Military Burn Center, the 990th Hospital of the Joint Logistics Support Forces of Chinese PLA (the 159th Hospital of Chinese PLA), Zhumadian, 463000, Henan, China.
Bundeswehr Institute of Radiobiology, Munich, Germany.
Mil Med Res. 2019 Mar 31;6(1):10. doi: 10.1186/s40779-019-0200-2.
Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.
吸入性损伤常与烧伤有关，并显著增加发病率和死亡率。火灾烟雾的主要有毒成分是一氧化碳、氰化氢和刺激性物质。在与火灾有关的核电站或回收设施事故中，烟雾中也可能含有放射性物质。医疗治疗方法在不同国家可能有所不同，在本文中，我们讨论了中国和德国治疗方法的异同。一氧化碳中毒在中国和德国都采用 100%氧气治疗，如果有条件，还采用高压氧治疗。此外，结合氰化物离子并缓解呼吸链的解毒剂也很重要。形成高铁血红蛋白的药物（例如亚硝酸盐、二甲氨基酚）或羟钴胺（维生素 B12）是可选药物。氰化物的代谢消除可以通过硫代硫酸钠增强。在中国，亚硝酸盐与硫代硫酸钠是最常见的组合。与中国不同，德国常用二甲氨基酚代替亚硝酸盐，如果因吸入火灾烟雾而氰化物中毒，且有条件获得，则羟钴胺被认为是首选解毒剂，因为它不会进一步降低氧气运输能力。在中国和德国，都不建议系统性预防性使用皮质类固醇预防中毒性肺水肿。如果放射性碘暴露，则需要在数小时内给予稳定碘。金属放射性核素的去污染可以用 Ca（DTPA）或普鲁士蓝进行，应尽快给予。这些药物在两国都有使用，但在中国似乎使用的 Ca（DTPA）剂量较低。尽管吸入性损伤和放射性核素去污染的治疗细节可能有所不同，但中国和德国的总体治疗策略非常相似。
