者在治疗中均出现多次反复的细菌感染,同时伴有持续的真菌感染,经强有力的抗细菌和真菌治疗后细菌感染得到暂时控制,真菌感染始终没有控制。病例A于受照后14天出现急性腹膜炎,照后19天出现肺部感染,经泰能加万古霉素等抗生素治疗细菌感染得到控制,于照后33天死于真菌感染败血症和多脏器功能衰竭。病例B于受照后反复出现肺部感染,且于照后55天和照后71天出现G-杆菌败血症,经泰能加万古霉素等抗生素治疗后细菌感染均控制,但真菌感染一直存在,于照后75天因多脏器功能衰竭抢救无效死亡。结论极重度骨髓型和肠型急性放射病患者的细菌感染呈阶段性。全身性阶段性应用高强抗生素是防治细菌感染的主要有效措施。Objective To practice the prevention and treatment of severe bone marrow form and intestine form of acute radiation sickness complicated by bacteria infection for providing an effective method on the treatment of acute radiation sickness. Method Two patients with severe acute radiation sickness suffered from different infection during treatment. Based on their clinical symptoms, image analysis and the findings of microbiological culture, the patients underwent different anti-bacteria and anti-fungi treatment, and the results were evaluated. Result Repeated multiple bacterial infection companied with fungi infection occurred in the two patients with severe acute radiation sickness during the period of treatment. The bacterial infection was controlled temporarily by an intensively antibacterial and antimycotic treatment, but the fungi infection was uncontrolled. In patient A, acute peritonitis occurred 14 days after exposure, and pulmonary infection occurred 19 days after exposure. The pulmonary infection in patient A was controlled by using antibacterial drugs Tienam and Vancocin, while the patient died of multiple organ failure and fungi infection 33 days after exposur~ In patient B, pulmonary infection occurred 17 days after exposure, and the septicemia occurred twice with Gram-negative bacteria at 55th day and 71st day after exposure. The pulmonary infection was controlled provisionally by using antibacterial drugs Tienam and Vancocin, while the patient died of multiple organ failure 75 days after exposure. Conclusion The bacterial infection companied with severe acute radiation sickness is phased occurrence. The generalized and phased application of intensive antibiotics might be an effective treatment.

关 键 词：急性放射病 辐射损伤 细菌感染 防治 骨髓型 肠型 

分 类 号：R818.71[医药卫生—放射医学] R63[医药卫生—临床医学]