Baud F J, Barriot P, Toffis V, Riou B, Vicaut E, Lecarpentier Y, Bourdon R, Astier A, Bismuth C
Réanimation Toxicologique, Hôpital Fernand Widal, Université Paris 7, France.
N Engl J Med. 1991 Dec 19;325(25):1761-6. doi: 10.1056/NEJM199112193252502.
The nature of the toxic gases that cause death from smoke inhalation is not known. In addition to carbon monoxide, hydrogen cyanide may be responsible, but its role is uncertain, because blood cyanide concentrations are often measured only long after exposure.
We measured cyanide concentrations in blood samples obtained at the scene of residential fires from 109 fire victims before they received any treatment. We compared the results with those in 114 persons with drug intoxication (40 subjects), carbon monoxide intoxication (29 subjects), or trauma (45 subjects). The metabolic effect of smoke inhalation was assessed by measuring plasma lactate at the time of admission to the hospital in 39 patients who did not have severe burns.
The mean (+/-SD) blood cyanide concentrations in the 66 surviving fire victims (21.6 +/- 36.4 mumol per liter, P less than 0.001) and the 43 victims who died (116.4 +/- 89.6 mumol per liter, P less than 0.001) were significantly higher than those in the 114 control subjects (5.0 +/- 5.5 mumol per liter). Among the 43 victims who died, the blood cyanide concentrations were above 40 mumol per liter in 32 (74 percent), and above 100 mumol per liter in 20 of these (46 percent). There was a significant correlation between blood cyanide and carbon monoxide concentrations in the fire victims (P less than 0.001). Plasma lactate concentrations at the time of hospital admission correlated more closely with blood cyanide concentrations than with blood carbon monoxide concentrations. Plasma lactate concentrations above 10 mmol per liter were a sensitive indicator of cyanide intoxication, as defined by the presence of a blood cyanide concentration above 40 mumol per liter.
Residential fires may cause cyanide poisoning. At the time of a patient's hospital admission, an elevated plasma lactate concentration is a useful indicator of cyanide toxicity in fire victims who do not have severe burns.
因吸入烟雾致死的有毒气体的性质尚不清楚。除一氧化碳外，氰化氢可能也有责任，但它的作用尚不确定，因为血氰化物浓度通常仅在接触很久之后才进行测量。
我们测量了109名住宅火灾受害者在接受任何治疗之前于火灾现场采集的血样中的氰化物浓度。我们将结果与114名药物中毒（40名受试者）、一氧化碳中毒（29名受试者）或创伤（45名受试者）的人员的结果进行了比较。通过测量39名无严重烧伤的患者入院时的血浆乳酸来评估吸入烟雾的代谢影响。
66名幸存的火灾受害者的平均（±标准差）血氰化物浓度（21.6±36.4微摩尔/升，P<）和43名死亡受害者的（116.4±89.6微摩尔/升，P<）显著高于114名对照受试者的（5.0±5.5微摩尔/升）。在43名死亡受害者中，32名（74%）的血氰化物浓度高于40微摩尔/升，其中20名（46%）高于100微摩尔/升。火灾受害者的血氰化物与一氧化碳浓度之间存在显著相关性（P<***）。入院时的血浆乳酸浓度与血氰化物浓度的相关性比与血一氧化碳浓度的相关性更密切。血浆乳酸浓度高于10毫摩尔/升是氰化物中毒的敏感指标，定义为血氰化物浓度高于40微摩尔/升。
住宅火灾可能导致氰化物中毒。在患者入院时，血浆乳酸浓度升高是无严重烧伤的火灾受害者氰化物毒性的有用指标。
