Occupational Diseases / / August 12, 2017
As a result of the impact of different types of ionizing radiation may develop a violation of vital activity with the defeat of his organs and systems, which is known as radiation sickness.
clinical picture of the disease depends on the type and dose of radiation, the duration of action of the latter, the place of its application, the general state of the organism.There is an acute and chronic form of radiation sickness.
Acute radiation sickness can occur in an emergency with a single external irradiation at a dose of more than 0.0258 C / kg, or 100 R. Chronic radiation disease can develop as a result of prolonged exposure to ionizing radiation on the body in relatively small doses.
initial signs of chronic exposure to radiation arising to the development of a clear clinical picture of radiation sickness (preclinical stage), manifested in the form of functional disorders of various systems and organs.Most often observed fluctuations of individual indicators of blood, vegetative-vascular reac
I stage of chronic radiation sickness is characterized primarily functional disorders in neurohumoral regulation system.The most frequently reported general weakness, fatigue, headache, dizziness, sleep disturbances and light dyspeptic symptoms.Women are possible menstrual irregularities.Symptoms of this stage maloharakternye and nonspecific - Moderate asthenic syndrome in combination with autonomic instability, blood pressure lability (often a tendency to hypotension).There may be an increase in basal metabolism, weight loss, bowel dysfunction observed phenomena and biliary tract, gastric acidity fluctuations from high to low numbers.Blood changes are minor and unstable.Give them value is possible only when comparing the figures with those of previous studies.There may be a moderate increase in the number of white blood cells with lymphocytosis and shift leukocyte left (stimulation of hematopoiesis).This stage is captured rare, more common in unstable mild leukopenia (up to 4 • 10 * 9 / l - 3,5 • 10 * 9 / L) with lymphopenia and neutropenia;can be observed hypersegmentation neutrophils, elevated neutrophils with abnormal grain, moderate thrombocytopenia.The number of red blood cells usually normal, but their resistance is reduced, there are spherocytosis, increased content of reticulocytes.There may be initial signs of increased permeability and capillary fragility, positive symptoms and pinch the harness, lengthening the time of blood clotting.
Termination of contact with ionizing radiation and the appropriate treatment leads to the complete restoration of health.If contact is terminated, the disease progresses to the next stage.
Boosts headaches, dizziness, sharply reduced efficiency, more severe dyspeptic symptoms (pain and heaviness in the stomach, unstable stool, nausea, heartburn), pain in angina-type heart.Against the expressed asthenic conditions may occur diencephalic crises, as well as the initial symptoms of an organic lesion of the central nervous system, lungs vestibular disorders.Blood pressure persistently lowered, especially diastolic.Reduced pressure in the superficial temporal artery and central retinal artery.Heart sounds are muffled, sometimes auscultated systolic murmur pas top.Degenerative changes in the heart muscle (ECG).In some cases, may develop hepatitis, decreased pancreatic, adrenal and thyroid glands, reducing body weight.There is a violation of all kinds of exchange.
disrupted function of the ovaries, amenorrhea develops.Men may come resistant sterility due to the death of sperm.Changes in blood: persistent leukopenia (3 • 10 * 9 / L - 2 • 10 * 9 / L), neutropenia and lymphopenia, increase in the number of neutrophils with abnormal grain.Severe thrombocytopenia (up to 100 • 10 * 9 / L or less).Reduced hemoglobin, and Anisocytosis poikilocytosis erythrocytes.In the bone marrow hypoplasia is found, sometimes with a tendency to megaloblastic hematopoiesis.Clear signs of hemorrhagic diathesis (bruising, nosebleeds, bleeding gums).Develop gingivitis and stomatitis by increasing vascular permeability and bleeding disorders.At this stage, often joined by a variety of infectious diseases of the upper respiratory tract, bronchitis, lesions of the biliary tract, and others., But they usually occur unresponsiveness.
III stage is characterized by irreversible changes in the body.In the foreground organic lesions of the nervous system - the brain in the form of disseminated encephalomyelitis, manifesting various disorders of motor, reflex and sensitive areas, the phenomena of diencephalic and hypertensive syndromes.
There have been marked changes in the cardiovascular system (bradycardia, arrythmia, gross degenerative changes in the myocardium, hypotension) and gastrointestinal (constipation alternating with diarrhea), abnormal liver function.It can develop nephritis in violation azotovydelitelnoy function, residual nitrogen of blood increases.Expressed lesions of the endocrine system (adrenal, thyroid, pituitary, gonads).There are multiple hemorrhages, ulcer-necrotic lesions of the mucous membranes.In the bone marrow - hypoplasia (up to panmieloftiza) with a decrease in the number of formed elements in the periphery.Violation of skin trophism.The course can be long (several years).Perhaps the development of sepsis.Infections, trauma, intoxication dramatically worsen the disease.
features of radiation sickness
After contact with the radioactive substances into the body clinic depends on their properties (half-life, the nature of the distribution of matter, its chemical nature, and so on. D.).
Depot radioactive substances can be different: radium and strontium accumulate mainly in the bone tissue, plutonium - bone and lung, polonium - in the liver, spleen, lymph nodes, adrenal cortex, uranium - the liver, kidney and bones.
After contact with radioactive substances via the respiratory tract (radioactive dust) may develop cancer of the bronchi and lungs.The tumor is generally located near the roots of the lungs and is clearly demarcated from the adjacent lung tissue.Often, there are also multiple primary tumors, most often squamous cell carcinoma.
Clinically, the disease is characterized by slow flow, persistent cough with viscous, sometimes bloody sputum, stabbing chest pain and increasing weakness.If inhaled radioactive dust, as well as prolonged exposure to X-rays revealed the phenomenon of pulmonary fibrosis and carnification, alternating with areas of emphysema.As with external irradiation, and as a result of radioactive substances in the organism can develop changes in the skeleton.They occur usually during prolonged excessive radiation exposure, without observing the basic rules of protection.
The bones (often - brushes) formed dystrophic changes are expressed in the cellular restructuring of the bone structure of the type of osteoporosis in cortical thinning, atrophy and degenerative changes in phalangeal joints.
first radiological symptom is bone loss, later joined by osteosclerosis and bone restructuring.they usually precede changes in the skin, but they can not be removed.
Prolonged exposure to ionizing radiation can cause the development of chronic dermatitis.Early signs of skin damage are angiodistroficheskie change, smoothed skin pattern.By the later symptoms include dystrophic nail changes, benign tumors (pigmentation, vascular, fibrous), keratoses and finally skin cancer.Prolonged exposure to ionizing radiation is sometimes leads to clouding of the lens.These changes can be detected at any stage of radiation sickness;Sometimes there are cases when they are not accompanied by common symptoms.
addition to these stages of chronic radiation sickness, perhaps predominant involvement of one system or another.
Chronic exposure to ionizing radiation can lead to the development of any diseases of the blood and bone marrow.Possible negative effects on the offspring.
presence of radioactive substances in the body and keeping them in the urine without clinical manifestations should be interpreted as a carrier of radioactive substances.
syndromic strictly individual systems depending on the stage of the disease;preferably in a hospital or sanatorium conditions (2-3 months).Meals should be high-calorie, high in protein and vitamins.Stimulants hemopoiesis - leucogen, vitamin B12, folic acid, antianemin sodium nukleinat, pentoksil, thesis;with persistent severe changes in hematopoietic system - repeated blood transfusions, bone marrow transplantation;in severe hypoplasia white germ hematopoiesis with persistent leukopenia recommend the use of corticosteroid hormones: ACTH, cortisone, prednisolone, appointed by the long course (30-40 days), it is best combined with a blood transfusion.Anabolic hormones (Nerobolum et al.).At a hemorrhagic syndrome - ascorbic acid, rutin, vitamin E, menadione, calcium chloride or gluconate.
After contact with the radioactive substances into the body appointed drinking plenty of fluids, diuretics.For binding and accelerate the elimination - chelators (tetatsin calcium, pentatsin, 5% solution of 5 ml intravenous course - 20-30 injections, ingestion of polonium - unitiol).
disability Already at the initial stages of radiation sickness is recommended to permanent sustainable employment.In the case of difficulty of the latter, the high qualification of the patient and his strong desire to continue to work need a temporary suspension of work associated with exposure to ionizing radiation, and the duration of the transfer may be up to 6 months.This term can be used for retraining.Returning to his work is possible only with full recovery, improvement of working conditions and further careful medical supervision of the patient.