Beasley D M, Glass W I
University of Otago School of Medicine, Dunedin, New Zealand.
Occup Med (Lond). 1998 Oct;48(7):427-31. doi: 10.1093/occmed/48.7.427.
This paper aims to assess and compare currently available antidotes for cyanide poisoning. Such evaluation, however, is difficult. Thus, extrapolation from the results of animal studies has potential pitfalls, as significant inter-species differences in response may exist, and these experiments often involve administration of toxin and antidote almost simultaneously, rather than incorporating a more realistic time delay before initiation of treatment. Direct inference from human case reports is also problematic; either because of uncertainties over the exposure levels involved (and hence the likely outcome without treatment), or because of difficulties in identifying the specific contribution of a particular antidote within the overall treatment regimen. Certainly an effort to compare the relative efficacy of cyanide antidotes produces equivocal findings, with no single regimen clearly standing out. Indeed, factors such as the risks of antidote toxicity to various individuals and other practical issues, may be more important considerations. There is therefore no single treatment regimen which is best for all situations. Besides individual risk factors for antidote toxicity, the nature of the exposure and hence its likely severity, the evolving clinical features and the number of persons involved and their proximity to hospital facilities, all need to be considered. Clinically mild poisoning may be treated by rest, oxygen and amyl nitrite. Intravenous antidotes are indicated for moderate poisoning. Where the diagnosis is uncertain, sodium thiosulphate may be the first choice. With severe poisoning, an additional agent is required. Given the various risks with methaemoglobin formers or with unselective use of kelocyanor, hydroxocobalamin may be preferred from a purely risk-benefit perspective. However the former alternatives will likely remain important.
本文旨在评估和比较目前可用的氰化物中毒解毒剂。然而，这样的评估很困难。因此，从动物研究结果进行推断存在潜在的缺陷，因为不同物种之间可能存在显著的反应差异，而且这些实验通常几乎同时给予毒素和解药，而不是在开始治疗前纳入更现实的时间延迟。从人类病例报告直接推断也存在问题；要么是因为所涉及的暴露水平存在不确定性（以及因此未经治疗时可能的结果），要么是因为难以确定特定解毒剂在整个治疗方案中的具体作用。当然，比较氰化物解毒剂相对疗效的努力产生了模棱两可的结果，没有一种单一的方案明显突出。事实上，解毒剂对不同个体的毒性风险等因素以及其他实际问题，可能是更重要的考虑因素。因此，没有一种单一的治疗方案对所有情况都是最佳的。除了解毒剂毒性的个体风险因素外，暴露的性质及其可能的严重程度、不断演变的临床特征、涉及的人数及其与医院设施的距离，都需要考虑。临床上轻度中毒可通过休息、吸氧和亚硝酸异戊酯治疗。中度中毒需要静脉注射解毒剂。在诊断不确定的情况下，硫代硫酸钠可能是首选。对于重度中毒，需要额外的药物。考虑到高铁血红蛋白形成剂或无选择地使用氯钴胺素存在的各种风险，从纯粹的风险效益角度来看，羟钴胺素可能更受青睐。然而，前几种选择可能仍然很重要。
