Toxicology Consulting and Medical Translating Services, Inc., Laramie, WY 82072, USA.
Crit Rev Toxicol. 2009;39(7):541-52. doi: 10.1080/10408440802304944.
Cyanide has several antidotes, with differing mechanisms of action and diverse toxicological, clinical, and risk-benefit profiles. The international medical community lacks consensus about the antidote or antidotes with the best risk-benefit ratio. Critical assessment of cyanide antidotes is needed to aid in therapeutic and administrative decisions that will improve care for victims of cyanide poisoning (particularly poisoning from enclosed-space fire-smoke inhalation), and enhance readiness for cyanide toxic terrorism and other mass-casualty incidents. This paper reviews preclinical and clinical data on available cyanide antidotes and considers the profiles of these antidotes relative to properties of a hypothetical ideal cyanide antidote. Each of the antidotes shows evidence of efficacy in animal studies and clinical experience. The data available to date do not suggest obvious differences in efficacy among antidotes, with the exception of a slower onset of action of sodium thiosulfate (administered alone) than of the other antidotes. The potential for serious toxicity limits or prevents the use of the Cyanide Antidote Kit, dicobalt edetate, and 4-dimethylaminophenol in prehospital empiric treatment of suspected cyanide poisoning. Hydroxocobalamin differs from these antidotes in that it has not been associated with clinically significant toxicity in antidotal doses. Hydroxocobalamin is an antidote that seems to have many of the characteristics of the ideal cyanide antidote: rapid onset of action, neutralizes cyanide without interfering with cellular oxygen use, tolerability and safety profiles conducive to prehospital use, safe for use with smoke-inhalation victims, not harmful when administered to non-poisoned patients, easy to administer.
氰化物有几种解毒剂，其作用机制不同，毒理学、临床和风险效益特征也不同。国际医学界对于哪种解毒剂或解毒剂具有最佳的风险效益比尚未达成共识。需要对氰化物解毒剂进行批判性评估，以帮助做出治疗和管理决策，从而改善氰化物中毒（尤其是密闭空间火灾烟雾吸入中毒）患者的护理，并为氰化物毒性恐怖主义和其他大规模伤亡事件做好准备。本文综述了现有氰化物解毒剂的临床前和临床数据，并考虑了这些解毒剂相对于假设的理想氰化物解毒剂的特性。每种解毒剂在动物研究和临床经验中都显示出疗效的证据。迄今为止，可用数据并未表明解毒剂之间的疗效存在明显差异，除了硫代硫酸钠（单独使用）的作用开始较慢，而其他解毒剂则没有。严重毒性的潜在风险限制或阻止了氰化物解毒试剂盒、乙二胺四乙酸二钴和 4-二甲氨基酚在疑似氰化物中毒的院前经验性治疗中的使用。羟钴胺与这些解毒剂不同，在解毒剂量下它没有与临床上明显的毒性相关。羟钴胺是一种解毒剂，它似乎具有理想氰化物解毒剂的许多特征：作用开始迅速，中和氰化物而不干扰细胞氧气利用，耐受性和安全性特征有利于院前使用，对烟雾吸入受害者安全，对未中毒患者无害，易于给药。
