核与辐射应急医学救援中放射性核素内污染阻吸收与促排药物使用时机探讨  

Discussion on decorporation strategies for internal radionuclides contamination during medical rescue in the nuclear and radiological emergency

作　　者：王涛[1] 李蓉[1] 王军平[1] 冉新泽[1] Wang Tao;Li Rong;Wang Junping;Ran Xinze(State Key Laboratory of Trauma and Chemical Poisoning,Department of Anti-Radiation Medicine,Institute of Combined Injury,School of Preventive Military Medicine,Army Medical University(Third Military Medical University),Chongqing 400038,China)

机构地区：[1]陆军军医大学(第三军医大学),军事预防医学系防原医学教研室,全军复合伤研究所创伤与化学中毒全国重点实验室,重庆400038

出　　处：《中华放射医学与防护杂志》2024年第5期404-409,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：军队后勤科研项目(ZLJ22J020);陆军军医大学教育训练改革研究课题(2022B07)。

摘　　要：放射性核素内污染是核与辐射事故应急医学救援中的常见问题,其医学处理是救援的重点内容。阻吸收和促排是放射性核素内污染治疗的主要手段,往往涉及药物使用,通常使用越早治疗效果越好。我国发布的多个标准、规范对于阻吸收药物的使用认识一致,认为在明确或高度疑似有放射性核素过量摄入时即可尽快使用阻吸收药物及措施。但对促排药物的使用时机表述存在差异性,容易在应用中造成困惑。通过梳理分析相关标准、规范的适用范围和适用条件,并结合国外的研究进展,就核与辐射应急医学救援中内污染促排药物的使用时机提出建议。认为,国内核事故场内应急的内污染阻吸收与促排药物使用策略与国外新近提出的“紧急处理方案”的思想值得借鉴、提倡,即对于高风险群体怀疑有放射性核素摄入就立即开始药物治疗的方法是谨慎可取的,后续如果内照射剂量评估达不到相关干预水平,停止治疗即可。同时,探讨了前述内污染处理药物使用策略在应用中需要注意的问题,以供相关人员参考。Internal radionuclide contamination is one of important issue in medical response to nuclear or radiological emergency,which is the key of medical rescue.The medical uses of both preventive absorption drugs and acceleration elimination drugs are crucial means to control internal contamination.Usually the earlier use of such drugs could result in the better effects.Chinese national standards formulate that both preventive absorption of radionuclides and decorporation treatment should be applied as soon as possible in the event of there bing definite or highly suspected excessive intake of radionuclides.However,there are differences and inconsistencies in use of acceleration elimination drugs and strategies of acceleration elimination drugs between many national standards to some degree,easily causing confusion.Thus,this paper proposes the applicable time for applying decorporation drugs on the basis of comparison of the applicable scope and conditions between relevant national standards in combination with the related foreign advancements.It suggests that the ideas of decorporation strategies in both domestic on⁃site emergency response for nuclear accidents and abroad“urgent approach”are worth to advocate.According to the strategies,it is prudent and advisable to start decorporation treatment immediately even when radionuclide incorporation is just suspected,and treatment should be discontinued once internal dosimetric result are below intervention level.Meanwhile,the issues in need of attention in the application of the above⁃mentioned strategies for internal contamination are discussed.

关 键 词：核与辐射应急 放射性核素内污染 医学救援 促排 干预水平 国家标准 

分 类 号：R144.1[医药卫生—公共卫生与预防医学]