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关于伴有烟雾生成的火灾研究报告:受害者血液中氰化物水平、临床症状及实验室检查值的测定

Report on a study of fires with smoke gas development : determination of blood cyanide levels, clinical signs and laboratory values in victims.

作者信息

Geldner G, Koch E M, Gottwald-Hostalek U, Baud F, Burillo G, Fauville J-P, Levi F, Locatelli C, Zilker T

机构信息

Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany.

出版信息

Anaesthesist. 2013 Aug;62(8):609-16. doi: 10.1007/s00101-013-2209-3. Epub 2013 Aug 7.

Abstract

BACKGROUND

This is a report on an international non-interventional study of patients exposed to fires with smoke development in closed rooms. The objective of the study was to document clinical symptoms, relevant laboratory values and blood cyanide concentrations from fire victims in order to confirm or rule out presumptive correlations between the individual parameters.

MATERIALS AND METHODS

The study was conducted in five European countries with patients being included if they presented with the characteristic clinical signs, such as soot deposits and altered neurological status. Venous blood samples were taken from victims prior to administration of an antidote in all cases and determination of cyanide concentration was performed in a central laboratory using high performance liquid chromatography.

RESULTS

Data from 102 patients (62 % male, average age 49 years) were included in the evaluation with no blood samples being available for analysis from 2 patients. In 25 patients the blood cyanide concentration was below the limit of detection of 1.2 μmol/l. Cyanide levels between 1.2 and 10 μmol/l were measured in 54 patients, 7 patients had values between 10 and 20 μmol/l, 4 patients between 20 and 40 μmol/l while levels above 40 μmol/l were determined in 10 patients. The results of the study could not demonstrate that the cyanide level was influenced either by the interval between smoke exposure and blood sampling or the duration presence at the fire scene. The following clinical signs or laboratory values were recorded as relevant for increased and possibly toxic cyanide levels: respiratory arrest, dyspnea, resuscitation requirement, tracheal intubation, respiratory support measures, low Glasgow coma scale (GCS) score and respiratory frequency. A correlation between cyanide concentration and the total amount of soot deposits on the face and neck, in the oral cavity and in expectoration was confirmed. A correlation between cyanide and carboxyhemoglobin (COHb) levels in the blood of fire victims was also confirmed.

CONCLUSIONS

As long as it is not possible to immediately determine the blood cyanide concentration in patients exposed to fire with smoke development, a decreased GCS score, soot deposits particularly in expectoration, dyspnea and convulsions are to be regarded as risk markers for intoxication. In their presence immediate administration of hydroxocobalamin as an antidote is recommended.

摘要

背景

这是一份关于在封闭空间中接触伴有烟雾生成火灾的患者的国际非干预性研究报告。该研究的目的是记录火灾受害者的临床症状、相关实验室值和血液氰化物浓度,以确认或排除各个参数之间的假定相关性。

材料与方法

该研究在五个欧洲国家开展,纳入具有诸如烟灰沉积和神经状态改变等特征性临床体征的患者。在所有病例中,在给予解毒剂之前采集受害者的静脉血样,并在中央实验室使用高效液相色谱法测定氰化物浓度。

结果

102例患者(62%为男性,平均年龄49岁)的数据纳入评估,2例患者无血样可供分析。25例患者的血液氰化物浓度低于检测限1.2μmol/l。54例患者的氰化物水平在1.2至10μmol/l之间,7例患者的值在10至20μmol/l之间,4例患者在20至40μmol/l之间,10例患者的水平高于40μmol/l。研究结果未能表明氰化物水平受烟雾暴露与血样采集之间的间隔或在火灾现场停留时间的影响。以下临床体征或实验室值被记录为与升高且可能有毒的氰化物水平相关:呼吸骤停、呼吸困难、复苏需求、气管插管、呼吸支持措施、低格拉斯哥昏迷量表(GCS)评分和呼吸频率。氰化物浓度与面部、颈部、口腔和咳出物中烟灰沉积总量之间的相关性得到确认。火灾受害者血液中氰化物与碳氧血红蛋白(COHb)水平之间的相关性也得到确认。

结论

只要无法立即测定接触伴有烟雾生成火灾患者的血液氰化物浓度,GCS评分降低、特别是咳出物中的烟灰沉积、呼吸困难和抽搐应被视为中毒的风险标志物。出现这些情况时,建议立即给予羟钴胺作为解毒剂。

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