Studies on clinical features and causal analysis of multiple organs dysfunction syndrome caused by an extremely severe bone marrow form of acute radiation sickness / 解放军医学杂志

ABSTRACT

Objective To sum up the therapeutic experiences and to analyze the causes of multiple organ dysfunction syndrome (MODS) occurred in a patient who subjected to an accidental 60 Co exposure. Methods The patient was diagnosed as MODS by clinical manifestation, the auxiliary examinations and pathologic autopsy. In therapeutic aspects, intensive care, ventilator-assisted breathing, anti-infection, nutritional support treatment and protection management of important organs were given. Results After a successful transplantation of HLA-identical allogeneic peripheral blood stem cell, the complaints of MODS emerged repeatedly as fever, lung infection, respiratory failure, cardiac arrhythmia, circulatory failure, hepatic injury, decreased urine output and paralytic ileus. At last, the patient died of multi-organ failure 75 days after exposure to radiation. The results of auxiliary examinations showed enlargement of heart and cardiac arrhythmia. Biochemical examination also indicated the increased hyper-sensitive C-reactive protein. The results of pathologic autopsy indicated the existence of fungous infections in whole body, pulmonary fibrosis, myocardium degeneration and necrosis and radiation enteritis. In addition, congestive hepatopathy, renal hemorrhage and intracerebral hemorrhage were also found in the examination. Conclusion Some special clinical features were found in this case, and the cause of MODS is mainly related to radiation injury of important organs, low level of immunity and infection. So the measures of anti-infection and protective treatment of multiple organs should be taken. The key and difficulty for preventing such a kind of MODS might be to improve the patient's immunity and to help the tissue reparation after radiation injury.