Oddziaływanie promieniowania z atomami może skutkować jonizacją i tworzeniem się wolnych rodników, które uszkadzają tkanki niszcząc połączenia (wiązania) chemiczne i struktury molekularne w komórkach, w tym DNA. Uszkodzenia popromienne mogą prowadzić do obumierania komórek. Ocalałe komórki mogą ulegać mutacji i predysponować do zachorowania na raka. Wrażliwość komórek na promieniowanie rośnie wraz z tempem ich replikacji i gdy maleje ich zróżnicowanie. Wskutek narażenia ludzkiego ciała na promieniowanie jonizujące może rozwinąć się ostra choroba popromienna (ARS - acute radiation sickness). Objawy kliniczne ostrej choroby popromiennej odzwierciedlają wielkość pochłoniętej dawki promieniowania i typ radiacji oraz zależą od napromieniowania określonej okolicy ciała. Szpik kostny i nabłonek (żołądkowo-jelitowy) przewodu pokarmowego, gdzie aktywność mitotyczna jest wysoka, są znacznie bardziej wrażliwe niż powoli dzielące się tkanki takie jak kości czy mięśnie.
1. OSTRA CHOROBA POPROMIENNA - OBJAWY KLINICZNE
Objawy kliniczne ostrej choroby popromiennej obejmują następujące grupy:
W ostrej chorobie popromiennej rozróżnia się cztery następujące etapy:
Im wyższa dawka napromieniowania tym krótszy i ostrzejszy jest każdy etap. Etap początkowy pojawia się w ciągu kilku minut lub najpóźniej 4 dni po narażeniu na promieniowanie. Trwa on od kilku godzin do kilku dni, manifestując się pod postacią nudności, wymiotów, braku apetytu oraz biegunki. Pod koniec tego etapu ostra choroba popromienna przechodzi w fazę utajenia. Występują wtedy minimalne objawy lub ich brak, a okres ten trwa od 2,5 tygodnia do 6 tygodni. Czas trwania tej fazy zależy od pochłoniętej dawki promieniowania, zdrowia pacjenta oraz towarzyszących chorób lub urazu. Po etapie utajenia u pacjenta występują objawy rozwiniętej choroby, które mogą skończyć się wyzdrowieniem lub śmiercią.
Przy dawkach promieniowania < 1 Gy ostra choroba popromienna jest zazwyczaj łagodna. Objawy mogą być minimalne lub wcale nie wystąpić, nawet jeśli całe ciało zostanie narażone na promieniowanie jonizujące. W obrazie klinicznym stwierdza się zazwyczaj limfopenię, która trwa od 2 do 3 tygodni, a następnie ustępuje.
Ostra choroba popromienna ma znacznie ostrzejszy i bardziej poważny przebieg przy narażeniu na promieniowanie w dawce > 30 Gy. Przy takich dawkach etap prodromalny pojawia się w ciągu kilku minut, po nim następuje etap utajenia trwający 5-6 godzin, po czym występują nieodwracalne zmiany w układzie sercowo-naczyniowym powodujące w konsekwencji zatrzymanie krążenia.
Typ i dawka promieniowania, jak i napromieniowanie określonej okolicy ciała wpływają nie tylko na czas trwania poszczególnych etapów ostrej choroby popromiennej, ale również na obraz kliniczny przebiegu choroby.
Przy niskich dawkach promieniowania (0,7-4 Gy) dochodzi do uszkodzenia szpiku kostnego. W obrazie klinicznym choroby dominuje limfopenia. U pacjentów mogą rozwijać się wtórne infekcje i występować zwiększone prawdopodobieństwo krwotoków - w związku z niska liczbą leukocytów i płytek krwi. Jeśli w leczeniu dodatkowo zastosuje się krew, preparaty krwiopochodne i płyny infuzyjne oraz antybiotyki - szpik kostny ostatecznie zregeneruje się u większości pacjentów.
Przy narażeniu na działanie dawek promieniowania od 6 do 8 Gy obraz kliniczny ostrej choroby popromiennej jest znacznie bardziej skomplikowany. Przy takich dawkach szpik kostny nie zawsze się regeneruje i może dojść do zgonu pacjenta. Objawom hematopoetycznym mogą towarzyszyć dolegliwości dotyczące układu pokarmowego - pogarsza to stan zdrowia pacjenta. Uszkodzenie warstwy chłonnej przewodu pokarmowego wpływa na zmianę wchłaniania płynów, elektrolitów i składników odżywczych. Uszkodzenia układu pokarmowego mogą powodować wymioty, biegunkę, krwawienia w jego obrębie, posocznicę. Zaburzenia gospodarki wodno-elektrolitowej u pacjenta, u którego liczba płytek spada z każdym tygodniem mogą prowadzić do zgonu.
Ekspozycja całego ciała człowieka na promieniowanie w dawce > 9-10 Gy jest prawie zawsze śmiertelna. Istotne komponenty szpiku kostnego nie ulegną regeneracji. Co więcej, u pacjentów mogą wystąpić dolegliwości nerwowo-naczyniowe, jeśli dawka ekspozycji całego ciała przekroczyłaby 20 Gy. W ciągu kilku dni dochodzi zazwyczaj do ciężkiego uszkodzenia ośrodkowego układu nerwowego (utrata przytomności, drgawki, śpiączka) oraz uszkodzenia układu krążenia, aż do zatrzymania krążenia i śmierci włącznie. W takich przypadkach etap prodromalny i utajony skracaja się do kilku godzin.
- hematopoetyczną,
- żołądkowo-jelitową,
- nerwowo-naczyniową.
W ostrej chorobie popromiennej rozróżnia się cztery następujące etapy:
- początkowy (prodromalny),
- utajenia (latentny),
- pełnych objawów (rozwiniętej choroby),
- zdrowienia lub śmierci.
Im wyższa dawka napromieniowania tym krótszy i ostrzejszy jest każdy etap. Etap początkowy pojawia się w ciągu kilku minut lub najpóźniej 4 dni po narażeniu na promieniowanie. Trwa on od kilku godzin do kilku dni, manifestując się pod postacią nudności, wymiotów, braku apetytu oraz biegunki. Pod koniec tego etapu ostra choroba popromienna przechodzi w fazę utajenia. Występują wtedy minimalne objawy lub ich brak, a okres ten trwa od 2,5 tygodnia do 6 tygodni. Czas trwania tej fazy zależy od pochłoniętej dawki promieniowania, zdrowia pacjenta oraz towarzyszących chorób lub urazu. Po etapie utajenia u pacjenta występują objawy rozwiniętej choroby, które mogą skończyć się wyzdrowieniem lub śmiercią.
Przy dawkach promieniowania < 1 Gy ostra choroba popromienna jest zazwyczaj łagodna. Objawy mogą być minimalne lub wcale nie wystąpić, nawet jeśli całe ciało zostanie narażone na promieniowanie jonizujące. W obrazie klinicznym stwierdza się zazwyczaj limfopenię, która trwa od 2 do 3 tygodni, a następnie ustępuje.
Ostra choroba popromienna ma znacznie ostrzejszy i bardziej poważny przebieg przy narażeniu na promieniowanie w dawce > 30 Gy. Przy takich dawkach etap prodromalny pojawia się w ciągu kilku minut, po nim następuje etap utajenia trwający 5-6 godzin, po czym występują nieodwracalne zmiany w układzie sercowo-naczyniowym powodujące w konsekwencji zatrzymanie krążenia.
Typ i dawka promieniowania, jak i napromieniowanie określonej okolicy ciała wpływają nie tylko na czas trwania poszczególnych etapów ostrej choroby popromiennej, ale również na obraz kliniczny przebiegu choroby.
Przy niskich dawkach promieniowania (0,7-4 Gy) dochodzi do uszkodzenia szpiku kostnego. W obrazie klinicznym choroby dominuje limfopenia. U pacjentów mogą rozwijać się wtórne infekcje i występować zwiększone prawdopodobieństwo krwotoków - w związku z niska liczbą leukocytów i płytek krwi. Jeśli w leczeniu dodatkowo zastosuje się krew, preparaty krwiopochodne i płyny infuzyjne oraz antybiotyki - szpik kostny ostatecznie zregeneruje się u większości pacjentów.
Przy narażeniu na działanie dawek promieniowania od 6 do 8 Gy obraz kliniczny ostrej choroby popromiennej jest znacznie bardziej skomplikowany. Przy takich dawkach szpik kostny nie zawsze się regeneruje i może dojść do zgonu pacjenta. Objawom hematopoetycznym mogą towarzyszyć dolegliwości dotyczące układu pokarmowego - pogarsza to stan zdrowia pacjenta. Uszkodzenie warstwy chłonnej przewodu pokarmowego wpływa na zmianę wchłaniania płynów, elektrolitów i składników odżywczych. Uszkodzenia układu pokarmowego mogą powodować wymioty, biegunkę, krwawienia w jego obrębie, posocznicę. Zaburzenia gospodarki wodno-elektrolitowej u pacjenta, u którego liczba płytek spada z każdym tygodniem mogą prowadzić do zgonu.
Ekspozycja całego ciała człowieka na promieniowanie w dawce > 9-10 Gy jest prawie zawsze śmiertelna. Istotne komponenty szpiku kostnego nie ulegną regeneracji. Co więcej, u pacjentów mogą wystąpić dolegliwości nerwowo-naczyniowe, jeśli dawka ekspozycji całego ciała przekroczyłaby 20 Gy. W ciągu kilku dni dochodzi zazwyczaj do ciężkiego uszkodzenia ośrodkowego układu nerwowego (utrata przytomności, drgawki, śpiączka) oraz uszkodzenia układu krążenia, aż do zatrzymania krążenia i śmierci włącznie. W takich przypadkach etap prodromalny i utajony skracaja się do kilku godzin.
2. OSTRA CHOROBA POPROMIENNA - LECZENIE
Leczenie ostrej choroby popromiennej polega na zachowaniu homeostazy oraz daniu uszkodzonym narządom szansy na regenerację. Każdy uszkodzony układ otrzymuje agresywne wsparcie medyczne, a środki lecznicze powinny ściśle odpowiadać aktualnemu etapowi rozwoju choroby.
Leczenie układu krwiotwórczego obejmuje głównie terapię pod kątem neutropenii oraz wtórnych infekcji. Niezbędne jest przetaczanie krwi, preparatów krwiopochodnych oraz płynów krwiozastępczych, jak również podawanie leków pobudzających krwiotworzenie oraz leków przeciwbakteryjnych. Wartość przeszczepu szpiku kostnego jest w tym wypadku wysoce wątpliwa. Żaden z przeszczepów, jakim poddano ofiary katastrofy w Czarnobylu nie okazał się skuteczny.
Kolejnym istotnym elementem leczenia ostrej choroby popromiennej jest częściowe lub całkowite żywienie pozajelitowe, aby uniknąć pasażu pożywienia przez uszkodzony przewód pokarmowy. Konieczne jest także stosowanie diety.
Przy oparzeniach i obrażeniach powybuchowych stosuje się standardową terapię pourazową. W wielu przypadkach istotna jest pomoc psychologa.
KATEGORIA: BIOTERRORYZM, RADIOLOGIA
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فیلم فرابنفش میلا یوویچ فیلمها 紫外線 The interaction of radiation with atoms can result in ionization and the formation of free radicals that damage tissue destroying the connection (bonding), the chemical and molecular structures in cells, including DNA. Radiation damage can lead to cell death. The surviving cells may be subject to mutation and predispose to cancer. The sensitivity of cells to radiation increases with the rate of replication and when decreasing their diversity. The human body as a result of exposure to ionizing radiation may develop acute radiation sickness (ARS - acute radiation sickness). Clinical signs of acute radiation sickness reflect the size of the absorbed radiation dose and type of radiation and irradiation depend on the specific area of the body. Bone marrow and the epithelium (gastrointestinal tract) of the gastrointestinal tract, where the mitotic activity is high, is much more sensitive than the slowly proliferating tissues such as bone or muscle. 1. acute radiation sickness - CLINICAL SYMPTOMS Clinical signs of acute radiation sickness include the following groups: hematopoietic, gastrointestinal, neurovascular. In the acute radiation disease distinguishes four stages: initial (prodromal), latency (latent), full of signs (developed the disease), recovery or death. The higher the dose of radiation that is shorter and sharper every step. Initial phase occurs within minutes or at least 4 days after exposure to radiation. It lasts from a few hours to a few days, manifesting itself in the form of nausea, vomiting, loss of appetite and diarrhea. At the end of this phase of acute radiation disease goes into a latency. Then there are minimal or no symptoms, and this period lasts from 2.5 weeks to 6 weeks. The duration of this stage depends on the absorbed radiation dose of the patient and concomitant diseases or injury. After a period of latency in the patient developed symptoms of the disease, which can end up recoveries- or death. At doses of radiation & lt; 1 Gy acute radiation sickness is usually mild. Symptoms may be minimal or absent, even if the whole body is exposed to ionizing radiation. The clinical picture is usually identified, lymphopenia, which takes 2 to 3 weeks, and then disappears. Acute radiation sickness is much sharper and more severe course of the exposure to radiation at a dose of & gt; 30 Gy. At these doses prodromal stage occurs within a few minutes, followed by the latency stage lasts 5-6 hours, after which irreversible changes occur in the cardiovascular system and the consequent arrest. The type and dose of radiation and irradiation specific area of the body affect not only the duration of the various stages of acute radiation sickness, but also on the clinical course of the disease. At low doses of radiation (0,7-4 Gy) damage to the bone marrow. The clinical picture of the disease is dominated by lymphopenia. Patients may develop secondary infections and have an increased likelihood of hemorrhage - due to the low number of white blood cells and platelets. If the treatment also applies to blood, blood products and infusion fluids and antibiotics - eventually regenerate bone marrow in most patients. When exposed to radiation doses of 6 to 8 Gy clinical picture of acute radiation sickness is much more complicated. At these doses, the bone marrow is not always regenerates and can lead to death of the patient. These symptoms may be accompanied by hematopoietic gastrointestinal problems - aggravated by the patient's health status. Damage to the absorbent layer of the gastrointestinal tract such as to change the absorption of fluids, electrolytes and nutrients. Damage to the gastrointestinal tract may cause vomiting, diarrhea, bleeding within, septicemia. Disorders of fluid and electrolyte in a patient whose platelet count falls every week can lead to death. Exposure of the entire human body to radiation at a dose of & gt; 9-10 Gy is almost always fatal. Significant components of the bone marrow will not regenerate. Moreover, patients may experience discomfort neurovascular if the dose whole body exposure exceed 20 Gy. Within a few days, there is usually a severe damage to the central nervous system (loss of consciousness, seizures, coma) and damage to the circulatory system until cardiac arrest and death included. In such cases, the prodromal stage, and latent reduce to a few hours. 2. The acute radiation sickness - TREATMENT Treatment of acute radiation sickness is to maintain homeostasis and damaged organs giving the chance for recovery. Every corrupt system receives aggressive medical support, and remedies should closely correspond to the current stage of development of the disease. Treatment of the hematologic system includes mainly therapy for neutropenia and secondary infections. It is essential to blood transfusion, blood products and blood substitutes fluids, as well as the administration of drugs that stimulate hematopoiesis and antibacterial agents. The value of a bone marrow transplant is in this case highly questionable. None of the grafts, which were the victims of the Chernobyl disaster proved to be effective. Another important element in the treatment of acute radiation sickness is partial or total parenteral nutrition to prevent the passage of food through the digestive tract damaged. It is also a diet. Burns and injuries postexplosion used standard post-traumatic therapy. In many cases, it is important to counseling. CATEGORY: bioterrorism, RADIOLOGY Die Wechselwirkung der Strahlung mit Atomen in Ionisierung und die Bildung von freien Radikalen führen, dass die Zerstörung der Verbindung (bonding), die chemischen und molekularen Strukturen in Zellen, einschließlich DNA-Schädigung Gewebe. Strahlenschäden können zum Zelltod führen. Die überlebenden Zellen können unterliegen Mutation und prädisponieren zu Krebs. Die Empfindlichkeit von Zellen gegenüber Strahlung nimmt mit der Replikationsrate und wenn eine Verringerung von deren Vielfalt. Der menschliche Körper als Folge der Exposition gegenüber ionisierender Strahlung kann akute Strahlenkrankheit (ARS - akute Strahlenkrankheit) entwickeln. Klinische Anzeichen einer akuten Strahlenkrankheit beziehen sich die Größe der absorbierten Strahlendosis und der Art der Strahlung und die Bestrahlung hängen von dem speziellen Bereich des Körpers. Knochenmark und das Epithel (Magen-Darm-Trakt) des Magen-Darm-Trakt, wobei die mitotische Aktivität hoch ist, ist wesentlich empfindlicher als die langsamer proliferierenden Geweben wie Knochen oder Muskeln. 1. akute Strahlenkrankheit - klinische Symptome Klinische Zeichen der akuten Strahlenkrankheit umfassen die folgenden Gruppen: hämatopoetische, Magen-Darm, neurovaskuläre. In der akuten Strahlenkrankheit unterscheidet vier Phasen: Anfangs (prodromal), Latenz (latent), voller Zeichen (entwickelte die Krankheit), Wiedergewinnung oder Tod. Je höher die Dosis der Strahlung, die kürzer und schärfer jeder Schritt ist. Anfangsphase tritt innerhalb von Minuten oder mindestens 4 Tage nach der Bestrahlung. Er dauert zwischen einigen Stunden bis zu einigen Tagen, was sich in Form von Übelkeit, Erbrechen, Appetitlosigkeit und Durchfall. Am Ende dieser Phase der akuten Strahlenkrankheit geht in eine Latenz. Dann gibt es nur geringe oder keine Symptome, und diese Periode dauert von 2,5 Wochen bis 6 Wochen. Die Dauer dieser Phase hängt von der absorbierten Strahlendosis des Patienten und damit einhergehenden Erkrankungen oder Verletzungen. Nach einer Latenzzeit in der Patientin entwickelte Symptome der Krankheit, die am Ende recoveries- oder Tod. Bei Dosen von Strahlung & lt; 1 Gy akute Strahlenkrankheit ist in der Regel mild. Symptome minimal oder nicht vorhanden sein, auch wenn der gesamte Körper einer ionisierenden Strahlung ausgesetzt wird. Das klinische Bild ist in der Regel identifiziert, Lymphopenie, die 2 bis 3 Wochen dauert, und dann verschwindet. Akute Strahlenkrankheit ist viel schärfer und schwereren Verlauf der Bestrahlung mit einer Dosis von & gt; 30 Gy. Bei diesen Dosen innerhalb von wenigen Minuten Prodromalstadium auftritt, gefolgt von der Latenzphase dauert 5-6 Stunden, nach denen irreversible Veränderungen des kardiovaskulären Systems und die daraus resultierende Stillstand auftritt. Der Typ und die Strahlendosis und Bestrahlungs bestimmten Bereich des Körpers betreffen nicht nur die Dauer der verschiedenen Phasen einer akuten Strahlenkrankheit, aber auch auf den klinischen Verlauf der Erkrankung. Bei niedrigen Strahlendosen (0,7-4 Gy) Schäden am Knochenmark. Das klinische Bild der Krankheit wird durch Lymphopenie dominiert. Aufgrund der geringen Anzahl der weißen Blutkörperchen und Blutplättchen - Patienten können sekundäre Infektionen entwickeln und eine erhöhte Wahrscheinlichkeit der Blutung. Wenn die Behandlung gilt auch für Blut, Blutprodukte und Infusionsflüssigkeiten und Antibiotika - schließlich regeneriert Knochenmark in den meisten Patienten. Wann Strahlendosen von 6 bis 8 Gy klinische Bild der akuten Strahlenkrankheit ausgesetzt ist viel komplizierter. Bei diesen Dosen ist das Knochenmark nicht immer regeneriert und können zum Tod des Patienten führen. Diese Symptome können durch hämatopoetische gastrointestinale Probleme begleitet werden - von den Gesundheitsstatus des Patienten verschlimmert. Schäden an der absorbierenden Schicht des Gastrointestinaltrakts, wie die Absorption von Flüssigkeiten, Elektrolyte und Nährstoffe zu ändern. Schäden an der Magen-Darm-Trakt kann zu Erbrechen, Durchfall, Blutungen innerhalb, Septikämie. Störungen des Flüssigkeits- und Elektrolyt bei einem Patienten, deren Thrombozytenzahl fällt jede Woche kann zum Tod führen. Belichtung der gesamten menschlichen Körper, um Strahlung bei einer Dosis von & gt; 9-10 Gy ist fast immer tödlich. Wesentliche Bestandteile des Knochenmarks nicht regenerieren. Darüber hinaus können Patienten Beschwerden neurovaskulären erleben, wenn die Dosis Ganzkörperexposition über 20 Gy. Innerhalb von wenigen Tagen, gibt es normalerweise eine schwere Schädigung des zentralen Nervensystems (Verlust des Bewusstseins, Krampfanfälle, Koma) und eine Beschädigung der Kreislaufsystems, bis Herzstillstand und Tod enthalten. In solchen Fällen wird die Prodromalstadium und latente Reduzierung auf wenige Stunden. 2. Die akute Strahlenkrankheit - BEHANDLUNG Die Behandlung der akuten Strahlenkrankheit ist die Homöostase und geschädigte Organe geben die Chance für die Wiederherstellung zu erhalten. Jeder korrupte System erhält aggressive medizinische Unterstützung und Maßnahmen sollte eng mit dem derzeitigen Stand der Entwicklung der Krankheit entsprechen. Die Behandlung des hämatologischen Systems umfasst hauptsächlich Therapie für Neutropenie und Sekundärinfektionen. Es ist wichtig, Bluttransfusion, Blutprodukten und Blutersatzflüssigkeiten , sowie die Verabreichung von Arzneimitteln, die Blutbildung und antibakteriellen Mitteln stimulieren. Der Wert einer Knochenmarktransplantation ist in diesem Fall sehr fraglich. Keiner der Transplantate, die die Opfer der Katastrophe von Tschernobyl waren als wirksam erwiesen. Ein weiteres wichtiges Element bei der Behandlung von akuten Strahlenkrankheit ist eine teilweise oder totale parenterale Ernährung, den Durchgang von Nahrung durch den Verdauungstrakt beschädigt werden. Es ist auch eine Diät. Verbrennungen und Verletzungen postexplosion verwendeten Standard posttraumatische Therapie. In vielen Fällen ist es wichtig, Beratung. KATEGORIE: Bioterrorismus, Radiologie L'interaction de la radiation avec des atomes peut donner lieu à l'ionisation et la formation de radicaux libres qui endommagent les tissus détruisant la liaison (connexion), le produit chimique et les structures moléculaires dans les cellules, y compris l'ADN. Dégâts d'irradiation peut conduire à la mort cellulaire. Les cellules qui survivent peuvent être soumis à mutation et prédispose au cancer. La sensibilité des cellules aux radiations augmente avec le taux de réplication et lors de la diminution de leur diversité. Le corps humain en raison de l'exposition aux rayonnements ionisants peut se développer syndrome d'irradiation aiguë (ARS - syndrome aigu d'irradiation). Les signes cliniques de la maladie d'irradiation aiguë reflètent la taille de la dose de rayonnement absorbée et le type de rayonnement et l'irradiation dépend de la région spécifique du corps. La moelle osseuse et l'épithélium (tractus gastro-intestinal) du tractus gastro-intestinal, où l'activité mitotique est élevée, est beaucoup plus sensible que les tissus à prolifération lente tels que des os ou des muscles. 1. syndrome aigu d'irradiation - symptômes cliniques Les signes cliniques de la maladie d'irradiation aiguë comprend les groupes suivants: hématopoïétique, gastro-intestinal, neurovasculaire. Dans la maladie d'irradiation aiguë distingue quatre étapes: initiale (avant-coureurs), la latence (latent), plein de signes (développé la maladie), la récupération ou la mort. Plus la dose de rayonnement qui est plus courte et plus nette à chaque étape. La phase initiale se produit en quelques minutes ou au moins 4 jours après l'exposition au rayonnement. Il dure de quelques heures à quelques jours, se manifestant sous la forme de la nausée, des vomissements, une perte d'appétit et la diarrhée. A la fin de cette phase de la maladie aiguë du rayonnement qui entre dans une période de latence. Ensuite, il ya peu de symptômes ou pas, et cette période dure de 2,5 à 6 semaines. La durée de cette étape dépend de la dose de rayonnement absorbée du patient et des maladies concomitantes ou d'une blessure. Après une période de latence dans les symptômes de la patiente a développé de la maladie, ce qui peut finir par recoveries- ou la mort. A des doses de rayonnement & lt; 1 Gy syndrome aigu d'irradiation est généralement bénigne. Les symptômes peuvent être minimes voire inexistants, même si tout le corps est exposé à des rayonnements ionisants. Le tableau clinique est généralement identifié, lymphopénie, qui prend 2 à 3 semaines, et puis disparaît. Syndrome aigu d'irradiation est beaucoup plus nette et bien sûr plus grave de l'exposition aux rayonnements à la dose de & gt; 30 Gy. A ces doses stade prodromique se produit en quelques minutes, suivie par la phase de latence dure 5-6 heures, après quoi des changements irréversibles se produisent dans le système cardio-vasculaire et l'arrestation consécutive. Le type et la dose de rayonnement et l'irradiation zone spécifique du corps affectent non seulement la durée des différentes étapes de la maladie de rayonnement de courte durée, mais également sur l'évolution clinique de la maladie. A faibles doses de rayonnement (0,7-4 Gy) des dommages à la moelle osseuse. Le tableau clinique de la maladie est dominée par la lymphopénie. Les patients peuvent développer des infections secondaires et avoir un risque accru d'hémorragie - en raison du faible nombre de cellules et de plaquettes sanguines blanches. Si le traitement est également valable pour le sang, les produits sanguins et des liquides de perfusion et d'antibiotiques - finalement régénérer la moelle osseuse chez la plupart des patients. Lorsqu'ils sont exposés à des doses de rayonnement de 6 à 8 Gy tableau clinique de la maladie d'irradiation aiguë est beaucoup plus compliqué. A ces doses, la moelle osseuse ne sont pas toujours régénère et peut conduire à la mort du patient. Ces symptômes peuvent être accompagnés par des problèmes gastro-intestinaux hématopoïétiques - aggravée par l'état de santé du patient. Les dommages à la couche absorbante du tractus gastro-intestinal de manière à modifier l'absorption des liquides, des électrolytes et des nutriments. Dommages à l'appareil gastro-intestinal peut causer des vomissements, de la diarrhée, des saignements dans, septicémie. Troubles de liquide et d'électrolytes chez un patient dont la numération plaquettaire tombe chaque semaine peut entraîner la mort. L'exposition de l'ensemble du corps humain à un rayonnement à une dose de & gt; 9-10 Gy est presque toujours mortelle. Les éléments importants de la moelle osseuse ne se régénérer. En outre, les patients peuvent ressentir une gêne neurovasculaire si l'exposition du corps entier de la dose dépasse 20 Gy. Dans quelques jours, il ya habituellement un dommage grave du système nerveux central (perte de conscience, des convulsions, le coma) et des dommages au système circulatoire jusqu'à l'arrestation et la mort cardiaque inclus. Dans de tels cas, la phase prodromique, et latente se réduisent à quelques heures. 2. Le syndrome aigu d'irradiation - TRAITEMENT Le traitement de la maladie d'irradiation aiguë est de maintenir l'homéostasie et des organes endommagés donnant la chance de rétablissement. Chaque système corrompu reçoit un soutien médical agressif, et les remèdes doivent correspondre étroitement au stade actuel de développement de la maladie. Le traitement du système hématologique comprend principalement le traitement de la neutropénie et des infections secondaires. Il est essentiel de transfusion de sang, des produits sanguins et succédanés de sang fluides, ainsi que l'administration de médicaments qui stimulent l'hématopoïèse et des agents antibactériens. La valeur d'une greffe de moelle osseuse est dans ce cas très discutable. Aucun des greffes, qui ont été les victimes de la catastrophe de Tchernobyl a prouvé pour être efficace. Un autre élément important dans le traitement de la maladie d'irradiation aiguë est la nutrition parentérale partielle ou totale pour empêcher le passage des aliments dans le tube digestif endommagé. Il est également un régime alimentaire. Des brûlures et blessures postexplosion utilisés thérapie post-traumatique standard. Dans de nombreux cas, il est important de consultation. CATÉGORIE: bioterrorisme, RADIOLOGIE Взаимодействие излучения с атомами, может привести к ионизации и к образованию свободных радикалов, что повреждение ткани разрушает соединение (сцепления), химической и молекулярные структуры в клетках, в том числе ДНК. Радиационное повреждение может привести к гибели клетки. Выжившие клетки могут быть подвергнуты мутации и предрасполагают к развитию рака. Чувствительность клеток к радиации увеличивается со скоростью репликации и при уменьшении их разнообразие. Тело человека в результате воздействия ионизирующего излучения может развиться острая лучевая болезнь (ОЛБ - острая лучевая болезнь). Клинические признаки острой лучевой болезни отражают размер поглощенной дозы излучения и вида излучения и облучения зависит от конкретной области тела. Костный мозг и эпителий (желудочно-кишечный тракт) из желудочно-кишечного тракта, где митотический активность высока, гораздо более чувствителен, чем медленно пролиферирующих тканей, таких как кости или мышцы. 1. острая лучевая болезнь - клинические симптомы Клинические признаки острой лучевой болезни включают следующие группы: кроветворную, желудочно-кишечного тракта, нервно-сосудистых. В острой лучевой болезни выделяет четыре этапа: начальный (продромальный), задержки (скрытая), полон знаков (разработанные болезнь), восстановление или смерти. Чем выше доза облучения, которая короче, и острее с каждым шагом. Начальная фаза происходит в течение нескольких минут или, по крайней мере 4 дней после облучения. Она длится от нескольких часов до нескольких дней, проявляясь в виде тошноты, рвоты, потери аппетита и диарея. В конце этой фазы острого заболевания излучения переходит в латентности. Тогда есть минимальные или нет симптомов, и этот период длится от 2,5 недель до 6 недель. Продолжительность этой стадии зависит от поглощенной дозы облучения пациента и сопутствующих заболеваний или травмы. После периода задержки в пациентов появились симптомы заболевания, которые могут в конечном итоге recoveries- или смерть. При дозах облучения и LT; 1 Гр острая лучевая болезнь, как правило, мягкая. Симптомы могут быть минимальными или отсутствовали, даже если весь организм подвергается воздействию ионизирующего излучения. Клиническая картина обычно идентифицируется, лимфопения, которая занимает от 2 до 3 недель, а затем исчезает. Острая лучевая болезнь гораздо острее и более тяжелое течение с воздействием радиации в дозе & GT; 30 Гр. В этих дозах продромальный период происходит в течение нескольких минут, после чего на сцене латентного длится 5-6 часа, после чего необратимые изменения происходят в сердечно-сосудистой системе и, как следствие ареста. Тип и доза излучения и облучения конкретной области тела влияет не только продолжительность различных стадий острой лучевой болезни, но и на клиническом течении заболевания. При низких доз радиации (0,7-4 Гр) повреждения костного мозга. Клиническая картина заболевания преобладают лимфопения. Пациенты могут развиваться вторичные инфекции и имеют повышенную вероятность кровотечения - из-за низкого количества лейкоцитов и тромбоцитов. Если обработка также относится и к крови, продуктов крови и инфузионных растворов и антибиотиков - в конечном счете, регенерировать костный мозг у большинства пациентов. При воздействии на радиационных доз 6 до 8 Гр клинической картины острой лучевой болезни гораздо сложнее. В этих дозах, костный мозг не всегда регенерирует и может привести к смерти пациента. Эти симптомы могут сопровождаться гемопоэтических желудочно-кишечные проблемы - усугубляется состоянием здоровья пациента. Повреждение абсорбирующего слоя желудочно-кишечного тракта, таких как изменить поглощение жидкостей, электролитов и питательных веществ. Повреждение желудочно-кишечного тракта могут вызвать рвоту, понос, кровотечение в течение, сепсис. Нарушения водно-электролитного в пациенте, у которого количество тромбоцитов падает каждую неделю может привести к смерти. Воздействие на весь организм человека радиации в дозе & GT; 9-10 Гр почти всегда заканчивается смертельным исходом. Значительные компоненты костного мозга не будет восстанавливаться. Кроме того, пациенты могут испытывать дискомфорт сосудисто-нервного если облучения всего тела доза превышает 20 Гр. В течение нескольких дней, как правило, имеется серьезный ущерб центральной нервной системы (потеря сознания, судороги, кома) и повреждения системы кровообращения до остановки сердца и смерти включены. В таких случаях, продромальной стадии, и латентное уменьшить до нескольких часов. 2. Острая лучевая болезнь - ЛЕЧЕНИЕ Лечение острой лучевой болезни является поддержание гомеостаза и поврежденные органы, дающие шанс на выздоровление. Каждый коррумпированная система получает агрессивный медицинской помощи, и средства должны в точности соответствуют текущей стадии развития заболевания. Лечение гематологической системы включает в себя, главным образом, для лечения нейтропении и вторичных инфекций. Это имеет важное значение для переливания крови, препаратов крови и кровезаменителей жидкостей, а также введения лекарств, стимулирующих кроветворение и антибактериальные вещества. Значение трансплантации костного мозга в этом случае весьма сомнительна. Ни один из шунтов, которые были жертвами аварии на Чернобыльской АЭС не оказался эффективным. Еще одним важным элементом в лечении острой лучевой болезни является частичное или полное питание парентеральным, чтобы предотвратить прохождение пищи через пищеварительный тракт поврежденного. Это также диеты. Ожоги и травмы postexplosion используется стандартный посттравматического терапии. Во многих случаях, очень важно, чтобы консультирования. КАТЕГОРИИ: биотерроризма, La interacción de la radiación con los átomos puede dar lugar a la ionización y la formación de radicales libres que dañan los tejidos destruir la conexión (unión), la química y estructuras moleculares en las células, incluyendo el ADN. El daño por radiación puede conducir a la muerte celular. Las células supervivientes pueden estar sujetos a mutación y predisponer al cáncer. La sensibilidad de las células a la radiación aumenta con la tasa de replicación y cuando la disminución de su diversidad. El cuerpo humano como resultado de la exposición a la radiación ionizante puede desarrollar la enfermedad por radiación aguda (ARS - enfermedad por radiación aguda). Los signos clínicos de la enfermedad por radiación aguda reflejan el tamaño de la dosis de radiación absorbida y el tipo de radiación y la irradiación dependerá de la zona específica del cuerpo. La médula ósea y el epitelio (tracto gastrointestinal) del tracto gastrointestinal, donde la actividad mitótica es alta, es mucho más sensible que los tejidos que proliferan lentamente, tales como hueso o músculo. 1. la enfermedad por radiación aguda - Síntomas clínicos Los signos clínicos de la enfermedad por radiación aguda incluyen los siguientes grupos: hematopoyético, gastrointestinal, neurovascular. En la enfermedad por radiación aguda que distingue cuatro etapas: inicial (prodrómicos), latencia (latente), lleno de signos (desarrollado la enfermedad), la recuperación o la muerte. Cuanto mayor sea la dosis de radiación que es más corto y más cortante cada paso. Fase inicial se produce en cuestión de minutos o al menos 4 días después de la exposición a la radiación. Tiene una duración de unas pocas horas a unos pocos días, que se manifiesta en forma de náuseas, vómitos, pérdida de apetito y diarrea. Al final de esta fase de la enfermedad aguda por radiación entra en un estado latente. Luego están los síntomas mínimos o no, y este período dura de 2,5 semanas a 6 semanas. La duración de esta etapa depende de la dosis de radiación absorbida del paciente y las enfermedades concomitantes o lesión. Después de un período de latencia en los síntomas del paciente desarrollada de la enfermedad, lo que puede terminar recoveries- o la muerte. A dosis de radiación & lt; 1 Gy enfermedad por radiación aguda suele ser leve. Los síntomas pueden ser mínimos o inexistentes, incluso si todo el cuerpo se expone a la radiación ionizante. El cuadro clínico es generalmente identificado, linfopenia, que tarda de 2 a 3 semanas, y luego desaparece. Enfermedad por radiación aguda es mucho más nítida y el curso más grave de la exposición a la radiación a una dosis de & gt; 30 Gy. A estas dosis fase prodrómica se produce a los pocos minutos, seguido de la etapa de latencia dura 5-6 horas, después de lo cual se producen cambios irreversibles en el sistema cardiovascular y el paro consecuente. El tipo y la dosis de radiación y la irradiación área específica del cuerpo no sólo afectan a la duración de las diferentes etapas de la enfermedad por radiación aguda, sino también en el curso clínico de la enfermedad. En dosis bajas de radiación (0,7-4 Gy) daño a la médula ósea. El cuadro clínico de la enfermedad está dominado por linfopenia. Los pacientes pueden desarrollar infecciones secundarias y tienen una mayor probabilidad de hemorragia - debido al bajo número de glóbulos blancos y plaquetas. Si el tratamiento también se aplica a la sangre, los productos sanguíneos y fluidos de infusión y antibióticos - finalmente regenerar la médula ósea en la mayoría de los pacientes. Cuando se expone a dosis de radiación de 6 a 8 Gy cuadro clínico de la enfermedad por radiación aguda es mucho más complicado. A estas dosis, la médula ósea no es siempre regenera y puede conducir a la muerte del paciente. Estos síntomas pueden ir acompañados de problemas gastrointestinales hematopoyéticas - agravado por el estado de salud del paciente. El daño a la capa absorbente del tracto gastrointestinal, tales como para cambiar la absorción de líquidos, electrolitos y nutrientes. Daños en el tracto gastrointestinal puede causar vómitos, diarrea, sangrado dentro, la septicemia. Trastornos de líquidos y electrolitos en un paciente cuyo recuento de plaquetas cae cada semana puede llevar a la muerte. La exposición de todo el cuerpo humano a la radiación a una dosis de & gt; 9-10 Gy es casi siempre fatal. Componentes significativos de la médula ósea no se regeneran. Por otra parte, los pacientes pueden experimentar neurovascular molestias si la dosis de exposición de todo el cuerpo exceda del 20 Gy. A los pocos días, por lo general hay un daño severo al sistema nervioso central (pérdida de conciencia, convulsiones, estado de coma) y daños en el sistema circulatorio hasta el paro cardíaco y la muerte incluidas. En tales casos, la fase prodrómica, y latente se reducen a unas pocas horas. 2. La enfermedad por radiación aguda - TRATAMIENTO El tratamiento de la enfermedad por radiación aguda es la de mantener la homeostasis y órganos dañados que dan la probabilidad de recuperación. Cada sistema corrupto recibe apoyo médico agresivo, y remedios debe corresponder estrechamente a la etapa actual de desarrollo de la enfermedad. El tratamiento del sistema hematológico incluye terapia principalmente para la neutropenia y las infecciones secundarias. Es esencial a la transfusión de sangre, productos sanguíneos y líquidos, sustitutos sanguíneos, así como la administración de fármacos que estimulan la hematopoyesis y agentes antibacterianos. El valor de un trasplante de médula ósea es en este caso muy cuestionable. Ninguno de los injertos, que eran las víctimas del desastre de Chernobyl ha demostrado ser eficaz. Otro elemento importante en el tratamiento de la enfermedad por radiación aguda es la nutrición parenteral parcial o total para evitar el paso de alimentos a través del tracto digestivo dañado. También es una dieta. Las quemaduras y lesiones postexplosion utilizan la terapia post-traumática estándar. En muchos casos, es importante el asesoramiento. CATEGORÍA: el bioterrorismo, la radiología
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