摘要本文报告一例受 60Coγ线放射源，强度为5.3万居里误照约40秒钟而引起重度骨髓型急性放射病。本病例早期反复呕吐、生物剂量推算为4.72～6.48Gy，现场模拟全身造血干细胞活存计权等效均匀剂量为5.22Gy。入院50天内较平稳地度过了初期、假愈期、极期和恢复期。整个病程未发热、无明显感染和出血，从宏观上看不出有极期的表现。这样顺利的经过在国内外17例同类患者病史上是罕见的。 主要治疗包括（1）抗感染措施、良好护理和营养；（2）抗辐射药Ⅰ号（雌三醇）、Ⅱ号（中草药）的应用；（3）改善微循环措施；（4）胎肝细胞移植；（5）输HLA相合或半相合的新鲜全血或有形成份；（6）抗出血措施和促进造血功能；（7）第50～59天因头部受照剂量过大出现轻度脑水肿和头面肿胀进行对症处理。

abstractsThis paper presents the clinical manifestations of, and essential measures for, a heavily exposed 25 year-old man who was accidentally exposed to a 60Co source of 5.3×10 4Ci for about 40 sec. He had an early profuse vomiting and blood lymphocytes reduced to 0.25 × 10 9/1 48 hours after exposure. The dose was estimated to be 5.2 Gy as weighted by survival of hemopoietic stem cells and within 4.72~6.48Gy according to biological dosimetric evaluation such as chromosome aberrations, micronuclei and acid phosphatase stain of lymphocytes, and alkaline phosphatase stain of neutrophils. It was a severe acute radiation syndrome of bone marrow form. He experienced a smooth clinical course throughout its 4 stages, even without microscopic clinical symptoms and signs at critical stage. No fever except for a low one (38.2~38.4℃) on the 1st day post -irradiation and on the day of fetal liver cell transfusion. The nadirs of WBC and platelet counts were 0.35 × 10 9/l (day 25) and 10 × 10 9/l (day 24) respectively. Owing to heavy exposure (13.9 Gy) at the head, he had mild brain edema with an inverted fever of central type (38.2℃in maximum) 50~59 days after irradiation. Essental therapeutic measures included (1) anti-radiation drugs No. 1*and No. 2** developed in Institute of Radiation Medicine, Beijing (1st case of clinical trial); (2) measures improving the microcirculation; (3) early fetal liver cell transplantation; (4) transfusion of HLA-identical or semi-identical whole blood or its components; (5) complete rest, adequate nutrition and strict control of infection including the use of laminar air flow room; (6) administration of hemostatics and hemopoiesis-promoting drugs; and (7) treatment of brain edema etc. *estriol **Chinese herbal medicine