Role of hydroxocobalamin in acute cyanide poisoning
Role of hydroxocobalamin in acute cyanide poisoning
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DOI：
10.1345/aph.1k559
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发表时间：
2008-05-01
影响因子：
2.9
通讯作者：
Velez, Larissa I.
中科院分区：
文献类型：
--
作者：
Shepherd, Greene;Velez, Larissa I.
目的：回顾最近批准的氰化物解毒剂羟钴胺，并描述其在治疗中的作用。数据来源：通过使用 MeSH 术语和关键词羟钴胺和氰化物对 PubMed 进行系统检索，确定了相关出版物。此检索仅限于 2000 年以来发表的人类研究。系统检索一直持续到 2008 年 1 月。对已确定文章的参考文献进行了审查，以了解其他相关的人类研究。研究选择和数据提取：文献检索检索了 7 项关于羟钴胺在人类中的安全性和/或有效性的研究。通过检索确定了 4 项新研究，并从参考文献中确定了 3 项研究。 数据综合：解毒剂对人体功效的研究在伦理上和逻辑上都很困难。一项临床前研究表明，志愿者受试者对静脉注射 5 g 羟钴胺的耐受性良好。在硝普钠治疗和重度吸烟者的对照研究中，羟钴胺已被证明可以降低氰化物浓度。对 14 例急性氰化物中毒的回顾性研究也证明了羟钴胺的安全性和有效性。两项研究羟钴胺对烟雾吸入相关氰化物中毒的治疗表明可能有好处，但不足以建立在这种情况下使用的明确标准。缺乏羟钴胺和传统氰化物解毒剂（亚硝酸盐/硫代硫酸盐）的随机对照试验。结论：氰化物中毒可迅速导致死亡。对于提供紧急护理的机构来说，拥有现成的有效解毒剂至关重要。如果摄入氰化物，亚硝酸盐/硫代硫酸盐组合和羟钴胺都是有效的解毒剂。羟钴胺为儿童和孕妇提供了更好的安全性。在氰化物中毒并吸入烟雾的情况下，羟钴胺似乎也具有更好的安全性。然而，目前的数据不足以建议所有烟雾吸入受害者经验性地给予羟钴胺。
OBJECTIVE: To review the recently approved cyanide antidote, hydroxocobalamin, and describe its role in therapy.DATA SOURCES: Relevant publications were identified through a systematic search of PubMed using the MeSH terms and key words hydroxocobalamin and cyanide. This search was then limited to human studies published since 2000. Systematic searches were conducted through January 2008. References from identified articles were reviewed for additional pertinent human studies.STUDY SELECTION AND DATA EXTRACTION: The literature search retrieved 7 studies on the safety and/or efficacy of hydroxocobalamin in humans. Four new studies were identified by the search and 3 studies were identified from the references.DATA SYNTHESIS: Studies of antidote efficacy in humans are ethically and logistically difficult. A preclinical study demonstrated that intravenous doses of hydroxocobalamin 5 g are well tolerated by volunteer subjects. Hydroxocobalamin has been shown to reduce cyanide concentrations in controlled studies of nitroprusside therapy and in heavy smokers. A retrospective study of 14 acute cyanide poisonings also demonstrated hydroxocobalamin's safety and efficacy. Two studies examining hydroxocobalamin for smoke inhalation-associated cyanide poisoning indicated a possible benefit, but they are insufficient to establish definitive criteria for use in this setting. Randomized controlled trials of hydroxocobalamin and traditional cyanide antidotes (nitrites/thiosulfate) are lacking.CONCLUSIONS: Cyanide poisoning can rapidly cause death. Having an effective antidote readily available is essential for facilities that provide emergency care. In cases of cyanide ingestion, both the nitrite/thiosulfate combination and hydroxocobalamin are effective antidotes. Hydroxocobalamin offers an improved safety profile for children and pregnant women. Hydroxocobalamin also appears to have a better safety profile in the setting of cyanide poisoning in conjunction with smoke inhalation. However, current data are insufficient to recommend the empiric administration of hydroxocobalamin to all victims of smoke inhalation.