当初日本地震袭来，八爪抢先报道了相关健康知识。如今，地震的局势已基本控制，然核辐射的阴影却驱之不散。核辐射所带来的长短期健康风险都有哪些呢？本期新英格兰权威专家结合美国三里岛和前苏联切尔诺贝利核事件为您解答。

核泄漏如何发生？

在灾害未发生之时，核电站里有铀或钚的同位素作为燃料，它们发生裂变产生能量，供人类使用。当自然灾害如地震发生时，核电站的装置可能遭到破坏，造成放射性物质泄漏到环境中。其中一个机制是冷却系统的失灵，造成反应堆芯甚至燃料本身发生熔解，高温高压导致反应堆内爆炸、放射性物质外泄。在大部分核电站，冷却系统失灵都会被控制到最小程度，因为核反应堆芯会被一个巨大的钢容器包裹，里面填实了钢筋混凝土，将放射性物质保护得严严实实。值得注意的是，自然灾害所导致的核爆炸的危害远不及核武器，因为后者放射性同位素的含量、构造和核电站是不一样的。所以大家不必太过恐慌^^

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当年美国三里岛核电站就有上述的预防装置，泄漏的放射性物质很少，至今也没有报道直接相关的健康危害。而前苏联的切尔诺贝利核电站就没有这种装置，大量放射性物质泄漏，当年28人在该事件后死于核辐射相关因素。至于日本福岛的状况呢？核电站现在每天仍有泄漏，专家推测其危害会居于三里岛和切尔诺贝利之间。

核辐射都有哪些种类呢？

核辐射大体可以分三种：体表暴露辐射，外辐射污染和内辐射污染。体表暴露辐射可以是β射线这样的仅侵及皮肤表层，也可以是γ射线这样的可到达人体深层。过去的核事件中，仅有核电站工作人员和急救队员会遭到此类辐射。外辐射污染指的是裂变产物落到人体，辐射皮肤或器官。因此核事件后附近的居民不建议出门。内辐射污染指的是裂变产物被摄入、吸入，或者通过体表伤口进入体内，这是核事件后大多数居民遭受核辐射的主要原因。大部分放射性物质不是半衰期短就是不易聚集到实体物质中，故不易为人体所摄入。而I₁₃₁受到关注，因为它在反应堆中含量丰富，且易通过食物链进入体内并聚在甲状腺中，我们稍后再做讨论。

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核辐射对人体有哪些影响呢？

八爪悦读抢先看，电离辐射与健康风险已有科普版报道，新英格兰学术版综述又强调了如下观点——

急性放射病：当放射剂量达到1戈瑞(吸收剂量单位,等于焦耳／千克)时，大部分人会发生急性放射病，表现为恶心、呕吐、腹泻、乏力、发热、食欲下降、抽搐、昏迷等。根据血液系统、胃肠系统和神经系统的症状可分为前驱期、潜伏期和发病期。详见原文表3。由于该病目前仅见于核电站工作人员和急救队员，所以大部分人都不用担心的。但作为医生，我们需要知道，该病患者短期内的疾病和死亡主要和血液系统、胃肠道系统或皮肤后遗症相关。如何治疗呢？专家强调抢救时应首先处理外伤、烧伤等危重情况，随后的治疗应依据辐射剂量而定。当辐射剂量小于2戈瑞时，对症支持治疗即可。当辐射剂量大于2戈瑞时，对骨髓枯竭并发症的治疗应放在首位。可考虑使用抗生素等药物抗感染，也可以使用造血生长因子或骨髓移植力图恢复造血系统。但骨髓移植至今仍有争议，当年切尔诺贝利核事件后13位骨髓移植者只有两位长期存活，其余11位中有2位死于移植并发症。对胃肠道后遗症主要支持治疗，亦可预防性使用益生菌。皮肤后遗症治疗则应注意急慢性炎症和继发感染。

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长期癌症风险：这大概是核泄漏阴影能在民众心里长期存在的主要原因吧。好消息是，目前尚无有效证据表明核辐射会增加白血病和非甲状腺癌症的发生率和死亡率，即便有些调查项目显示了相关数据的轻微增高，也可能是由于核事件后人们普查癌症的积极度增高所致，故不具说服力。然而，也有坏消息，确有证据表明I¹³¹的摄入和儿童继发甲状腺癌相关，其中年纪小和碘缺乏是两个重要因素。资料表明，在核泄漏当时相对碘缺乏的地区，儿童患甲状腺癌的几率比摄碘正常的儿童要高2-3倍；并且，核泄漏后定期补碘的儿童患甲状腺癌的风险是未补碘的儿童的三分之一。看来，核事件后儿童补碘还是有一定道理的，可能和他们正处于生长发育期有关。但I¹³¹对胎儿和成人的影响并无定论。

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那我们到底需不需要补碘呢？确实有机构推荐通过摄入碘化钾以阻挡甲状腺对I¹³¹的摄入，并认为在接触辐射前或接触辐射后几小时内补碘效果为佳，之后效果有限，当然会遭受持续辐射的另当别论。美国FDA还颁布了根据年龄和辐射量制定的。碘，补，还是不补？请自行决定^^

另外，我们现在可不可以吃海鲜呢？核泄漏后人们确实应尽力避免摄入可能被I₁₃₁污染的食物。幸运的是，I¹³¹的半衰期只有8天，故2-3个月后当地的物质中应不会再含有I¹³¹了。所以很快就可以放心了^^

鉴于核事件毕竟是少有的灾害，有关当局治疗病人或公共预防的经验都不多，故应积极规划应对措施，加强与病人、社会的交流。核辐射的防护不只是一个单纯的医学问题。

来源：《新英格兰医学杂志》2011-4-20 综述

Short-Term and Long-Term Health Risks of Nuclear-Power-Plant Accidents, John P. Christodouleas, M.D., NEJM April 20, 2011