Engwall A J, Blache A, Lintner A, Bright A, Kahn S
Michigan State University, Lansing, Michigan, USA.
University of South Alabama, Mobile, Alabama, USA.
Ann Burns Fire Disasters. 2021 Sep 30;34(3):240-244.
Hydroxocobalamin has been administered in the United States since 2006 by first responders and burn centers as a safe antidote for cyanide toxicity, a serious complication of smoke inhalation. There are no current contraindications to the use of this rescue measure. A recent retrospective French publication reported a potential correlation between hydroxcobalamin administration and acute mesenteric ischemia (AMI) in critically ill burn and inhalation injury patients. The purpose of this study is to characterize the risk of AMI related to hydroxocobalamin. A retrospective review of hydroxocobalamin administration among adult burn patients was conducted at a regional burn center over a 2-year period. Injury characteristics, demographics, and outcomes including presence of mesenteric ischemia (defined as presence of pneumatosis or perforation on CT scan or necrotic bowel on laparotomy) were recorded. Of 17 confirmed inhalation injuries, patients had a median (interquartile range) age, total body surface area (TBSA), and abbreviated burn severity (ABSI) index as follows: 60 (45, 65 IQR), 8.5 (1.8, 39 IQR), and 6 (5,7 IQR). Inhalation injury was diagnosed with bronchoscopy, carboxyhemoglobin, or clinical suspicion. Eighty-two percent of those with bronchoscopy had an inhalation grade of 2 or greater. None (0%) of the patients showed signs of mesenteric ischemia, tube feeding intolerance, pneumatosis/perforation on CT, or necrotic bowel on laparotomy. Aware of the study limitations, we conclude that hydroxocobalamin does not increase risk for AMI.
自2006年以来，美国的急救人员和烧伤中心一直使用羟钴胺作为氰化物中毒的安全解毒剂，氰化物中毒是烟雾吸入的一种严重并发症。目前没有使用这种急救措施的禁忌证。最近一份法国的回顾性出版物报道，在重症烧伤和吸入性损伤患者中，使用羟钴胺与急性肠系膜缺血（AMI）之间可能存在关联。本研究的目的是确定与羟钴胺相关的AMI风险特征。在一家地区烧伤中心对成年烧伤患者使用羟钴胺的情况进行了为期2年的回顾性研究。记录了损伤特征、人口统计学数据和结局，包括肠系膜缺血的情况（定义为CT扫描显示有积气或穿孔，或剖腹手术时发现肠坏死）。在17例确诊的吸入性损伤患者中，患者的年龄中位数（四分位间距）、总体表面积（TBSA）和简化烧伤严重程度（ABSI）指数如下：60（45，65四分位间距）、8.5（1.8，39四分位间距）和6（5，7四分位间距）。通过支气管镜检查、碳氧血红蛋白或临床怀疑来诊断吸入性损伤。接受支气管镜检查的患者中，82%的吸入等级为2级或更高。没有患者（0%）表现出肠系膜缺血的迹象、管饲不耐受、CT显示积气/穿孔或剖腹手术时肠坏死。考虑到研究的局限性，我们得出结论，羟钴胺不会增加AMI的风险。
