Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection.
Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection.
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DOI：
10.1016/j.annemergmed.2016.09.034
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发表时间：
2017-06
影响因子：
6.2
通讯作者：
Boss GR
中科院分区：
文献类型：
--
作者：
Bebarta VS;Brittain M;Chan A;Garrett N;Yoon D;Burney T;Mukai D;Babin M;Pilz RB;Mahon SB;Brenner M;Boss GR
在美国，急性氰化物中毒的两种解毒剂必须通过静脉注射给药。在院前环境中，静脉注射是不切实际的，特别是对于大规模伤亡，肌肉注射将是首选。本研究的目的是确定亚硝酸钠和硫代硫酸钠是有效的氰化物解毒剂时，肌肉注射。我们在三种哺乳动物模型中使用了随机、非盲、平行组研究设计：小鼠吸入氰化物气体，暴露后进行治疗;家兔静脉注射氰化钠，以严重低血压作为治疗的触发因素;猪静脉注射氰化钾，以呼吸暂停作为治疗的触发因素。这些药物通过肌肉注射给药，在没有治疗的情况下，所有三种模型都是致命的。我们发现，亚硝酸钠和硫代硫酸钠单独拯救了100%的小鼠，两种药物联合拯救了73%的兔子和80%的猪。在所有三个物种中，治疗动物的存活率显著优于对照动物（对数秩检验，p < 0.05）。在猪中，药物在注射解毒剂后5分钟内减弱了血浆乳酸盐浓度的升高（差异：生理盐水与亚硝酸盐-硫代硫酸盐处理的血浆乳酸盐为1.76 [95%置信区间1.25-2.27]）。我们的结论是，亚硝酸钠和硫代硫酸钠肌肉注射是有效的，对严重的氰化物中毒在三个临床相关的动物模型的院前急救。
The two antidotes for acute cyanide poisoning in the United States must be given by intravenous injection. In the pre-hospital setting, intravenous injection is not practical, particularly for mass casualties, and intramuscular injection would be preferred. The purpose of this study was to determine if sodium nitrite and sodium thiosulfate are effective cyanide antidotes when given by intramuscular injection. We used a randomized, non-blinded, parallel group study design in three mammalian models: cyanide gas inhalation in mice, with treatment post exposure; intravenous sodium cyanide infusion in rabbits, with severe hypotension as the trigger for treatment; and intravenous potassium cyanide infusion in pigs, with apnea as the trigger for treatment. The drugs were administered by intramuscular injection, and all three models were lethal in the absence of therapy. We found that sodium nitrite and sodium thiosulfate individually rescued 100% of the mice, and that the combination of the two drugs rescued 73% of the rabbits and 80% of the pigs. In all three species, survival in treated animals was significantly better than in control animals (log rank test, p < 0.05). In the pigs, the drugs attenuated a rise in the plasma lactate concentration within five minutes post-antidote injection (difference: plasma lactate, saline-versus nitrite-thiosulfate-treated 1.76 [95% confidence interval 1.25-2.27]). We conclude that sodium nitrite and sodium thiosulfate given by intramuscular injection are effective against severe cyanide poisoning in three clinically relevant animal models of prehospital emergency care.