Departments of 1Obstetrics and Gynecology and 2Medical Toxicology Service, Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX; 3Department of Emergency Medicine, School of Pharmacy, Concordia University, Mequon, WI; and 4Texas A & M University Health Science Center College of Medicine, Scott and White Hospital, Temple, TX.
Am J Ther. 2014 Jul-Aug;21(4):244-9. doi: 10.1097/MJT.0b013e31824ea656.
Sodium nitrite and sodium thiosulfate are common cyanide antidotes. Hydroxocobalamin was approved for use in the United States in 2006. Our objective was to determine the frequency of antidote use as reported to the US poison centers from 2005 to 2009 and describe which antidotes were used in critically ill cyanide toxic patients. We performed a retrospective review over 5 years (2005-2009) from 61 US poison centers. We identified all cyanide-exposed cases that received a cyanide antidote. Variables collected included demographics, gastric decontamination, antidote used, predefined serious clinical effects (hypotension, cardiac arrest, respiratory arrest, and coma), and predefined serious therapies (cardiopulmonary resuscitation, vasopressors, atropine, anticonvulsant, antidysrhythmic, and intubation/ventilation). One trained abstractor abstracted each chart to a standardized electronic form. Another investigator audited 20% of the charts. Kappa values were calculated. One hundred sixty-five exposures were identified. Mean age was 42 years (range, 3-93 years). Seventy-one percent were male. Exposures were 27% ingestion and 53% inhalation. Thirty-two percent of the ingestions were suicide attempts. Twenty percent (32 of 157) of all cases died. Over all years reported, hydroxocobalamin was administered to 29% (45 of 157) of patients, sodium nitrite to 25%, and sodium thiosulfate to 46%. Hydroxocobalamin use increased from 24% to 54% from 2007 to 2009, respectively (P = 0.024). Sodium thiosulfate use decreased from 73% to 31% (P = 0.002) and sodium nitrite use decreased from 26% to 14% (P = 0.39). The proportion of cases with serious clinical effects that received hydroxocobalamin increased each year, and the proportion that received other antidotes decreased. Hydroxocobalamin was also administered more often in cases that required serious therapies and increased each year. Hydroxocobalamin use for cyanide toxicity increased each year as reported to the US poison centers. Reported use of sodium thiosulfate and sodium nitrite decreased over the same years. In addition, hydroxocobalamin was used more often each year in critically ill cyanide toxic patients than were sodium nitrite or sodium thiosulfate.
亚硝酸钠和硫代硫酸钠是常见的氰化物解毒剂。羟钴胺素于 2006 年在美国获得批准使用。我们的目的是确定 2005 年至 2009 年向美国毒物中心报告的解毒剂使用频率，并描述在危重病氰化物中毒患者中使用了哪些解毒剂。我们对 61 个美国毒物中心进行了为期 5 年（2005-2009 年）的回顾性研究。我们确定了所有接受氰化物解毒剂治疗的氰化物暴露病例。收集的变量包括人口统计学数据、胃灌洗、使用的解毒剂、预先定义的严重临床影响（低血压、心脏骤停、呼吸骤停和昏迷）以及预先定义的严重治疗（心肺复苏、血管加压药、阿托品、抗惊厥药、抗心律失常药和插管/通气）。一名训练有素的摘要员将每张图表摘录到标准化的电子表格中。另一名调查员审核了 20%的图表。计算了 Kappa 值。确定了 165 次暴露。平均年龄为 42 岁（范围，3-93 岁）。71%为男性。暴露途径 27%为摄入，53%为吸入。32%的摄入是自杀企图。20%（32/157）的所有病例死亡。在报告的所有年份中，羟钴胺素分别施用于 29%（45/157）和 25%的患者，硫代硫酸钠施用于 46%的患者。羟钴胺素的使用从 2007 年到 2009 年分别从 24%增加到 54%（P = 0.024）。硫代硫酸钠的使用从 73%下降到 31%（P = 0.002），而亚硝酸钠的使用从 26%下降到 14%（P = 0.39）。接受羟钴胺素治疗的严重临床影响病例比例逐年增加，而接受其他解毒剂治疗的比例则下降。需要严重治疗的病例中，羟钴胺素的给药频率也逐年增加。向美国毒物中心报告的氰化物毒性使用羟钴胺素的频率逐年增加。同期报告的硫代硫酸钠和亚硝酸钠的使用量减少。此外，在危重病氰化物中毒患者中，羟钴胺素的使用频率每年都高于亚硝酸钠或硫代硫酸钠。
