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药物中毒

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在烟雾吸入受害者中,识别氰化物中毒
原作者: Hong Kim,江利冰 翻译,肖锋 校 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-12-18

Title: Identification of cyanide poisoning in smoke inhalation victims.
题目:在烟雾吸入受害者中,识别氰化物中毒
Author 作者: Hong Kim
翻译:江利冰 校对:肖锋

Cyanide poisoning is rare but highly lethal. Cyanide exposure can occur during residential fire (most common source of exposure) where combustion of synthetic materials (i.e. plastic and polyurethane) releases cyanide gas as well as other toxic gases, including carbon monoxide. Although carbon monoxide poisoning can be readily identified by CO-Hb level using CO-oximetry, serum/blood cyanide level is not readily available for acute management.
 氰化物中毒是比较罕见的但会是致命的。氰化物暴露常常发生在住宅起火(最常见的暴露原因),合成材料(例如塑料以及聚氨酯)的燃烧会释放氰化物气体以及其它毒性气体,包括一氧化碳。尽管一氧化碳中毒可以通过碳氧血红蛋白监测技术对碳氧血红蛋白水平进行检测而快速识别,而指导紧急抢救时血清/全血中的氰化物水平并不容易检测。
However, elevated lactate level (> 10 mmol/L ) has shown to be highly correlated with toxic level of cyanide (40 micromol/L or 1 mg/L) in smoke inhalation victims (Baude FJ et al. N Engl J Med 1991;325:1761-6).  
但是,在烟雾吸入患者中,高乳酸水平(> 10 mmol/L)已显示和氰化物的中毒水平(40 micromol/L or 1 mg/L)高度有关。

•Sensitivity: 87%
•敏感度:87%
•Specificity: 94%
•特异度:94%
•Positive predictive value: 95%
•阳性预测值:95%

Bottom line: when managing smoke inhalation victims, think about cyanide poisoning in addition to carbon monoxide poisoning and check the lactate level. Lactate > 10 mmol/L is suggestive of cyanide poisoning and should be treated with hydroxocobalamin. 
要点:对于烟雾吸入患者,在考虑一氧化碳中毒的同时,需要考虑氰化物中毒,同时检查乳酸水平。乳酸>10 mmol/L提示氰化物中毒,应该启动羟钴胺素治疗。

References 参考文献
Baude FJ et al. Elevated blood cyanide concentrations in victims of smoke inhalation N Engl J Med 1991;325:1761-1766

文章来源:《中华急诊医学杂志》编辑部