Radiation/Nuclear Countermeasures Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.
Disaster Med Public Health Prep. 2011 Mar;5 Suppl 1(0 1):S32-44. doi: 10.1001/dmp.2011.17.
A 10-kiloton (kT) nuclear detonation within a US city could expose hundreds of thousands of people to radiation. The Scarce Resources for a Nuclear Detonation Project was undertaken to guide community planning and response in the aftermath of a nuclear detonation, when demand will greatly exceed available resources. This article reviews the pertinent literature on radiation injuries from human exposures and animal models to provide a foundation for the triage and management approaches outlined in this special issue. Whole-body doses >2 Gy can produce clinically significant acute radiation syndrome (ARS), which classically involves the hematologic, gastrointestinal, cutaneous, and cardiovascular/central nervous systems. The severity and presentation of ARS are affected by several factors, including radiation dose and dose rate, interindividual variability in radiation response, type of radiation (eg, gamma alone, gamma plus neutrons), partial-body shielding, and possibly age, sex, and certain preexisting medical conditions. The combination of radiation with trauma, burns, or both (ie, combined injury) confers a worse prognosis than the same dose of radiation alone. Supportive care measures, including fluid support, antibiotics, and possibly myeloid cytokines (eg, granulocyte colony-stimulating factor), can improve the prognosis for some irradiated casualties. Finally, expert guidance and surge capacity for casualties with ARS are available from the Radiation Emergency Medical Management Web site and the Radiation Injury Treatment Network.
在美国城市内进行一次 10 千吨（kT）级核爆炸，可能会使数十万人暴露在辐射之下。《核爆炸稀缺资源项目》的开展旨在指导核爆炸后的社区规划和应对，因为在这之后，需求将大大超过可用资源。本文回顾了有关人类暴露和动物模型中辐射损伤的相关文献，为本期特刊中概述的分诊和管理方法提供了基础。全身剂量>2Gy 可导致临床上显著的急性辐射综合征（ARS），其经典表现涉及血液学、胃肠道、皮肤和心血管/中枢神经系统。ARS 的严重程度和表现受多种因素影响，包括辐射剂量和剂量率、个体对辐射反应的变异性、辐射类型（例如，单纯γ射线、γ射线加中子）、半身屏蔽以及年龄、性别和某些预先存在的医疗状况等。辐射与创伤、烧伤或两者（即复合损伤）的结合比单纯相同剂量的辐射预后更差。支持性护理措施，包括液体支持、抗生素和可能的髓样细胞因子（例如，粒细胞集落刺激因子），可以改善一些辐射伤员的预后。最后，《辐射应急医疗管理》网站和《辐射损伤治疗网络》为 ARS 伤员提供了专家指导和应急能力。
