Rambam Health Care Campus, Israel Poison Information Center, Haifa, Israel.
Clin Toxicol (Phila). 2010 Jul;48(6):477-84. doi: 10.3109/15563650.2010.505573.
Amyl nitrite has been recommended as a cyanide antidote for several decades. Its antidotal properties were initially attributed to induction of methemoglobin and later to a nitric oxide mediated hemodynamic effect. The ease of administration and alleged rapid clinical effect would recommend its wide use in the pre-hospital management of mass casualty cyanide poisoning; yet there are concerns regarding the use of amyl nitrite for this indication.
Review the data on amyl nitrite in cyanide poisoning and evaluate its efficacy and safety in mass casualty cyanide poisoning.
A literature search utilizing PubMed, Toxnet, textbooks in toxicology and pharmacology, and the bibliographies of the articles retrieved identified 17 experimental studies and human reports on the use of amyl nitrite in cyanide poisoning, and 40 additional articles on amyl nitrite's properties and adverse effects. One paper was excluded as it was a conference abstract with limited data.
The antidotal properties of amyl nitrite were attributed initially to induction of methemoglobinemia and later to nitric oxide mediated vasodilation.
Animal studies on the use of amyl nitrite in cyanide poisoning are limited, and their results are inconsistent, which makes their extrapolation to humans questionable.
Clinical reports are limited in number and the part played by amyl nitrite relative to the other treatments administered (e.g. life support, sodium nitrite, and sodium thiosulfate) is unclear.
Amyl nitrite can be associated with potentially serious adverse reactions such as hypotension, syncope, excessive methemoglobinemia, and hemolysis in G6PD deficient patients. These effects are more pronounced in young children, in the elderly, and in patients with cardiac and pulmonary disorders. Dose regimen. The method of administration of amyl nitrite (breaking pearls into gauze or a handkerchief and applying it intermittently to the victim's nose and mouth for a few minutes) is not easily controlled, might result in under- or over-dosing, can prevent the caregiver from administering life support, and possibly expose him/her to amyl nitrite's adverse effects.
Administration of amyl nitrite in mass casualty cyanide poisoning can result in unnecessary morbidity and may interfere with the proper management of the incident and the required supportive treatment and rapid evacuation. In the authors' opinion these drawbacks make the use of amyl nitrite in pre-hospital mass casualty cyanide poisoning unwarranted.
亚硝酸戊酯作为氰化物解毒剂已被推荐使用几十年。其解毒作用最初归因于诱导高铁血红蛋白血症，后来归因于一氧化氮介导的血液动力学效应。由于其给药方便，据称临床效果迅速，因此建议在大规模伤亡氰化物中毒的院前管理中广泛使用；然而，人们对亚硝酸戊酯在这种情况下的使用存在担忧。
综述亚硝酸戊酯在氰化物中毒中的相关数据，并评估其在大规模伤亡氰化物中毒中的疗效和安全性。
利用 PubMed、Toxnet、毒理学和药理学教科书以及检索到的文章的参考文献，对亚硝酸戊酯在氰化物中毒中的应用进行文献检索，共检索到 17 项关于亚硝酸戊酯在氰化物中毒中应用的实验研究和人类报告，以及 40 篇关于亚硝酸戊酯性质和不良反应的文章。有一篇论文被排除在外，因为它是一份数据有限的会议摘要。
亚硝酸戊酯的解毒作用最初归因于诱导高铁血红蛋白血症，后来归因于一氧化氮介导的血管扩张。
关于亚硝酸戊酯在氰化物中毒中的应用的动物研究数量有限，结果不一致，因此其在人类中的推断值得怀疑。
临床报告数量有限，亚硝酸戊酯相对于其他治疗方法（如生命支持、亚硝酸钠和硫代硫酸钠）的作用尚不清楚。
亚硝酸戊酯可能与潜在的严重不良反应有关，如低血压、晕厥、高铁血红蛋白血症和葡萄糖-6-磷酸脱氢酶缺乏症患者的溶血。这些影响在幼儿、老年人以及患有心肺疾病的患者中更为明显。剂量方案。亚硝酸戊酯的给药方法（将珍珠打破成纱布或手帕，间歇性地将其应用于受害者的鼻子和嘴巴几分钟）不易控制，可能导致剂量不足或过量，可能阻止护理人员进行生命支持，并且可能使他们接触到亚硝酸戊酯的不良反应。
在大规模伤亡氰化物中毒中使用亚硝酸戊酯可能导致不必要的发病率，并可能干扰事件的适当管理以及所需的支持治疗和快速疏散。作者认为，这些缺点使得在院前大规模伤亡氰化物中毒中使用亚硝酸戊酯是不合理的。
Zotero 插件