Borron S W, Baud F J
Toxicological Intensive Care Unit, Fernand Widal Hospital, Paris, France.
Arh Hig Rada Toksikol. 1996 Sep;47(3):307-22.
Cyanide poisoning presents in many forms. Industrial intoxications occur due to extensive use of cyanide compounds as reaction products. Smoke inhalation, a polyintoxication, is most often responsible for domestic cyanide poisonings. Suicidal poisonings are rare. Cyanogenic compounds may produce acute or subacute toxicity. Signs of cyanide poisoning include headache, vertigo, agitation, confusion, coma, convulsions and death. Definitive laboratory confirmation is generally delayed. Elevated plasma lactate, associated with cardiovascular collapse, should suggest cyanide intoxication. Immediate treatment includes 100% oxygen, assisted ventilation, decontamination, correction of acidosis and blood pressure support. Antidotes include oxygen, hydroxocobalamin, di-cobalt EDTA and methaemoglobin-inducers. Hydroxocobalamin is an attractive antidote due to its rapid cyanide binding and its lack of serious side-effects, even in the absence of cyanide intoxication. Sodium thiosulphate acts more slowly than other antidotes and is indicated in subacute cyanogen poisoning and as an adjunct to acute cyanide poisoning. Initial evaluation of antidotal efficacy is based on correction of hypotension and lactic acidosis; the final analysis rests on the degree of permanent central nervous system injury.
氰化物中毒有多种表现形式。由于氰化物化合物作为反应产物被广泛使用，导致工业中毒。吸入烟雾属于多种毒物中毒，是家庭氰化物中毒最常见的原因。自杀性中毒较为罕见。含氰化合物可能产生急性或亚急性毒性。氰化物中毒的症状包括头痛、眩晕、激动、意识模糊、昏迷、抽搐和死亡。明确的实验室确诊通常会延迟。与心血管衰竭相关的血浆乳酸升高应提示氰化物中毒。立即治疗包括给予100%氧气、辅助通气、去污、纠正酸中毒和维持血压。解毒剂包括氧气、羟钴胺、乙二胺四乙酸二钴和高铁血红蛋白诱导剂。羟钴胺是一种有吸引力的解毒剂，因为它能迅速结合氰化物，且即使在没有氰化物中毒的情况下也没有严重的副作用。硫代硫酸钠的作用比其他解毒剂慢，适用于亚急性氰化物中毒以及作为急性氰化物中毒的辅助治疗。解毒剂疗效的初步评估基于低血压和乳酸酸中毒的纠正情况；最终分析则取决于永久性中枢神经系统损伤的程度。
