Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation
Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation
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DOI：
10.1016/j.annemergmed.2007.01.026
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发表时间：
2007-06-01
影响因子：
6.2
通讯作者：
Bismuth, Chantal
中科院分区：
文献类型：
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作者：
Borron, Stephen W.;Baud, Frederic J.;Bismuth, Chantal
研究目的：评价疑似烟雾吸入性氰化物中毒患者在火灾现场或ICU接受羟钴胺治疗的疗效。方法：1987~1994年间，因面部、口腔、鼻子或咳出烟尘而怀疑氰化物中毒并有神经功能障碍的成人烟雾吸入患者在火灾现场或ICU静脉滴注羟钴胺5g(最多15g)。羟钴胺给药前采集血氰化物标本。氰化物中毒阈值预定义为大于或等于39mU·mol/L。结果：样本包括69例患者(平均年龄49.6岁，男性33例)，其中39例昏迷。院外死亡被排除在外。在住进ICU的69名患者中，有50名(72%)在服用羟钴胺后存活。在后来证实氰化物中毒的组中(n=42)，给予羟钴胺后67%(28/42)存活。最常见的不良反应是色尿(n=6)、粉红色或红色皮肤变色(n=4)、高血压(n=3)、红斑(n=2)和血压升高(n=2)。羟钴胺没有引起严重的不良反应。实验室检查显示，肾和肝功能的一过性改变符合患者的危重情况，轻度贫血符合进行性血液稀释。结论：经验性应用羟钴胺与67%后来确诊为氰化物中毒的患者的生存有关。羟钴胺耐受性良好，无论是否存在氰化物中毒。羟钴胺似乎对烟雾吸入所致的假定氰化物中毒的院外治疗是安全的。
Study objective: To assess outcomes in patients treated with hydroxocobalamin at the fire scene or in the ICU for suspected smoke inhalation-associated cyanide poisoning.Methods: Adult smoke inhalation victims with suspected cyanide poisoning as determined by soot in the face, mouth, or nose or expectorations and neurologic impairment received an intravenous infusion of hydroxcicobalamin 5 g (maximum 15 g) at the fire scene or in the ICU in this observational case series conducted from 1987 to 1994. Blood cyanide specimens were collected before administration of hydroxocobalamin. The threshold for cyanide toxicity was predefined as greater than or equal to 39 mu mol/L.Results: The sample included 69 patients (mean age 49.6 years; 33 men), of whom 39 were comatose. Out-of-hospital deaths were excluded. Fifty of the 69 patients (72%) admitted to the ICU survived after administration of hydroxocobalamin. In the group in which cyanide poisoning was confirmed a posteriori (n=42), 67% (28/42) survived after administration of hydroxocobalamin. The most common adverse events were chromaturia (n=6), pink or red skin discoloration (n=4), hypertension (n=3), erythema (n=2), and increased blood pressure (n=2). No serious adverse events were attributed to hydroxocobalamin. Laboratory tests revealed transient alterations in renal and hepatic function consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution.Conclusion: Empiric administration of hydroxocobalamin was associated with survival among 67% of patients confirmed a posteriori to have had cyanide poisoning. Hydroxocobalamin was well tolerated irrespective of the presence of cyanide poisoning. Hydroxocobalamin appears to be safe for the out-of-hospital treatment of presumptive cyanide poisoning from smoke inhalation.