Hall Alan H, Dart Richard, Bogdan Gregory
Toxicology Consulting and Medical Translating Services, Inc., Elk Mountain, WY 82324, USA.
Ann Emerg Med. 2007 Jun;49(6):806-13. doi: 10.1016/j.annemergmed.2006.09.021. Epub 2006 Nov 13.
Cyanide poisoning must be seriously considered in victims of smoke inhalation from enclosed space fires; it is also a credible terrorism threat agent. The treatment of cyanide poisoning is empiric because laboratory confirmation can take hours or days. Empiric treatment requires a safe and effective antidote that can be rapidly administered by either out-of-hospital or emergency department personnel. Among several cyanide antidotes available, sodium thiosulfate and hydroxocobalamin have been proposed for use in these circumstances. The evidence available to assess either sodium thiosulfate or hydroxocobalamin is incomplete. According to recent safety and efficacy studies in animals and human safety and uncontrolled efficacy studies, hydroxocobalamin seems to be an appropriate antidote for empiric treatment of smoke inhalation and other suspected cyanide poisoning victims in the out-of-hospital setting. Sodium thiosulfate can also be administered in the out-of-hospital setting. The efficacy of sodium thiosulfate is based on individual case studies, and there are contradictory conclusions about efficacy in animal models. The onset of antidotal action of sodium thiosulfate may be too slow for it to be the only cyanide antidote for emergency use. Hydroxocobalamin is being developed for potential introduction in the United States and may represent a new option for emergency personnel in cases of suspected or confirmed cyanide poisoning in the out-of-hospital setting.
对于密闭空间火灾烟雾吸入受害者，必须认真考虑氰化物中毒情况；它也是一种可信的恐怖主义威胁制剂。氰化物中毒的治疗是经验性的，因为实验室确诊可能需要数小时或数天时间。经验性治疗需要一种安全有效的解毒剂，可由院外人员或急诊科人员迅速给药。在几种可用的氰化物解毒剂中，已提议在这些情况下使用硫代硫酸钠和羟钴胺素。评估硫代硫酸钠或羟钴胺素的现有证据并不完整。根据近期动物安全与疗效研究以及人体安全与非对照疗效研究，羟钴胺素似乎是院外环境中对烟雾吸入和其他疑似氰化物中毒受害者进行经验性治疗的合适解毒剂。硫代硫酸钠也可在院外环境中给药。硫代硫酸钠的疗效基于个别案例研究，并且在动物模型中的疗效存在相互矛盾的结论。硫代硫酸钠解毒作用的起效可能过慢，无法成为唯一用于紧急情况的氰化物解毒剂。羟钴胺素正在开发中，可能会在美国投入使用，对于院外环境中疑似或确诊的氰化物中毒病例，它可能为急救人员提供一种新的选择。
