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20.10.2017

Ionizing radiation causes a number of changes in the body, doctors call such a complex of symptoms radiation sickness. All signs of radiation sickness are distinguished depending on the type of radiation, its dosage and the location of the harmful source. Due to harmful radiation, processes begin to occur in the body that threaten to malfunction in the functioning of systems and organs.

Pathology is included in the list of diseases, because of it, irreversible processes develop. The current level of medicine allows you to slow down the destructive processes in the body, but not to cure a person. The severity of the course of this disease depends on what area of the body was irradiated, for how long and how it reacted. the immune system person.

Doctors distinguish between forms of pathology when irradiation was general and local, and also distinguish combined and transitional varieties of pathology. Due to penetrating radiation, oxidative processes begin in the cells of the body, as a result they die. The metabolism is seriously disturbed.

The main impact of radiation falls on the gastrointestinal tract, nervous and circulatory system, spinal cord. In case of violation in the work of systems, dysfunctions arise in the form of combined and single complications. A complex complication occurs with a lesion of the 3rd degree. Such cases end fatally.

Pathology proceeds in a chronic form, what is radiation sickness in a specific form, the doctor can determine the magnitude and duration of exposure. Each of the forms has a mechanism of development, therefore, the transition of the identified form to another is excluded.

Types of harmful radiation

In the development of pathology, an important role is assigned to a specific type of radiation, each has a particular effect on different organs.

The main ones are listed:

alpha radiation. It is characterized by high ionization, but low ability to go deep into tissues. Sources of such radiation are limited in their damaging effect;
beta radiation. It is characterized by weak ionizing and penetrating power. Usually affects only those parts of the body, which are closely adjacent to the source of harmful radiation;
gamma and x-ray radiation. Such types of radiation are capable of hitting tissues to a serious depth in the source area;
neutron radiation. It differs in different penetrating ability, which is why organs with such irradiation are affected heterogeneously.

If the exposure reaches 50-100 Gy, then the main manifestation of the disease will be CNS damage. With such symptoms, you can live 4-8 days.

When irradiated with 10-50 Gy, the organs of the gastrointestinal tract are more damaged, the intestinal mucosa is rejected and death occurs within 2 weeks.

With a slight exposure (1-10 Gy), the symptoms of radiation sickness are manifested by bleeding and hematological syndromes, as well as complications of an infectious type.

What causes radiation sickness?

Irradiation is external and internal, depending on how the radiation enters the body - percutaneously, with air, through the gastrointestinal tract, mucous membranes or in the form of injections. Small doses of radiation always affect a person, but pathology does not develop.
One speaks of a disease when the radiation dose is 1-10 Gy or more. Among those who risk learning about a pathology called radiation sickness, what it is and why it is dangerous, there are groups of people:

receiving low doses of radioactive exposure in medical facilities (X-ray employees and patients who must undergo examinations);
who received a single dose of radiation during experiments, during man-made disasters, from the use of nuclear weapons, during the treatment of hematological diseases.

Signs of radiation exposure

When radiation sickness is suspected, symptoms appear depending on the dose of radiation and the severity of complications. Doctors distinguish 4 phases, each with its own symptoms:

- The first phase occurs in people who have received radiation at a dosage of 2 Gy. Appearance rate clinical signs depends on the dose and is measured in hours and minutes. Main symptoms: nausea and vomiting, dryness and bitterness in the mouth, fatigue and weakness, drowsiness and headaches. Revealed state of shock, in which the victim faints, an increase in temperature, a drop in pressure, diarrhea can be detected. Such clinical picture typical for irradiation at a dosage of 10 Gy. In victims, the skin turns red in those areas that have been in contact with radiation. There will be a change in pulse, low pressure, trembling fingers. On the first day from the moment of irradiation, the number of lymphocytes in the blood decreases - the cells die.

The second phase is called sluggish. It begins after the first phase has passed - approximately 3 days after exposure. The second stage lasts up to 30 days, during which the state of health returns to normal. If the irradiation dosage is more than 10 Gy, then the second phase may be absent, and the pathology passes into the third. The second phase is characterized skin lesions. This indicates an unfavorable course of the disease. A neurological clinic appears - the eye proteins tremble, the physical activity, reduced reflexes. By the end of the course of the second stage, the vascular wall becomes weak, blood clotting slows down.
The third stage is characterized by the clinical picture of the disease. The timing of its onset depends on the dose of radiation. Phase 3 lasts 1-3 weeks. Become noticeable: damage circulatory system, decreased immunity, autointoxication. The phase begins with a serious deterioration in well-being, fever, increased heart rate and a drop in blood pressure. The gums bleed, the tissues swell. The mucous organs of the gastrointestinal tract and mouth are affected, ulcerations appear. If the radiation dose is low, the mucosa is restored over time. If the dose is high, the small intestine is damaged, which is characterized by bloating and diarrhea, abdominal pain. There are infectious tonsillitis and pneumonia, the hematopoietic system is inhibited. The patient has hemorrhages on the skin, digestive organs, mucous membrane of the respiratory system, ureters. Bleeding is strong enough. The neurological picture is manifested by weakness, confusion, meningeal manifestations.
In the fourth stage, the structures and functions of the organs improve, bleeding disappears, hair loss begins to grow, and damaged skin heals. The body recovers for a long time, more than 6 months. If the radiation dose was high, rehabilitation may take up to 2 years. If the last, fourth, phase is over, we can say that the person has recovered. Residual effects can manifest as pressure surges and complications in the form of neuroses, cataracts, leukemia.

Radiation sickness options

The classification of the disease by type is carried out according to the duration of exposure to radiation and dose. If the body is exposed to radiation, they speak of an acute form of pathology. If the irradiation is repeated in small doses, they speak of a chronic form.
Depending on the dosage of the received radiation, there are the following forms lesions:

- less than 1 Gy - radiation injury with reversible damage;
- from 1-2 to 6-10 Gy - typical shape, another name is bone marrow. Develops after short exposure. Mortality occurs in 50% of cases. Depending on the dosage, they are divided into 4 degrees - from mild to extremely severe;
- 10-20 Gy - gastrointestinal form arising from short-term exposure. Accompanied by fever, enteritis, septic and infectious complications;

20-80 Gy - toxemic or vascular form arising from single-stage irradiation. Accompanied by hemodynamic disturbances and severe intoxication;
over 80 Gy - cerebral form, when death occurs within 1-3 days. The cause of death is cerebral edema.

The chronic course of the pathology is characterized by 3 periods of development - in the first a lesion is formed, in the second - the body is restored, in the third there are complications, consequences. The first period lasts from 1 to 3 years, during which the clinical picture develops with different severity manifestations.

The second period begins when radiation ceases to act on the body or the dosage is reduced. The third period is characterized by recovery, then partial recovery, and then stabilization of positive changes or progression.

Radiation sickness treatment

Irradiation with a dosage of more than 2.5 Gy is fraught with a fatal outcome. From a dose of 4 Gy, the condition is considered fatal. Timely and competent treatment radiation sickness from exposure to a dose of 5-10 Gy still gives a chance for clinical recovery, but usually a person dies from a dose of 6 Gy.

When radiation sickness is established, treatment in the hospital is reduced to an aseptic regimen in the wards designated for this. Also shown symptomatic therapy and prevention of infections. If fever and agranulocytosis are detected, antibacterial and antiviral drugs are prescribed.

The following are used in treatment:

Atropine, Aeron - stop nausea and vomiting;
physiological saline - against dehydration;
Mezaton - for detoxification on the first day after exposure;
gamma globulin increases the effectiveness of anti-infective therapy;
antiseptics for the treatment of mucous membranes and skin;
Kanamycin, Gentamicin and antibacterial drugs inhibit the activity of the intestinal flora;
donor platelet mass, irradiated with a dose of 15 Gy, is injected to replace the deficiency in the victim. If necessary, appoint a transfusion of erythrocytes;
hemostatics of local and overall impact to combat bleeding;
Rutin and vitamin C, hormones and other drugs that strengthen the walls of blood vessels;
Fibrinogen to increase blood clotting.

In the room where patients with radiation sickness are being treated, infections are prevented (both internal and external), sterile air is supplied, the same applies to food and materials.

At local lesion mucous membranes are treated with mucolytics bactericidal action. Lesions on the skin are treated with collagen films and special aerosols, dressings with tannins and antiseptic solutions. Bandages with hydrocortisone ointment are shown. If ulcers and wounds do not heal, they are excised and plastic surgery is prescribed.

If the patient develops necrotic enteropathy, antibacterial drugs and Biseptol are prescribed to sterilize the gastrointestinal tract. At this time, the patient is shown fasting. You can drink water and take medicine for diarrhea. In severe cases, parenteral nutrition is prescribed.

If the radiation dosage was high, the victim has no contraindications, a suitable donor was found, transplantation is indicated bone marrow. The motive for the procedure is a violation of the process of hematopoiesis, suppression of the immunological reaction.

Complications of radiation sickness

It is possible to predict the state of health of a patient taking into account the degree of exposure and the duration of the harmful effects on the body. Those patients who survived after 12 weeks from the moment of irradiation have a lot of chances. This period is considered critical.

Even from radiation, which is not fatal, complications of varying severity develop. It will be malignant neoplasm, hemoblastosis, inability to have children. Distant disorders can occur in offspring at the genetic level.

The victim is aggravated chronic infections. Gets cloudy vitreous body and the lens, vision is impaired. are found in the body dystrophic processes. Contacting the clinic will give the maximum chance to prevent the development of consequences.

Radiation sickness is considered severe and dangerous pathology, which is manifested by the complex various symptoms. While doctors have not developed a treatment, treatment is aimed at maintaining the body and reducing negative manifestations.

Of paramount importance in the prevention of such disease is the exercise of caution in the vicinity of potential sources of hazardous radiation.

GENERAL PRINCIPLES OF THERAPY

Treatment of acute radiation sickness is carried out in a complex manner, taking into account the form, period of the disease, severity and is aimed at stopping the main syndromes of the disease. At the same time, it should be remembered that only the bone marrow form of ARS can be treated, the therapy of the most acute forms (intestinal, vascular-toxemic and cerebral), in terms of recovery, is not yet effective all over the world.

One of the conditions determining the success of treatment is the timeliness of hospitalization of patients. Patients with bone marrow form of ARS grade IY and the most acute forms of diseases (intestinal, vascular toxemic, cerebral) are hospitalized according to the severity of the condition immediately after the lesion. Most patients with bone marrow I-III degree after stopping the primary reaction, they are able to perform official duties until signs of the height of ARS appear. In this regard, patients with ARS of the 1st degree should be hospitalized only when clinical signs of a peak or development of leukopenia appear (4-5 weeks), with moderate and severe degrees, hospitalization is desirable from the first day in a favorable environment and is strictly required from 18-20 and 7 -10 days respectively.

Measures for urgent indications are carried out in case of radiation injuries during the period of the primary reaction to radiation, the development of intestinal and cerebral syndromes, according to vital indications in case of combined radiation injuries, as well as in case of ingestion of radioactive substances.

When irradiated in doses (10-80 Gy), causing the development of an intestinal or vascular-toxemic form of acute radiation sickness, symptoms of intestinal damage, the so-called early primary radiation gastroenterocolitis, begin to come to the fore already during the primary reaction. Complex emergency care in these cases, it should consist mainly of means of combating vomiting and dehydration of the body. If vomiting occurs, the use of dimetpramide (2% solution of 1 ml) or aminazine (0.5% solution of 1 ml) is indicated. However, it should be remembered that the introduction of these drugs is contraindicated in collapse. An effective remedy for the relief of vomiting and diarrhea in intestinal form acute radiation sickness is dinetrol. In addition to antiemetic action, it has analgesic and tranquilizing effect. In extremely severe cases, accompanied by diarrhea, signs of dehydration and hypochloremia, it is advisable intravenous administration 10% sodium chloride solution, saline or 5% glucose solution. For the purpose of detoxification, transfusion of low molecular weight polyvinylpyrrolidol, polyglucin and saline solutions is indicated. With a sharp decrease in blood pressure, caffeine and mezaton should be administered intramuscularly. In severe cases, these drugs are administered intravenously, and with their low effectiveness, noradrenaline is added in combination with polyglucin. Can also be used camphor (subcutaneously), and with symptoms of heart failure - corglicon or strophanthin (intravenously).

An even more serious condition of patients requiring urgent interventions by medical personnel occurs when cerebral form acute radiation sickness (occurring after exposure to doses above 80 Gy). In the pathogenesis of such lesions, the leading role belongs to radiation damage to the central nervous system with early and profound impairment of its function. Patients with cerebral syndrome cannot be saved and they should be treated with symptomatic therapy aimed at alleviating their suffering (analgesics, sedatives, antiemetics, anticonvulsants).

In case of combined radiation injuries, the complex of measures provided as emergency medical care consists in combining methods and means of treating acute radiation sickness and non-radiation injuries. Depending on the specific types of injuries, as well as the leading component of the lesion in a given period, the content and sequence of assistance may vary, but in general they represent single system complex treatment. During the acute period (i.e. immediately and shortly after injury) with radiation-mechanical injuries, the main efforts should be directed to providing emergency and emergency care for mechanical and gunshot injuries (stopping bleeding, maintaining heart and respiratory function, anesthesia, immobilization, etc.). In severe injuries complicated by shock, it is necessary to carry out anti-shock therapy. Surgical interventions are carried out only for health reasons. At the same time, it should be borne in mind that surgical trauma can increase the severity of the syndrome of mutual burdening. Therefore, the surgical intervention should be minimal in volume and carried out under reliable anesthesia. During this period, only emergency resuscitation and anti-shock operations are performed.

With radiation-burn injuries health care in the acute period, it consists in anesthesia, the imposition of primary dressings and immobilization, and in case of burn shock, in addition, in anti-shock therapy. In cases where, when there are manifestations of a primary reaction to radiation, their relief is indicated. The use of antibiotics in the acute period is primarily aimed at preventing the development of wound infection.

When radioactive substances enter the gastrointestinal tract, emergency care consists of measures aimed at preventing their absorption into the blood and accumulation in the internal organs. To do this, the victims are prescribed adsorbents. At the same time, it should be remembered that adsorbents do not have polyvalent properties, and in each individual case it is necessary to use appropriate adsorbents that are effective for binding a particular type of radioisotope. For example, when strontium and barium isotopes enter the gastrointestinal tract, adsorbar, polysurmin, highly oxidized cellulose and calcium alginate are effective; when radioactive iodine enters the body - stable iodine preparations. To prevent the absorption of cesium isotopes, the use of ferrocin, bentonite clay, vermiculite (hydromica), Prussian blue is shown. Such well-known sorbents as activated carbon (carbolene) and white clay are practically ineffective in these cases due to the fact that they are not able to capture small amounts of substances. Ion-exchange resins are used with great success for these purposes. Radio active substances, which are in the cationic (for example, strontium-90, barium-140, polonium-210) or anionic (molybdenum-99, tellurium-127, uranium-238) form, replace the corresponding group in the resin and bind to it, which reduces by 1 ,5-2 times their resorption in the intestine.

Adsorbents should be applied immediately after establishing the fact of internal contamination, since radioactive substances are absorbed very quickly. So, when uranium fission products get inside, after 3 hours up to 35-50% of radioactive strontium has time to be absorbed from the intestine and deposited in the bones. Radioactive substances are absorbed very quickly and in large quantities from wounds, as well as from the respiratory tract. Isotopes deposited in tissues and organs are very difficult to remove from the body.

After the use of adsorbents, it is necessary to take measures to free the gastrointestinal tract from the contents. Optimal time for this are the first 1-1.5 hours after the incorporation of radionuclides, but in without fail this should be done more late dates. Apomorphine and some other drugs that cause vomiting are effective means for releasing the contents of the stomach. With contraindications to the use of apomorphine, it is necessary to wash the stomach with water.

Since isotopes can linger in the intestines for a long time, especially in the large intestine (for example, poorly absorbed transuranium and rare earth elements), siphon and conventional enemas should be administered to clean these sections of the intestinal tract, as well as saline laxatives should be prescribed.

In case of inhalation contamination with radioactive substances, the victims are given expectorants and the stomach is washed. When prescribing these procedures, it should be remembered that 50-80% of the radionuclides that linger in the upper respiratory tract soon enter the stomach as a result of swallowing sputum. In some cases, it is advisable to use inhalation in the form of aerosols substances that are able to bind radioisotopes and form complex compounds. Subsequently, these compounds are absorbed into the blood and then excreted in the urine. Similar assistance should be provided when radioactive substances enter the blood and lymph, i.e. at a later stage after infection. For these purposes, it is recommended to prescribe pentacin (trisodium calcium salt of diethylenetriaminepentaacetic acid), which has the ability to bind such radionuclides as plutonium, transplutonium elements, radioactive isotopes of rare earth elements, zinc and some others into stable non-dissociating complexes.

To prevent the absorption of radioactive substances from wound surfaces, wounds must be washed with an adsorbent or saline solution.

IN THE PERIOD OF THE PRIMARY REACTION of the bone marrow form of ARS, treatment is carried out in order to preserve the combat and working capacity of the victim and early pathogenetic therapy. The first includes the use of antiemetics, psychostimulants (dimetpramide, dimetkarb, dixafen, methaclopramide, diphenidol, atropine, chlorpromazine, aeron, etc.). To prevent nausea and vomiting, it is taken orally a tablet of dimetcarb or dimedpramide 20 mg 3 times a day, as well as chlorpromazine (especially against the background of psychomotor agitation) 25 mg 2 times a day. With developed vomiting, dimetpramide is administered intramuscularly in 1 ml of a 2% solution or dixafen in 1 ml, or chlorpromazine in 1 ml of a 0.5% solution, or subcutaneously atropine in 1 ml of a 0.1% solution. Cordiamin, caffeine, camphor can be used to combat hemodynamic disorders, with collapse - prednisolone, mezaton, norepinephrine, polyglucin, with heart failure - corglicon, strophanthin). With indomitable vomiting, diarrhea and symptoms of dehydration - 10% sodium chloride solution, saline.

The basis of early pathogenetic therapy is the development of post-radiation toxicosis and inhibition of cell proliferation processes, accompanied by a decrease in the synthesis of protective proteins, suppression of phagocytosis, the function of immunocompetent cells, etc. This therapy consists of detoxifying, antiproteolytic therapy, the use of agents that restore microcirculation, stimulate hematopoiesis and nonspecific immunological resistance of the body.

Post-radiation toxicosis develops immediately after irradiation as a result of the accumulation of so-called radiotoxins in cells and tissues, which, depending on the timing of appearance and chemical nature, are divided into primary and secondary. Primary radiotoxins include products of water radiolysis, substances of a quinoid nature, and compounds that appear during lipid oxidation (aldehydes, ketones, etc.). Secondary radiotoxins are the result of the decay of radiosensitive tissues; predominantly, these are the products of oxidation of phenolic and hydroaromatic compounds formed in excess. They appear at the later stages of the formation of radiation injury as a result of deep biochemical changes in the metabolism and physiological disorders. Radiotoxins, having high biological activity, can cause breaks in chemical bonds in DNA molecules and prevent their repair, contribute to the occurrence of chromosomal aberrations, damage the structure of cell membranes, and suppress cell division processes.

The means and methods of pathogenetic therapy are aimed at preventing the occurrence or reducing the formation of toxic products, inactivating or reducing their activity, and increasing the rate of elimination of toxins from the body. The latter can be achieved by forcing diuresis using osmotic diuretics. However, since these measures can cause undesirable shifts in the water-electrolyte balance, at present, in the system of combating early post-radiation toxemia, preference is given to detoxifiers - plasma substitutes of hemodynamic, detoxification and polyfunctional action. Among the first, in the mechanism of action of which the main role is played by the effect of "diluting" the concentration of toxins and accelerating their elimination, are polyglucin, reopoliglyukin and some other drugs based on dextran. The introduction of these drugs not only provides a dilution of the concentration of radiotoxins, but also binds them. Polyvinylpyrrolidone derivatives gemodez (6% PVP solution), aminodesis (a mixture of PVP, amino acids and sorbitol), gluconodesis (a mixture of PVP and glucose), preparations based on low molecular weight polyvinyl alcohol - polyvisoline (a mixture of NSAIDs, glucose, potassium, sodium and magnesium salts), rheogluman (10% dextran solution with the addition of 5% mannitol), in addition to the complexing action, also has a pronounced hemodynamic effect, which improves blood microcirculation and improves lymphatic drainage, reduces blood viscosity, and inhibits the processes of aggregation of formed elements.

Many detoxifiers-plasma substitutes have an immunocorrective effect (stimulate the system of mononuclear phagocytes, interferon synthesis, migration and cooperation of T- and B-lymphocytes), which ensures a more favorable course of post-radiation repair processes.

Very effective are the methods of extracorporeal sorption detoxification - hemosorption and plasmapheresis. At present, the positive effect of hemosorption has already been confirmed by a large practice in the treatment of patients with acute radiation injury, however, this procedure causes a number of undesirable consequences (increases thrombus formation, hypovolemia, increases blood viscosity, hypotension, causes nausea, chills). Plasmapheresis is more promising in this regard, it is a transfusiological procedure, which consists in removing a certain volume of plasma from the bloodstream while replenishing with an adequate amount of plasma-substituting fluids. Plasmapheresis in the first 3 days after irradiation, in the mechanisms of therapeutic action of which, it is believed, not only the elimination of antigens and autoimmune complexes, decay products of radiosensitive tissues, inflammatory mediators and other "radiotoxins", but also the improvement of the rheological properties of blood. Unfortunately, the methods of extracorporeal detoxification are very laborious and therefore can be applied mainly at the stage of specialized medical care, if the appropriate forces and means are available.

The development of toxemia and microcirculation disorders in the first days after irradiation is partly associated with the activation of proteolytic enzymes and disseminated intravascular coagulation. To mitigate these disorders, the use of protease inhibitors (kontrykal, trasilol, gordox, etc.) and direct anticoagulants (heparin) during the first 2-3 days of the irradiation field in radiation sickness III-IY degrees is indicated.

In addition to detoxifiers, a large group of drugs used in the early stages after irradiation are biologically active substances of natural and synthetic origin: cytokines, interferon inducers, polyribonucleotides, nucleosides, coenzymes, and some hormonal drugs.

The mechanisms of their anti-radiation action are associated with an increase in radioresistance of tissues by activating the processes of migration of lymphoid cells to the bone marrow, an increase in the number of receptors on immunocompetent cells, an increase in the interaction of macrophages with T- and B-lymphocytes, an increase in the proliferation of hematopoietic stem cells, and activation of granulocytopoiesis. At the same time, the synthesis of gamma globulin, nucleic acids and lysosomal enzymes is stimulated, the phagocytic activity of macrophages is enhanced, the production of lysozyme, beta-lysines, etc. is increased. Some macromolecular compounds (polysaccharides, exogenous RNA and DNA) are also capable of absorbing and inactivating radiotoxins.

Carrying out early pathogenetic therapy, as a rule, will be carried out only in hospitals.

IN THE HIDDEN PERIOD

In the latent period, sanitation of possible foci of infection is carried out. Sedatives, antihistamines (phenazepam, diphenhydramine, pipolfen, etc.), vitamin preparations (group B, C, P) can be prescribed. In some cases, with an extremely severe degree of acute radiation sickness from a relatively uniform irradiation (a dose equal to or more than 6 Gy), if possible, on the 5-6th day, it is possible earlier, after irradiation, transplantation of an allogeneic or syngeneic (previously prepared) can be performed. from the injured and preserved) bone marrow. Allogeneic bone marrow should be selected according to the ABO group, Rh factor and typed according to the HLA antigenic system of leukocytes and the lymphocytic MS test. The number of cells in the transplant should be at least 15-20 billion. Transplantation is usually carried out by intravenous injection of bone marrow. When transplanting bone marrow to an irradiated person, we can count on three effects: engraftment of the transplanted bone marrow of a donor with subsequent reproduction of stem cells, stimulation of the remnants of the victim's bone marrow, and replacement of the affected bone marrow with a donor one without engraftment.

Engraftment of donor bone marrow is possible almost against the background of complete suppression of the immune activity of the irradiated person. Therefore, bone marrow transplantation is performed with active immunosuppressive therapy with antilymphocyte serum or 6% antilymphocyte globulin solution using corticosteroid hormones. The engraftment with the production of full-fledged cells occurs no earlier than 7-14 days after transplantation. Against the background of an accustomed transplant, the revival of the remnants of the irradiated hematopoiesis can occur, which inevitably leads to an immune conflict between one's own bone marrow and the engrafted donor's. In international literature, this is called a secondary disease (foreign transplant rejection disease), and the effect of temporary engraftment of a donor's bone marrow in the body of an irradiated person is called "radiation chimeras". To enhance reparative processes in the bone marrow in patients who received sublethal radiation doses (less than 6 Gy), untyped allogeneic bone marrow compatible with ABO and Rh factor at a dose of 10-15x10 9 cells can be used as a stimulating hematopoiesis and replacement agent. At the end of the latent period, the patient is transferred to a special mode. In anticipation of agranulocytosis and during it, to combat exogenous infection, it is necessary to create an aseptic regimen: bedding with maximum isolation (dispersal of patients, boxed wards with bactericidal lamps, aseptic boxes, sterile wards).

DURING THE HIGH PERIOD, therapeutic and preventive measures are carried out primarily aimed at:

Replacement therapy and restoration of hematopoiesis;

Prevention and treatment of hemorrhagic syndrome;

Prevention and therapy infectious complications.

Treatment of acute radiation sickness should be carried out intensively and comprehensively using not only pathogenetically substantiated means, but also symptomatic drug therapy.

The staff, before entering the ward to the patient, puts on gauze respirators, an additional gown and shoes that are on a rug moistened with a 1% chloramine solution. Systematic bacterial control of air and items in the ward is carried out. Careful oral care is required, hygienic treatment of the skin with an antiseptic solution. When choosing antibacterial agents, one should be guided by the results of determining the sensitivity of the microorganism to antibiotics. In cases where individual bacteriological control is not possible (for example, with a massive influx of affected), it is recommended to selectively determine antibiotic sensitivity to microorganisms isolated from individual victims.

For the treatment of this contingent of patients, antibiotics should be used, to which the most common pathogenic strain of the microbe is sensitive. If bacteriological control is not possible, antibiotics are prescribed empirically, and the therapeutic effect is assessed by body temperature and clinical symptoms characterizing the severity of the infectious process.

Prevention of agranulocytic infectious complications begins within 8-15 days, depending on the severity of ARS (stage II-III) or a decrease in the number of leukocytes less than 1x10 9 /l with maximum doses of bactericidal antibiotics, which are prescribed empirically even before determining the type of pathogen

The use of sulfonamides, due to the fact that they increase granulocytopenia, should be avoided, they are used only in the absence of antibiotics. Antibiotics of choice are semi-synthetic penicillins (ocacillin, methicillin, ampicillin 0.5 orally 4 times a day, carbenicillin). The effect is assessed by the clinical manifestations of the first 48 hours (decrease in fever, disappearance or smoothing of focal symptoms of infection). If there is no effect, it is necessary to replace these antibiotics with tseporin (3-6 g per day) and gentamicin (120-180 mg per day), ampiox, kanamycin (0.5 2 times a day), doxycycline, carbenicillin, lincomycin, rimfampicin. The replacement is made empirically, without taking into account the data of bacteriological studies. If successful, continue the introduction of the drug until the exit from agranulocytosis - an increase in the content of leukocytes in the peripheral blood to 2.0-3.0x10 9 /l (7-10 days). The emergence of a new focus of inflammation on this antibiotic regimen requires a change in drugs. If possible, regular bacteriological examination is carried out, while antibiotic therapy becomes targeted. Antibiotics are administered (including penicillin up to 20 million units per day) at intervals not exceeding 6 hours. If there is no effect, you can add another antibiotic, for example, carbencillin (20 grams per course), reverin, gentomycin. To prevent superinfection with fungi, nystatin is prescribed 1 million units per day 4-6 times or levorin or amphitericin. In severe staphylococcal lesions of the mucosa of the mouth and pharynx, pneumonia, septicemia, antistaphylococcal plasma or antistaphylococcal gamma globulin, other directional globulins are also indicated. In acute radiation sickness of 2 and 3 degrees, it is desirable to introduce agents that increase the nonspecific resistance of the body.

To fight hemorrhagic syndrome use in appropriate doses of funds that compensate for the deficiency of platelets. First of all, it is a platelet mass. Previously, it (300x109 cells in 200-250 ml of plasma per transfusion) is irradiated at a dose of 15 Gy to inactivate immunocomponent cells. Transfusions begin with a decrease in the number of platelets in the blood less than 20x10 9 cells / l. In total, each patient produces from 3 to 8 transfusions. In addition, in the absence of platelet mass, direct blood transfusions, native or freshly prepared blood for no more than 1 day of storage are possible (the presence of a stabilizer and storage of blood for a longer time increase the hemorrhagic syndrome in ARS and transfusion of such blood is not desirable, except in cases of anemic bleeding). Also used are agents that enhance blood coagulation (aminocaproic acid, amben), affecting vascular wall(serotonin, dicynone, ascorutin). In case of bleeding from the mucous membranes, local hemostatic agents should be used: thrombin, a hemostatic sponge, tampons moistened with a solution of epsilon-aminocaproic acid, as well as dry plasma (it can be applied topically for bleeding from the nose, wounds)

In case of anemia, blood transfusions of single-group Rh-compatible blood are necessary, preferably - erythrocyte mass, erythropoiesis, direct transfusions of freshly prepared blood for no more than 1 day of storage. Hematopoietic stimulants are not prescribed during the peak period. Moreover, leukopoiesis stimulants pentoxyl, sodium nucleinate, tezan-25 cause depletion of the bone marrow and aggravate the course of the disease. To eliminate toxemia, an isotonic sodium chloride solution, 5% glucose solution, gemodez, polyglucin and other liquids are dripped into the vein, sometimes in combination with diuretics (lasix, mannitol, etc.), especially with cerebral edema. Doses control the volume of diuresis and indicators of the electrolyte composition.

With a pronounced oropharyngeal and gastrointestinal syndrome - nutrition through a permanent (anorexia) nasal probe (special nutrition, pureed food), prescribe pepsin, antispasmodics, pancreatin, dermatol, calcium carbonate in generally accepted doses. In case of oropharyngeal syndrome, in addition, it is necessary to treat the oral cavity with antiseptic solutions and preparations that accelerate reparative processes (peach and sea buckthorn oil).

In severe intestinal lesions - parenteral nutrition (protein hydrolysates, fat emulsions, polyamine mixtures), starvation. If necessary, symptomatic therapy: vascular insufficiency- mezaton, norepinephrine, prednisolone; with heart failure - corglicon or strophanthin.

IN THE RECOVERY PERIOD, in order to stabilize and restore hematopoiesis and CNS function, small doses of anabolic steroids (nerobol, retabolil), tezan, pentoxyl, lithium carbonate, sodium nucleic acid, securinin, bemitil are prescribed; vitamins of groups B, A, C, R. The patient receives a diet rich in protein, vitamins and iron (diet 15, 11b); gradually the patient is transferred to a general regimen, antibacterial (when the number of leukocytes reaches 3x10 9 / l and more hemostatic (when the number of platelets increases to 60-80 thousand in 1 μl) are canceled, rational psychotherapy is carried out, and he is correctly oriented in work and life mode The terms of discharge from the hospital do not exceed 2.5-3 months for ARS grade III, 2-2.5 months for grade II ARS, and 1-1.5 months for grade I ARS.

Treatment of those affected by ionizing radiation at the stages of medical evacuation is carried out in accordance with the main directions of ARS therapy, taking into account the intensity of the flow of the injured, the prognosis for life, the regular and personnel capabilities of the stage.

FIRST MEDICAL AID is provided immediately after radiation damage in the order of self- and mutual assistance. Are taken orally means of preventing the primary reaction - dimetkarb, with developed vomiting and hypodynamia - dixafen in / m; when skin and clothes are contaminated with RV - partial sanitization; in case of danger of further irradiation (being on the ground) of contaminated RS, a radioprotector - cystamine or B-130 is taken orally.

FIRST AID is provided by a paramedic or medical instructor. With developed vomiting and hypodynamia - dimetpramide or dixafen in / m; at cardiovascular insufficiency- cordiamine s / c; caffeine i / m; with psychomotor agitation inside - phenazepam; if necessary, further stay in the zone increased radiation inside - cystamine or B-130; when skin or clothes are contaminated with RV - partial sanitization.

FIRST MEDICAL AID is carried out at the WFP. Of great importance is correctly, quickly and accurately carried out triage. At the sorting post, the affected, contaminated with RS, are isolated and sent to the site for partial sanitization (PSO). All the rest, as well as those affected after PSO, are examined by a doctor at the triage yard as part of the medical team (doctor, nurse, registrar). Those who are injured and need emergency care are identified.

Urgent first aid measures include: the introduction of severe vomiting - dimetpramide / m, with indomitable vomiting - dixaphene / m or atropine s / c, with severe dehydration - drinking plenty of salted water, saline s / c and / in ; in acute vascular insufficiency - cordiamin s / c, caffeine / m or mezaton / m; in heart failure - corglicon or strophanthin IV; with convulsions - phenazepam or barbamil i / m.

Delayed therapeutic measures include the appointment of febrile patients inside ampicillin or oxacillin, penicillin in / m; with the severity of bleeding, EACC or amben i / m.

Patients with ARS stage I (dose - 1-2 Gy) after stopping the primary reaction, they are returned to the unit; in the presence of manifestations of the height of the disease, as well as all patients with ARS of a more severe degree (dose more than 2 Gy), they are referred to the OMEDB (OMO) for the provision of qualified assistance.

QUALIFIED MEDICAL CARE. Upon admission to the OMEB of those affected by ionizing radiation, in the process of their sorting, victims are identified with contamination of the skin and uniforms with RV in excess of the permissible level. They are sent to the OSO, where a complete sanitization is carried out and, if necessary, emergency assistance is provided. In the sorting and evacuation department, the form and severity of ARS, the state of transportability are determined. Non-transportable affected (acute cardiovascular failure, indomitable vomiting with signs of dehydration) are sent to the anti-shock department, patients with signs of severe toxemia, psychomotor agitation, convulsive hyperkinetic syndrome - to the hospital department. Patients with ARS stage I (dose 1-2 Gy) after stopping the primary reaction, they are returned to their unit. All patients with a more severe degree of ARS (dose over 2 Gy), with the exception of those with a cerebral form of radiation sickness, are evacuated to therapeutic hospitals; patients with ARS stage I during the height of the disease, they are evacuated to VPGLR, with II-IY st. - in therapeutic hospitals.

Measures of emergency qualified medical care:

with a pronounced primary reaction (persistent vomiting) - dimetpramide or dixafen intramuscularly or atropine s / c, in case of severe dehydration, sodium chloride solutions, hemodez, reopoliglyukin - all intravenously.

in case of cardiovascular insufficiency - mezaton in / m or norepinephrine in / in with a glucose solution, in case of heart failure - corglicon and strophanthin in / in drip on a glucose solution;

with anemic bleeding - EACC or amben IV, locally - thrombin, hemostatic sponge, as well as transfusion of red blood cells or freshly prepared blood (direct blood transfusions);

in severe infectious complications - ampicillin with oxacillin or rifampicin or penicillin, or erythromycin inside.

Delayed qualified assistance measures include the appointment of:

when excited - phenazepam, oxylidine inside;

with a decrease in the number of leukocytes to 1x10 9 / l and fever - tetracycline, sulfonamides inside;

in the latent period - multivitamins, diphenhydramine, plasma transfusion, polyvinylpyrrolidone and polyglucin every other day;

in the cerebral form of ARS to alleviate suffering - phenazepam i / m, barbamil i / m, promedol s / c.

After the provision of qualified assistance and preparation for evacuation, ARS patients are evacuated to the hospital base.

SPECIALIZED MEDICAL CARE is provided in therapeutic hospitals. In addition to qualified assistance activities in initial period with ARS II-III st. hemosorption can be carried out, in the latent period, patients with stage IY. ARS (dose 6-10 Gy) - transplantation of allogeneic bone marrow, and in the peak period with the development of agranulocytosis and deep thrombocytopenia and severe enteritis - placement of patients in aseptic wards, tube or parenteral nutrition, transfusion of leukoconcentrates and platelet mass obtained by cell separation.

Staged treatment of combined and combined radiation injuries has a number of features.

With PSA incorporation, in addition to the treatment of ARS, medical care measures are taken to remove RV that have entered the body: gastric lavage, the appointment of laxatives, adsorbents, cleansing enemas, expectorants, diuretics, the introduction of complexones (EDTA, pentacin, etc.). With betadermatitis - anesthesia (novocaine blockade, local anaesthesia), dressings with antibacterial agents, etc.

With CRP, it is necessary to combine the complex therapy of radiation sickness with the treatment of non-radiation injuries. Surgical treatment must be completed in the latent period of radiation sickness, during the height of the operation is carried out only for health reasons. A feature of the treatment of CRP in the initial and latent periods of radiation sickness is the prophylactic administration of antibiotics (before the onset of infectious processes and agranulocytosis).

At the height of the disease, special attention is paid to the prevention and treatment of wound infection and the prevention of bleeding from wounds (the use of fibrin and hemostatic sponge, dry thrombin).

After completion of treatment of patients with ARS, a military medical examination is carried out to determine the suitability for further service in the Armed Forces.

Associated with the impact on the human body of ionizing radiation.

Causes and symptoms of radiation sickness

According to its occurrence, this disease is divided into acute, resulting from a single, but exceeding the norm, radiation exposure, and chronic, when radiation affects the human body for a long time regularly or periodically.

The acute form of radiation sickness has several stages.

Consider the degree of radiation sickness:

1 degree occurs as a result of exposure in the amount of 1-2 GR (100-200 rad). Appears after 2-3 weeks.
Grade 2 occurs as a result of exposure to radiation of 2-5 Gy (200-500 rad). Appears in 4-5 days.
Grade 3 appears at a radiation dose of 5-10 GR (500-1000 rad). It appears 10-12 hours after exposure.
Grade 4 occurs at a radiation dose of more than 10 Gy (1000 rad), manifests itself literally 30 minutes after exposure. This dose of radiation is absolutely lethal.

Radiation doses up to 1 Gy (100 rad) are considered mild and cause conditions that, in medical practice called predisease.

When exposed to more than 10 Gy, the first symptoms appear after a couple of hours. There is reddening of the skin in places where there was the strongest exposure. There is nausea and vomiting.

At high doses of radiation, there may be disorientation, and. Cells in the gastrointestinal tract die.

Over time, symptoms progress - atrophy of mucosal cells occurs and bacterial infections. Cells that have absorbed nutrients are destroyed. This often results in bleeding.

A dose of radiation over 10 Gy is lethal to humans. Death usually occurs within 2 weeks.

In the event of infectious complications, large doses are used antibacterial drugs. Severe radiation sickness sometimes requires a bone graft. But this method does not always help, as tissue incompatibility is often observed.

Upon contact with contaminated objects, shielding of all parts of the body is required. It is mandatory to take drugs that can reduce the level of sensitivity to radioactive radiation.

One of the most effective methods prevention is the use of radioprotectors. These elements are protective connections, but may cause others.

When exposed to human body ionizing rays in large doses, radiation sickness can occur - damage to cellular structures, tissues and liquid media, occurring in an acute or chronic form. In our time acute illness is relatively rare - this is possible only in case of accidents and a single high-power external exposure. Chronic radiation pathology caused by prolonged exposure to the body of the radiation flux in small doses, exceeding, however, the maximum allowable amount. In this case, almost all organs and systems are affected, so the clinical picture of the disease is diverse and not always the same.

ICD code 10

J 70.0 - Acute pulmonary pathology provoked by radiation.
J 70.1 - Chronic and other pulmonary pathology provoked by radiation.
K 52.0 - Radiation form of gastroenteritis and colitis.
K 62.7 - Radiation form of proctitis.
M 96.2 - Post-radiation form of kyphosis.
M 96.5 - Post-radiation form of scoliosis.
L 58 - Radiation dermatitis.
L 59 - Others dermatological diseases associated with exposure to radiation.
T 66 - Unspecified pathologies associated with radiation.

ICD-10 code

Z57.1 Occupational exposure to radiation

Causes of radiation sickness

The acute form of radiation sickness in humans occurs with a short (several minutes, hours, or 1-2 days) irradiation of the body in a dosage above 1 g (100 Rad.). Such exposure can be obtained while in the area of radiation exposure or during radioactive fallout, with wrong work with strong sources of radiation, in case of accidents occurring with the release of radiation, as well as when using radiotherapy for therapeutic purposes.

In addition, the causes of radiation sickness can be Various types radiation and radiation that are in the atmosphere, in food consumed, in water. The ingress of radioactive components into the body can occur during breathing, when eating. Substances can be absorbed through the pores of the skin, penetrate into the eyes, etc.

An important role in the appearance of the disease is played by biogeochemical anomalies, pollution environment due to a nuclear explosion, leakage of nuclear waste, etc. During a nuclear explosion, the atmosphere is saturated as a result of the release of radioactive substances into the air that have not entered into chain reaction, causing the appearance of new isotopes. Clearly marked severe course radiation injury observed after explosions or accidents at nuclear power plants or power plants.

Pathogenesis

Radiation sickness can be acute (subacute) or chronic, depending on the duration and magnitude of the learning impact, which determines the course of the changes that occur. The characteristic of the etiology of the appearance of pathology is that the acute form cannot become chronic or, conversely, unlike other diseases.

The appearance of certain signs of the disease directly depends on the dosage of the external radiation exposure received. In addition, the type of radiation is also important, because each of them has certain characteristics, including the power of the damaging effect on the body.

For example, α-rays have a high ionization density and a low penetrating property, due to which the sources of such radiation have a small spatial damaging effect.

ß-rays, with low penetration and low ionization density, affect tissues in areas of the body that are directly adjacent to the radiation source.

At the same time, γ-rays and X-rays lead to deep damage to tissues that have come under their influence.

Neutron beams affect organs unevenly, because their penetrating properties, as well as linear energy loss, can be different.

Symptoms of radiation sickness

Symptomatic manifestations of radiation sickness can be divided into several degrees of severity, which is explained by the dosage of the radiation received:

when exposed to 1-2 Gy, they talk about mild injury;
when exposed to 2-4 Gy - about medium degree;
when exposed to 4-6 Gy - about a severe lesion;
when exposed to radiation more than 6 Gy - about the defeat of an extremely severe degree.

Clinical signs in this case largely depend on the severity of the damage to the body.

Diagnosis of radiation sickness

When diagnosing a patient with irradiation of the body, it is first necessary to find out the dosage of rays to which the victim was exposed. Depending on this, further actions will be determined subsequently.

It is necessary to find out information from the patient or his relatives about the source of radiation, about the distance between him and the victim, about the duration of exposure, etc.
It is important to learn about the type of rays that have had an effect on a person.
The clinical picture, intensity and severity of symptoms are carefully studied.
Blood tests are carried out, preferably repeated within a few days.
Important information can be provided by a dosimeter - a special device that measures the amount of absorbed radiation.

Blood tests can provide the following information:

With light exposure (1-2 Gy):

lymphocytes - more than 20%;
leukocytes - more than 3000;
platelets - more than 80,000 in 1 µl.

With medium exposure (2-4 Gy):

lymphocytes - 6-20%;
leukocytes - 2000-3000;

For severe exposure (4-6 Gy):

lymphocytes - 2-5%;
leukocytes - 1000-2000;
platelets - less than 80,000 in 1 µl.

With extremely severe exposure (more than 6 Gy):

lymphocytes - 0.5-1.5%;
leukocytes - less than 1000;
platelets - less than 80,000 in 1 µl.

Additionally, such auxiliary research methods can be prescribed, which are not fundamental, but are of some value for clarifying the diagnosis.

Laboratory diagnostic methods ( microscopic examination scraping of ulcerative and mucous surfaces, analysis of blood sterility).
Instrumental diagnostics (electroencephalography, cardiography, ultrasonography abdomen, thyroid).
Consultation of doctors of narrow specializations (neuropathologist, hematologist, gastroenterologist, endocrinologist).

If necessary, differential diagnosis is carried out, although if there is reliable data on the fact of exposure, this moment is often missed.

The scheme for calculating the dose load using biological indicators in patients after exposure to ionizing radiation is called the term "biological dosimetry". In this case, it is not the total amount of radiated energy that was absorbed by the body that is calculated, but the ratio of biological disorders with the dose of a short single exposure. This technique helps to assess the severity of the pathology.

Radiation sickness treatment

In the acute form of radiation injury, the victim is placed in a special box, where appropriate aseptic conditions are maintained. Bed rest is prescribed.

First of all, such measures are taken as the treatment of wound surfaces, cleaning the stomach and intestines, eliminating vomiting, and normalizing blood pressure.

If the irradiation is of internal origin, then enter certain drugs, the action of which is aimed at neutralizing radioactive substances.

At first, a strong detoxification therapy is carried out, which includes intravenous administration of a saline or plasma-substituting solution, hemodez, and also forced diuresis. In case of damage to the gastrointestinal tract, dietary restrictions are prescribed in the first few days (it is possible to switch to parenteral nutrition), treatment oral cavity antiseptic liquids.

To eliminate hemorrhages, blood products, platelet or erythrocyte mass are administered. Possible transfusion of blood, plasma.

For a warning infectious diseases use antibacterial drugs.

In chronic radiation injury, symptomatic therapy is prescribed.

First aid for radiation sickness carried out in stages.

The victim must be subjected to pre-treatment: rid him of clothes, wash in the shower, be sure to rinse the mouth and nasal cavity, rinse his eyes. 2.
Next, gastric lavage should be carried out, if necessary, an antiemetic drug (for example, cerucal) should be given. 3.
After that, the doctor prescribes anti-shock and detoxification therapy, cardiac and sedative drugs.

In the first phase of the disease, drugs are prescribed that eliminate attacks of nausea and vomiting. With uncontrolled vomiting, 0.5 ml of a 0.1% solution of atropine is used s / c or / m. Can apply drip introduction 50-100 ml hypertonic saline sodium chloride. Severe course radiation sickness may require detoxification treatment. Drugs such as norepinephrine, contrical, cordiamine, trasilol, or mezaton are prescribed to prevent the collaptoid state. The skin and accessible mucous membranes are treated with antiseptic solutions. An overly active intestinal microflora is inhibited by the intake of indigestible antibacterial drugs, such as gentamicin, neomycin, ristomycin, in combination with antifungal therapy.

With the development of infection, intravenous administration of large doses of antibiotics is used - tseporin, methicillin, kanamycin. Often such treatment is supplemented with biological preparations - antistaphylococcal, hyperimmune or antipseudomonal plasma. As a rule, antibacterial agents show their effect for 2 days. If positive effect has not come, then the drug is replaced by another, stronger one.

With an extremely severe lesion with suppression of immunity and a decrease in the function of hematopoiesis, a bone marrow transplant operation is performed. The transplanted material is taken from a donor, and the transplant itself is carried out after a course of immunosuppressants (to prevent rejection).

Alternative treatment

Folk methods used to eliminate the signs of radiation sickness include the use garlic tincture, nettle leaves, berries chokeberry, eleutherococcus, sea buckthorn berries, ginseng, coconut, wild rose, grape and currant leaves, quince, seaweed, bee products, red wine. To improve the composition of the blood, plants such as knotweed, dandelion leaves, burdock, yarrow are used.

Mix 500 ml of red wine (preferably Cahors) with 500 ml of juice of the lower leaves of aloe, 500 g of flower honey and 200 g of ground calamus rhizome. Infuse the mixture for 2 weeks in the refrigerator, then use 1 tbsp. l. 1 hour before meals three times a day with milk.
600 ml of water and 3 tbsp. l. Boil dry oregano raw materials, insist overnight (you can in a thermos). In the morning, filter and drink 1/3-1/2 cup three times a day. It is allowed to add a spoonful of honey. The duration of treatment depends on the condition of the patient and may continue until persistent signs of improvement.
1 st. l. mix chagi with 200 ml of boiling water, leave for 15 minutes, then add baking soda on the tip of a knife and leave for 10 minutes. Take the medicine three times a day for 1 tbsp. l. half an hour before meals.
Pour 1 cup of flax seeds with two liters of boiling water and cook for about 2 hours. Remove from fire and cool. Take 100 ml up to 7 times a day.
2 tbsp. l. boil lingonberry berries for 10 minutes in 500 ml of water, then leave for 1 hour under the lid. Take 250 ml twice a day after meals.

Herbal treatment cannot be independent. Such treatment should only be combined with traditional medical therapy prescribed by a medical specialist.

Homeopathy for radiation sickness

The effectiveness of homeopathic medicines in the treatment of radiation sickness has not yet been thoroughly proven. However, American scientists continue to experiment, looking for ways to protect humans from harmful radiation.

One drug that has successfully withstood all research and testing is the food supplement Fucus vesiculosus. This remedy blocks the absorption of radioactive rays by the thyroid gland, preventing its receptors from carrying out their function. This dietary supplement is made from seaweed.

A remedy such as Cadmium sulphuratum also has a similar effect. Among other things, this drug significantly alleviates the symptoms of radiation sickness, such as pruritus, dyspeptic disorders, muscle pain.

However, it should be noted that there is no direct evidence of the effectiveness of these drugs yet, so the decision to use them is quite risky. Before you start taking homeopathic remedies, consult your doctor.

Prevention and prognosis of radiation sickness

The calculation of the prognosis of radiation sickness directly depends on the amount of radiation exposure received and the duration of its exposure. Victims who survived critical period(which is 3 months) after radiation injury, have every chance of a favorable outcome. But even in the absence of mortality, patients may have some health problems in the future. Blood diseases can develop, malignant tumors in almost any organs and tissues, and the next generation has high risk development of genetic disorders.

Preventive measures against radiation injury may include the installation of protective elements on the torso or individual parts of the body (the so-called screens). Employees of hazardous enterprises undergo certain training, put on special clothes. Also, people at risk may be prescribed drugs that reduce the sensitivity of tissues to radioactive rays. It is mandatory to take vitamins of group B, as well as C and P.

People who have regular contact with sources of radiation should periodically visit preventive examinations and take a blood test.

Radiation sickness is a difficult disease that cannot be cured on its own. And it’s hardly worth the risk, because the consequences of such a pathology are very serious. Therefore, in case of any suspicion of exposure, even if there are no symptoms of damage, it is necessary to consult a doctor and undergo the necessary examinations.

Radiation sickness is the body's reaction to the effects of radioactive radiation. Under its influence, unnatural processes are launched in the body, which lead to failures in many body systems.

The disease is considered very dangerous because it provokes irreversible processes. modern medicine can only stop their destructive development in the body.

The degree of radiation damage depends on the area of the irradiated surface of the body, the time of exposure, the way the radiation penetrates, and also on the body's immune response.

There are several forms of the disease: those that form as a result of uniform exposure, as well as with a narrowly localized effect of radiation on certain part body or organ. In addition, there are transitional and combined forms of the disease, in acute and chronic course.

Penetrating radiation provokes oxidative reactions in cells. This depletes the system antioxidant protection and the cells die. This leads to a gross violation of the metabolic processes.

Given the degree of damage by radiation, it is possible to determine the main systems that are most susceptible to pathological effects. First of all, the gastrointestinal tract, circulatory and central nervous system, spinal cord. By affecting these organs and systems, radiation causes serious dysfunction. The latter may appear as single complications or in combination with others. At complex symptoms usually talk about third-degree radiation damage. Such pathologies usually end in death.

Radiation sickness can occur in acute and chronic forms, depending on absolute value radiation load and the duration of its impact. A peculiar mechanism for the development of acute and chronic forms of the disease excludes the possibility of transition from one form of the disease to another.

The conditional boundary that separates sharp shape from chronic - this is the accumulation for a limited period (1 hour - 3 days) of the total tissue dose of radiation, which is equivalent to the effect of 1 Gy of external penetrating radiation.

An important role in the development of radiation sickness is played by the type of radiation. Each of them is characterized by the characteristics of the defeat various bodies and systems. Let's take a closer look:

alpha radiation. It is characterized by high ionization density, low penetrating power. Therefore, sources emitting a-waves have a damaging effect limited in space.
beta radiation. It has a weak penetrating and ionizing ability. It can affect tissues directly in areas of the body that are tightly adjacent to the source of radiation.
Gamma radiation and X-ray. Causes deep damage to all tissues in the area of action of the radiation source.
neutron radiation. It has a different penetrating ability, therefore it affects organs heterogeneously.

In the case of exposure to a dose of 50-100 Gy, damage to the central nervous system plays a major role in the development of the disease. In this case, a lethal outcome is usually observed 4-8 days after exposure to radiation.

When irradiated with a dosage of 10-50 Gy, the symptoms of damage to the digestive organs come to the fore. This results in mucosal shedding. small intestine and death occurs within 14 days.

At lower doses of radiation (1-10 Gy), there are, first of all, hematological syndromes, bleeding, complications of infectious genesis.

The main causes of radiation sickness

The development of the disease can be due to external and internal radiation. Radiation can enter the body with inhaled air, through the skin, gastrointestinal tract, mucous membranes, and also as a result of injections.

Small doses of ionizing radiation from various sources (natural and man-made) affect a person constantly. But at the same time, the development of radiation sickness does not occur. It occurs in humans under the influence of radioactive radiation received at a dosage of 1-10 Gy and above. At lower radiation doses (0.1-1 Gy), preclinical manifestations of the disease may occur.

There are two main causes of radiation sickness:

Single (short-term) irradiation high level during various man-made disasters of nuclear energy, conducting experiments, using nuclear weapons, treating oncological and hematological diseases.
Long-term training with small doses of radiation. It is usually noted in medical workers in the departments of radiation therapy and diagnostics (radiology, radiology), as well as patients who need regular radionuclide and radiological examinations.

Symptoms of radiation sickness

The symptomatology of the disease depends primarily on the dose of radiation received, as well as on the severity of the disease. There are several main phases of radiation sickness, which are characterized by certain symptoms:

The first phase is the primary general reaction. It is observed in all people who have received radiation doses above 2 Gy. The period of manifestation depends on the dose of radiation and, as a rule, is calculated in minutes and hours. Characteristic signs: nausea, vomiting, a feeling of bitterness and dryness in the mouth, weakness, fatigue, headache, drowsiness. Often there is a state of shock, which is accompanied by a drop in blood pressure, loss of consciousness, fever, diarrhea. Such symptoms of radiation sickness usually appear when exposed to a dose of more than 10 Gy. Sometimes there is reddening of the skin with a bluish tinge in areas of the body that have been irradiated with a dose of 6-10 Gy. Patients may experience variability in pulse, pressure with a tendency to decrease, overall muscle tone, tendon reflexes decrease, fingers tremble. There is also a developed inhibition of the cerebral cortex. During the first day, the number of lymphocytes in the blood decreases in patients. This process is associated with cell death.
The second phase is latent or latent, in which clinical well-being is noted. It usually occurs after the disappearance of the symptoms of the primary reaction 3-4 days after exposure to radiation. Can last up to 32 days. The state of health of patients improves significantly, only some lability of the pulse rate and pressure level can be maintained. If the dose of received radiation was more than 10 Gy, then this phase may be absent and the first one flows into the third one. On days 12-16, patients who received more than three Grays of radiation begin to lose their hair. Also during this period, there may be various lesions skin. Their prognosis is unfavorable and indicates a high dose of radiation. In the second phase, neurological symptoms may become distinct: movements are disturbed, trembling eyeballs, reflexes are reduced, mild pyramidal insufficiency. By the end of the second phase, blood clotting slows down, and the stability of the vascular wall decreases.
Third phase - bright severe symptoms . The timing of the onset and intensity of symptoms depend on the dose of ionizing radiation received. The duration of the period fluctuates around 7-20 days. Damage to the circulatory system, immunosuppression, hemorrhagic syndrome, the development of infections, and autointoxication come to the fore. By the beginning of this phase, the patient's condition worsens: weakness increases, there is a frequent pulse, fever, and blood pressure decreases. The gums begin to bleed, swelling appears. The mucous membranes of the oral cavity and digestive organs are also affected, necrotic ulcers appear. With a small dose of radiation, the mucosa is restored almost completely over time. With a large dose of radiation, inflammation of the small intestine occurs. It is characterized by diarrhea, bloating, soreness in iliac region. In the second month of radiation sickness, inflammation of the esophagus and stomach often joins. Infections, as a rule, manifest themselves in the form of erosive and ulcerative tonsillitis, pneumonia. Hematopoiesis is inhibited, and the immunobiological reactivity of the body is suppressed. Hemorrhagic syndrome manifests itself in the form of numerous hemorrhages that appear in various places such as skin, heart muscle, digestive organs, central nervous system, respiratory mucosa, urinary tract. There is usually extensive bleeding. Symptoms of a neurological nature are manifested in the form of general weakness, adynamia, decreased muscle tone, darkening of consciousness, growth of tendon reflexes, meningeal manifestations. Often reveal signs of increasing swelling of the brain and membranes.
The fourth phase is the period of restoration of structure and functions. The condition of patients improves, hemorrhagic manifestations disappear, damaged areas of the skin, mucous membranes begin to heal, new hair grows. Recovery period lasts, as a rule, about half a year. At high doses of radiation, recovery can take up to two years. After the end of the fourth phase, we can talk about full recovery. True, in most cases, after exposure and radiation sickness, residual manifestations remain. The healing process is accompanied by failures heart rate, jumps in blood pressure.

With radiation sickness, complications such as cataracts of the eyes, leukemia, neuroses of a different nature often occur.

Classification of radiation sickness

The classification of the disease is based on the criteria for the duration of the lesion and the dosage of ionizing radiation. With a single massive exposure to radiation, acute radiation sickness develops. With prolonged exposure, repeated in relatively small doses, it is a chronic ailment.

The degree of radiation sickness, the clinical form of the lesion is determined by the dosage of the radiation received:

radiation injury. May occur with short-term, simultaneous exposure to radiation with a dosage of less than 1 Gy. Pathological disorders are reversible.
Bone marrow form (typical). It develops with short-term single-stage exposure to 1-6 Gy. The mortality rate is 50%. It can have four degrees: mild (1-2 Gy), medium (2-4 Gy), severe (4-6 Gy), extremely severe (6-10 Gy).
Gastrointestinal form. The result of a one-time short-term exposure to radiation of 10-20 Gy. It is characterized by severe enteritis, hemorrhagic syndrome, fever, infectious and septic complications.
Vascular (toxemic) form. The result of single-stage irradiation with a dose of 20-80 Gy. Hemodynamic disorders and severe intoxication are noted.
cerebral form. It develops as a result of exposure to a dose of more than 80 Gy. Death occurs on the first or third day. The cause of death is cerebral edema.

Chronic radiation sickness occurs in three periods: formation, recovery, consequences (outcome, complications). The period of formation of pathologies lasts about 1-3 years. At this time, the clinical syndrome develops varying degrees gravity. The recovery period usually begins after the intensity of radiation has decreased or the exposure to radiation has completely ceased.

The outcome of chronic radiation sickness may be recovery, partial recovery, stabilization of favorable changes or their progression.

Features of the treatment of radiation sickness

When exposed to radiation with a dose above 2.5 Gy, lethal outcomes are possible. A dose of 4 Gy is considered an average lethal dose for humans. Clinical recovery is possible with correct and timely treatment radiation sickness with exposure to 5-10 Gy. However, in the vast majority of cases, exposure to a dose of 6 Gy leads to death.

Treatment of the disease consists in providing an aseptic regimen in specially equipped wards, preventing infectious complications and relieving symptoms. With an increase in fever and agranulocytosis, antibiotics and antiviral drugs are used.

For the relief of nausea and vomiting, Aeron, Aminazine, Atropine are prescribed. When dehydrated, saline is infused.

In severe irradiation, detoxification therapy with Cordiamin, Mezaton, Norepinephrine, kinin inhibitors is carried out during the first day.

To increase anti-infective therapy, hyperimmune plasma agents and gamma globulin are prescribed. The system of measures aimed at the prevention of internal and external infections uses isolators different types with the supply of sterile air, sterile materials, food. Skin and mucous membranes should be treated with antiseptics. To suppress the activity of the intestinal flora, nonabsorbable antibiotics are used - Gentamicin, Kanamycin, Neomycin, Ristomycin.

Replacement of platelet deficiency is carried out by introducing a platelet mass obtained from one donor after irradiation with a dose of 15 Gy. According to the indications, transfusions of washed fresh erythrocytes may be prescribed.

To combat bleeding, hemostatic drugs of general and local action. Means that strengthen the vascular wall are also prescribed - Dicinon, Rutin, ascorbic acid, steroid hormones, and also increase blood clotting - Fibrinogen.

Local lesions of the mucous membrane require special care and treatment with bactericidal mucolytic drugs. To eliminate skin lesions, aerosols and collagen films, moisturizing dressings with antiseptics and tannins, as well as ointment dressings with hydrocortisone and its derivatives are used. Non-healing wounds and ulcers are excised with further plasty.

With the development of necrotic enteropathy, Biseptol, antibiotics that sterilize the gastrointestinal tract are used. Complete fasting is also indicated. Allowed the use of boiled water and drugs against diarrhea. In especially severe cases, parenteral nutrition is used.

At high doses radiation exposure, absence of contraindications and availability of a suitable donor, bone marrow transplantation is recommended. Usually the indication is an irreversible depression of hematopoiesis, a deep suppression of immunological reactivity.

Consequences and complications of radiation sickness

The prognosis of the disease is associated with the massive dose of radiation and the duration of exposure. Patients who survive the critical period of 12 weeks after irradiation have a chance of a favorable outcome.

However, even after non-lethal radiation injury, victims often may subsequently develop various complications- hemoblastoses, malignant formations of different localization. Often there is a loss of reproductive function, and various genetic abnormalities can be detected in the offspring.

Latent chronic diseases may also be exacerbated. infectious diseases, blood pathology. Deviations also occur in the field of ophthalmology - the lens and vitreous body become cloudy. There are various dystrophic processes in the body.

It is possible to protect yourself from the consequences of radiation sickness as much as possible only with a timely visit to a specialized clinic.

How to treat radiation sickness- look at the video:

Radiation sickness is a serious illness that manifests itself with a whole “bouquet” of symptoms. effective treatment the disease does not currently exist, and therapy is reduced only to the suppression of symptoms. Therefore, it is important to take precautions near sources of radiation and try to protect yourself from ionizing radiation as much as possible.