泰国在建立国家解毒项目前后的氰化物中毒情况。

a Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital , Mahidol University , Bangkok , Thailand.

b Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital , Mahidol University , Bangkok , Thailand.

Clin Toxicol (Phila). 2018 Apr;56(4):285-293. doi: 10.1080/15563650.2017.1370098. Epub 2017 Sep 5.

CONTEXT

Antidote shortage is a global problem. In Thailand, the National Antidote Project (NAP) has operated since November 2010 to manage the national antidote stockpile, educate the healthcare providers on appropriate antidote use, and evaluate antidote usage.

OBJECTIVE

To evaluate the effect of NAP implementation on mortality rate and antidote use in cyanide poisoning cases arising from ingestion of cyanide or cyanogenic glycoside.

METHODS

This is a retrospective cohort of poisoning cases involving cyanide or cyanogenic glycoside ingestion reported to Ramathibodi Poison Center from 1 January 2007 to 31 December 2015. Mortality rate, antidote use, and appropriateness of antidote use (defined as correct indication, proper dosing regimen, and administration within 90 min) before and after NAP implementation were compared. Association between parameters and fatal outcomes was analyzed.

RESULTS

A total of 343 cases involving cyanide or cyanogenic glycoside ingestion were reported to Ramathibodi Poison Center. There were 213 cases (62.1%) during NAP (Project group) and 130 cases (37.9%) pre-NAP implementation (Before group). Implementation of NAP led to increased antidote use (39.9% in Project group versus 24.6% in Before group) and a higher rate of appropriate antidote use (74.1% in Project group versus 50.0% in Before group). All 30 deaths were presented with initial severe symptoms. Cyanide chemical source and self-harm intent were associated with death (OR: 12.919, 95% CI: 4.863-39.761 and OR: 10.747, 95% CI: 3.884-28.514, respectively). No difference in overall mortality rate (13 [10.0%] deaths before versus 17 [8.0%] deaths after NAP) was found. In subgroup analysis of 80 cases with initial severe symptoms, NAP and appropriate antidote use reduced mortality (OR: 0.327, 95% CI: 0.106-0.997 and OR: 0.024, 95% CI: 0.004-0.122, respectively). In the multivariate analysis of the cases with initial severe symptoms, presence of the NAP and appropriate antidote use independently reduced the risk of death (OR: 0.122, 95% CI: 0.023-0.633 and OR: 0.034, 95% CI: 0.007-0.167, respectively), adjusted for intent of exposure, cyanide source, age, and sex.

CONCLUSIONS

After NAP implementation, both antidote use and appropriate antidote use increased. In cases presenting with severe symptoms, presence of the NAP and appropriate antidote use independently reduced the risk of mortality.

背景

解毒剂短缺是一个全球性问题。在泰国，自 2010 年 11 月以来，国家解毒剂项目（NAP）一直在运作，以管理国家解毒剂储备，教育医疗保健提供者正确使用解毒剂，并评估解毒剂的使用情况。

目的

评估 NAP 实施对因摄入氰化物或氰苷而导致的氰化物中毒病例死亡率和解毒剂使用的影响。

方法

这是一项回顾性队列研究，纳入了 2007 年 1 月 1 日至 2015 年 12 月 31 日向 Ramathibodi 中毒中心报告的氰化物或氰苷摄入中毒病例。比较 NAP 实施前后（NAP 组：213 例[62.1%]；NAP 前组：130 例[37.9%]）死亡率、解毒剂使用情况以及解毒剂使用的适当性（定义为正确的适应证、适当的剂量方案以及在 90 分钟内给药）。分析参数与死亡结局之间的关联。

结果

共报告了 343 例氰化物或氰苷摄入中毒病例。NAP 组（项目组）213 例（62.1%），NAP 前组（130 例，37.9%）。实施 NAP 后，解毒剂的使用增加（项目组 39.9%，NAP 前组 24.6%），适当解毒剂使用的比例也增加（项目组 74.1%，NAP 前组 50.0%）。所有 30 例死亡均表现为初始严重症状。氰化物化学源和自残意图与死亡相关（OR：12.919，95%CI：4.863-39.761 和 OR：10.747，95%CI：3.884-28.514）。未发现总体死亡率（NAP 前组 13 例[10.0%]死亡与 NAP 后组 17 例[8.0%]死亡）有差异。在 80 例初始严重症状病例的亚组分析中，NAP 和适当的解毒剂使用降低了死亡率（OR：0.327，95%CI：0.106-0.997 和 OR：0.024，95%CI：0.004-0.122）。在初始严重症状病例的多变量分析中，NAP 存在和适当的解毒剂使用独立降低了死亡风险（OR：0.122，95%CI：0.023-0.633 和 OR：0.034，95%CI：0.007-0.167），调整了暴露意图、氰化物源、年龄和性别因素。