- 期刊
氰化物中毒之處置
Cyanide Poison Management
摘要
氰化物是一個強力而且作用快的毒物，在台灣，氰化物中毒並不常見，只有零星個案發生，常由於職業性接觸到氰化物，或因誤食含有氰化物成分的植物或因自殺而服用含氰化鉀的毒魚餌而引發中毒。中毒的嚴重程度和暴露劑量的多寡、暴露期間的長短、暴露途徑及過程（呼吸、食入、飲用或皮膚接觸）、合併其它化學物質暴露，還有個人特異性（年齡、性別、營養狀況、家族特徵、生活及健康狀態）有關。氰化物中毒最主要是影響到人體粒腺體電子傳遞鏈中的細胞色素氧化酶，抑制腺核苷三磷酸（ATP）的產生，使能量代謝受阻，只能進行無氧呼吸，造成乳酸堆積；同時和血紅素結合，影響血紅素釋放出氧分子，進一步造成組織嚴重缺氧及細胞壞死。由於中毒作用十分快速，常常不易搶救。病人早期症狀並不明顯，須詳細問出病人之暴露史、職業、環境、食物。病人常覺得虛弱，表現出呼吸困難及休克，進而影響到意識狀態。實驗室檢查常會有酸中毒及合併乳酸堆積的情形。懷疑氰化物中毒時，應適時給予解毒劑治療，早期發現且早期治療是避免不可逆傷害的不二法門。
並列摘要
Cyanide, one of the most rapidly acting lethal poisons known to humankind, was a main constituent of Earth's primordial atmosphere and probably played an important role in the development of life on Earth. Cyanide exists in many different forms. It can be a gas, liquid, or solid. It may be combined with salts (e.g., sodium, calcium, potassium), metals (cobalt, zinc, gold, mercury), and halides (chloride, fluoride, iodide, bromide), or with organic acids to form nitriles. It may cause poisoning when ingested, inhaled, smoked, or absorbed through the skin. Cyanide is very poisonous because it binds to cytochrome oxidase, stops its action in respiration and inhibits energy conversion process in the body. Cyanide poisoning appears to be dizziness and headache in mild intoxication, metabolic acidosis, cardiac and respiratory arrest and even death in severe intoxication. The diagnosis of cyanide intoxication depends on detail history taking and clinical suspicion. Rapid progression of poison history and severe metabolic acidosis are the clues of diagnosis of cyanide intoxication. The detoxification of cyanide may be accelerated by a number of methods, all of which take advantage of cyanide reversible reactions with the cytochrome oxidase system, its affinity for ferric iron, and its interaction with sulfur and vitamin B-12 derivatives that less or no toxic effect to human. Early diagnosis and prompt antidote treatment only can rescue the cyanide poisoning patients.