Sauer S W, Keim M E
US Army Medical Corps, Honolulu, HI, USA.
Ann Emerg Med. 2001 Jun;37(6):635-41. doi: 10.1067/mem.2001.114315.
The United States is under the constant threat of a mass casualty cyanide disaster from industrial accidents, hazardous material transportation incidents, and deliberate terrorist attacks. The current readiness for cyanide disaster by the emergency medical system in the United States is abysmal. We, as a nation, are simply not prepared for a significant cyanide-related event. The standard of care for cyanide intoxication is the cyanide antidote kit, which is based on the use of nitrites to induce methemoglobinemia. This kit is both expensive and ill suited for out-of-hospital use. It also has its own inherent toxicity that prevents rapid administration. Furthermore, our hospitals frequently fail to stock this life-saving antidote or decline to stock more than one. Hydroxocobalamin is well recognized as an efficacious, safe, and easily administered cyanide antidote. Because of its extremely low adverse effect profile, it is ideal for out-of-hospital use in suspected cyanide intoxication. To effectively prepare for a cyanide disaster, the United States must investigate, adopt, manufacture, and stockpile hydroxocobalamin to prevent needless morbidity and mortality.
美国一直面临着因工业事故、危险物质运输事故以及蓄意恐怖袭击而引发大规模氰化物伤亡灾难的威胁。美国紧急医疗系统目前对氰化物灾难的应对准备极为糟糕。作为一个国家，我们根本没有为重大的氰化物相关事件做好准备。氰化物中毒的标准治疗方法是使用氰化物解毒试剂盒，其原理是利用亚硝酸盐诱导高铁血红蛋白血症。该试剂盒既昂贵又不适合在院外使用。它自身还存在内在毒性，这使得无法快速给药。此外，我们的医院常常不备这种救命解毒剂，或者只备一剂。羟钴胺素被公认为是一种有效、安全且易于给药的氰化物解毒剂。由于其极低的不良反应发生率，它非常适合用于院外疑似氰化物中毒的情况。为了有效应对氰化物灾难，美国必须对羟钴胺素进行研究、采用、生产并储备，以防止不必要的发病和死亡。
