Australian Resuscitation Council, Royal Australasian College of Surgeons, College of Surgeons' Gardens, Melbourne, Australia.
Emerg Med Australas. 2012 Jun;24(3):225-38. doi: 10.1111/j.1742-6723.2012.01538.x. Epub 2012 Feb 21.
Cyanide poisoning is uncommon, but generates interest because of the presumed utility of an antidote immediately available in those areas with a high risk of cyanide exposure. As part of its regular review of guidelines, the Australian Resuscitation Council conducted a systematic review of the human evidence for the use of various proposed cyanide antidotes, and a narrative review of the relevant pharmacological and animal studies. There have been no relevant comparative or placebo-controlled human trials. Nine case series were identified. Treatment with hydroxocobalamin was reported in a total of 361 cases. No serious adverse effects of hydroxocobalamin were reported, and many patients with otherwise presumably fatal poisoning survived. Sodium thiosulphate use was reported in two case series, similarly with no adverse effects. Treatment with a combination of sodium nitrite, amyl nitrite and sodium thiosulphate was reported in 74 patients, with results indistinguishable from those of hydroxocobalamin and sodium thiosulphate. No case series using dicobalt edetate or 4-dimethylaminophenol were identified, but successful use in single cases has been reported. Hydroxocobalamin and sodium thiosulphate differ from alternatives in having negligible adverse effects, and on the basis of current evidence are the antidotes of choice. The indications for the use of an antidote, the requirements for supportive care and a recommended approach for workplaces where there is a risk of cyanide poisoning are presented.
氰化物中毒并不常见，但由于在氰化物暴露风险高的地区，有一种解毒剂可以立即使用，因此引起了人们的兴趣。作为其指南定期审查的一部分，澳大利亚复苏委员会对各种拟议的氰化物解毒剂在人类中的应用的证据进行了系统评价，并对相关的药理学和动物研究进行了叙述性评价。目前还没有相关的比较或安慰剂对照的人类试验。共确定了 9 项病例系列研究。共报告了 361 例羟钴胺治疗。没有报告羟钴胺的严重不良反应，许多原本中毒致死的患者幸存下来。有 2 项病例系列报告了硫代硫酸钠的使用，同样没有不良反应。有 74 例患者接受了亚硝酸钠、亚硝酸戊酯和硫代硫酸钠联合治疗，结果与羟钴胺和硫代硫酸钠相同。没有发现使用依地酸二钴或 4-二甲氨基苯酚的病例系列，但有成功治疗单个病例的报道。羟钴胺和硫代硫酸钠与其他解毒剂的不同之处在于其不良反应可忽略不计，并且基于目前的证据，它们是解毒剂的首选。本文提出了使用解毒剂的指征、支持性护理的要求以及有氰化物中毒风险的工作场所的推荐方法。
