Roderique Ensign Joseph D, Gebre-Giorgis Abel A, Stewart Dane H, Feldman Michael J, Pozez Andrea L
The Evans-Haynes Burn Center, VCU Health Systems, Richmond, Virginia, USA.
J Burn Care Res. 2012 Sep-Oct;33(5):624-33. doi: 10.1097/BCR.0b013e31824799d2.
For smoke inhalation injury of a pregnant woman, one must treat two patients and be aware of the potential effects of carbon monoxide (CO) and cyanide (CN) poisoning on both the mother and the fetus. In a pregnant woman, the size and age of the fetus and the degree of poisoning allow for tremendous variability in the toxicity of CO and CN and their respective treatment options. The authors will review a case of a 32-year-old woman who was at 37 weeks of gestation and admitted to the Evans-Haynes Burn Center after a house fire and received hydroxocobalamin (Cyanokit) for suspected CN poisoning. In addition, a review of the literature, current guidelines, and treatment options of inhalation injury during pregnancy will be discussed. The authors will focus only on the toxic components of smoke inhalation injury rather than the mechanical components from heat and particulate damage. Literature review clearly identifies that the treatment of pregnant women with inhalation injury remains a controversial subject. The use of hydroxocobalamin (Cyanokit) as a treatment modality for potential CN poisoning in a pregnant patient has not been reported in the literature. Animal studies have shown that combined CO and CN poisoning are more lethal than either one alone and at lower concentrations. Due to the synergistic effects of CO and CN, and because these two toxins concentrate at even higher levels in the fetus than the mother, the authors will clarify the urgent seriousness of prompt administration of hydroxocobalamin in a pregnant patient with suspected smoke inhalation injury. This case review details the treatment of a 32-year-old woman who was at 36 weeks of gestation on admission to the Evans-Haynes Burn Center. The authors will report her injuries and the course of treatment. Although burned and presenting with concomitant smoke inhalation injury, both the woman and her child fared well with no significant complications due to the smoke inhalation at 6 months of follow-up. Smoke inhaled from modern structural fires potentially contains both CN and CO gases. This makes the prompt recognition of this injury and selection of appropriate therapy an emergent priority. In October 2010, the Food and Drug Administration approved hydroxocobalamin for use in pregnant patients in the acute setting when CN toxicity is suspected. Because CO and CN have additive effects when both are present in the body, the prompt administration of hydroxocobalamin not only eliminates the effects of CN but also potentially attenuates its synergistic effects on CO. It is only through a better understanding of the details of smoke inhalation injury, the current treatment options, and the considerations regarding their use that new research and strong guidelines can be developed to better serve our patients.
对于孕妇吸入烟雾损伤，必须同时治疗两名患者，并了解一氧化碳（CO）和氰化物（CN）中毒对母亲和胎儿的潜在影响。在孕妇中，胎儿的大小和年龄以及中毒程度使得CO和CN的毒性及其各自的治疗方案存在巨大差异。作者将回顾一例32岁、孕37周的女性病例，该患者在房屋火灾后被收治于埃文斯 - 海恩斯烧伤中心，因疑似CN中毒接受了羟钴胺素（Cyanokit）治疗。此外，还将讨论孕期吸入性损伤的文献综述、当前指南及治疗选择。作者将仅关注吸入烟雾损伤的毒性成分，而非热和颗粒物损伤等机械性成分。文献综述明确指出，孕妇吸入性损伤的治疗仍是一个有争议的话题。文献中尚未报道将羟钴胺素（Cyanokit）用作孕妇潜在CN中毒的治疗方式。动物研究表明，CO和CN联合中毒比单独一种中毒更具致死性，且在更低浓度时即如此。由于CO和CN的协同作用，以及这两种毒素在胎儿体内的浓度甚至比母亲体内更高，作者将阐明对疑似吸入烟雾损伤的孕妇迅速给予羟钴胺素的紧迫性和严重性。本病例回顾详细介绍了一名入院时孕36周、被收治于埃文斯 - 海恩斯烧伤中心的32岁女性的治疗情况。作者将报告她的伤情及治疗过程。尽管该女性烧伤并伴有吸入烟雾损伤，但在随访6个月时，她和孩子情况良好，未因吸入烟雾出现重大并发症。现代建筑火灾中吸入的烟雾可能同时含有CN和CO气体。这使得迅速识别这种损伤并选择合适的治疗方法成为紧急优先事项。2010年10月，美国食品药品监督管理局批准羟钴胺素用于疑似CN中毒的急性情况下的孕妇。由于CO和CN在体内同时存在时有相加作用，迅速给予羟钴胺素不仅可消除CN的影响，还可能减轻其对CO的协同作用。只有通过更好地了解吸入烟雾损伤的细节、当前的治疗选择以及使用这些治疗方法时的注意事项，才能开展新的研究并制定强有力的指南，从而更好地为我们的患者服务。
