硝普钠致氰化物中毒及其防治  

Cyanide poisoning from sodium nitroprusside and its management and prevention

作　　者：黄竞[1] 刘芳[1] 翟所迪[1] 

机构地区：[1]北京大学第三医院药剂科

出　　处：《药物不良反应杂志》2007年第4期267-271,共5页Adverse Drug Reactions Journal

摘　　要：硝普钠为快速短效血管扩张剂,临床用于治疗高血压危象和严重心力衰竭。硝普钠在体内迅速代谢为氰化物,并进一步代谢为硫氰酸盐。因此,大剂量持续应用硝普钠易致氰化物和硫氰酸盐蓄积中毒。患者在应用硝普钠过程中若出现神经系统抑制、代谢性酸中毒及心血管系统不稳定等应考虑为氰化物或硫氰酸盐中毒,须立即停药,给予支持治疗以及解毒剂。常用解毒剂有:亚硝酸钠、亚甲蓝、硫代硫酸钠及羟钴胺等。硝普钠应用>3d应监测硫氰酸盐血浓度,也应监测氰化物血浓度。硫代硫酸钠与硝普钠联用可预防氰化物毒性反应。伴有肾损害的患者可用非诺多泮代替硝普钠。Sodium nitroprusside is a rapid and short-acting vasodilator. It is used in the treatment of hypertensive crises and severe heart failure. Sodium nitroprusside is rapidly metabolized into cyanide, which is further metabolized to thiocyanate. Therefore, cyanide poisoning or thiocyanate intoxication from their accumulation may occur with high-doses, prolonged administration of sodium nitroprusside. Should the patients develop metabolic acidosis, central nervous system depression, and cardiovascular instability that may consider cyanide poisoning or thiocyanate intoxication, and sodium nitroprusside should be stopped immediately. The patients should be given systematic therapy and antidote. The common antidotes are sodium nitrite, methylthioninium chloride, sodium thiosulfate, and hydroxocobalamin. The thiocyanate concentrations should be monitored if treatment continues for over than 3 days, and cyanide concentrations should also be monitored. Cyanide toxicity from sodium nitroprusside may be prevented by concomitant administration of sodium thiosulfate. The patient with renal impairment may use fenoldopam to replace sodium nitroprusside.

关 键 词：硝普钠 氰化物中毒 治疗 预防 

分 类 号：R595.4[医药卫生—内科学]