ELEVATED BLOOD CYANIDE CONCENTRATIONS IN VICTIMS OF SMOKE-INHALATION
ELEVATED BLOOD CYANIDE CONCENTRATIONS IN VICTIMS OF SMOKE-INHALATION
复制标题
DOI：
10.1056/nejm199112193252502
复制
发表时间：
1991-12-19
影响因子：
158.5
通讯作者：
BISMUTH, C
中科院分区：
文献类型：
--
作者：
BAUD, FJ;BARRIOT, P;BISMUTH, C
背景 吸入烟雾导致死亡的有毒气体的性质尚不清楚。除一氧化碳外，氰化氢也可能是原因之一，但其作用尚不确定，因为血液中氰化物浓度通常在中毒后很长时间才能测量。 我们测量了在住宅火灾现场从109火灾受害者的血液样本中的氰化物浓度，然后才接受任何治疗。我们将结果与114名药物中毒（40名受试者）、一氧化碳中毒（29名受试者）或创伤（45名受试者）的结果进行了比较。通过测定39例非严重烧伤患者入院时的血浆乳酸来评估烟雾吸入对代谢的影响。 66名火灾幸存者的平均（+/- SD）血氰化物浓度（21.6 +/- 36.4 μ mol/L，P < 0.001）和43名死亡的受害者（116.4 ± 89.6 μ mol/L，P < 0.001）显著高于114名对照组（5.0 ± 5.5 μ mol/L）。在43名死亡的受害者中，32人（74%）的血液氰化物浓度高于40 μ mol/L，其中20人（46%）高于100 μ mol/L。火灾后血氰化物浓度与一氧化碳浓度呈显著相关（P < 0.001）。入院时血浆乳酸浓度与血氰化物浓度的相关性比与血一氧化碳浓度的相关性更密切。血浆乳酸浓度高于10 mmol/L是氰化物中毒的敏感指标，其定义为血液氰化物浓度高于40 μ mol/L。 住宅火灾可能导致氰化物中毒。在患者入院时，血浆乳酸盐浓度升高是没有严重烧伤的火灾受害者氰化物毒性的有用指标。
Background. The nature of the toxic gases that cause death from smoke inhalation is not known. In addition to carbon monoxide, hydrogen cyanide may be responsible, but its role is uncertain, because blood cyanide concentrations are often measured only long after exposure.Methods. We measured cyanide concentrations in blood samples obtained at the scene of residential fires from 109 fire victims before they received any treatment. We compared the results with those in 114 persons with drug intoxication (40 subjects), carbon monoxide intoxication (29 subjects), or trauma (45 subjects). The metabolic effect of smoke inhalation was assessed by measuring plasma lactate at the time of admission to the hospital in 39 patients who did not have severe burns.Results. The mean (+/- SD) blood cyanide concentrations in the 66 surviving fire victims (21.6 +/- 36.4-mu-mol per liter, P < 0.001) and the 43 victims who died (116.4 +/- 89.6-mu-mol per liter, P < 0.001) were significantly higher than those in the 114 control subjects (5.0 +/- 5.5-mu-mol per liter). Among the 43 victims who died, the blood cyanide concentrations were above 40-mu-mol per liter in 32 (74 percent), and above 100-mu-mol per liter in 20 of these (46 percent). There was a significant correlation between blood cyanide and carbon monoxide concentrations in the fire victims (P < 0.001). Plasma lactate concentrations at the time of hospital admission correlated more closely with blood cyanide concentrations than with blood carbon monoxide concentrations. Plasma lactate concentrations above 10 mmol per liter were a sensitive indicator of cyanide intoxication, as defined by the presence of a blood cyanide concentration above 40-mu-mol per liter.Conclusions. Residential fires may cause cyanide poisoning. At the time of a patient's hospital admission, an elevated plasma lactate concentration is a useful indicator of cyanide toxicity in fire victims who do not have severe burns.