停車場管理員之猝死能否被認定為職業病？

Occupational Cardiovascular Disease

羅士翔(Shih-Hsiang Lo) ； 王榮德(Jung-Der Wang) ； 郭文楷(Wen-Kai Kuo)

《北市醫學雜誌》 3卷1期 (2006/01) Pp. 62-69

https://doi.org/10.6200/TCMJ.2006.3.1.09

摘要

職業心血管疾病隨著臺灣近年來在工業、經濟的急遽發展，再加上全球化(globalization)之趨勢，使得各國相對競爭力升高，職場壓力也就大大提高。就業人口老化及社會型態改變等因素之下，勞工心血管疾病之比率有明顯增加之趨勢。但因職場心血管疾病之致病因素複雜，職業因素與心血管因素相互交疊不易確立，故其診斷常被忽略與低估。現以職業醫學診斷之原則，就職業因素如：化學因素、物理因素、心理社會因素(psychosocial factor)，以及心血管疾病之致病等因素來分析討論停車場管理員之猝死是否為職業心血管疾病，並提出預防觀念。職業醫學診斷的原則，包括：(1)確實有病的證據；(2)確定有暴露的證據；(3)合乎時序性；(4)合乎一致性；(5)大致排除其他致病因。本文報告一位45歲男性停車場管理員猝死之案例，探討其死因之確立，其工作環境（寒冷），職場（地下停車場、一氧化碳）及輪班工作等相關暴露之確定，考慮其心血管疾病發生之時序性及一致性以及大致排除其他致病因等，確立停車場管理員之猝死為職業相關，特以鑑定為職業心血管疾病。本文之目的一是闡明職業醫學診斷的原則及個案診斷的驗證，俾以釐清疾病與職業病之相關性，二是重視勞工心血管疾病之預防，定期健檢，對心血管疾病之致病因素加以預防及治療，改善職場因素，使得職業心血管疾病減至最低。

關鍵字

職業心血管疾病 ； 職業醫學診斷原則 ； 職業因素 ； 心血管因素

並列摘要

Background and Purpose: Occupational cardiovascular disease, along with the sudden industrial and economic development and increased competition from globalization, has led to occupational stress in Taiwan. The significant increase of cardiovascular disease in workers has been caused by the aging of the working population and a change in the pattern of society. The diagnosis is often ignored and underestimated because of the complicated risk factors and numerous potential confounders. Methods: The case of sudden death of a parking garage guard was analyzed on the basis of chemical, physical and psychosocial factors. We also evaluated whether the death was caused by occupational cardiovascular disease or not, and went on to suggest a prevention concept. Occupational medicine diagnosis criteria include: 1. evidence of disease, 2. evidence of exposure, 3. appropriate temporal sequence, 4. consistency, and 5. largely ruling out other causes. Results: To prove the cause of the sudden death of a 45-year old male parking garage guard, the associated exposure to the working environment (cold temperature), the workplace (underground parking garage and carbon monoxide) and shift-work were investigated. Conclusion: The objectives of our study were, firstly, to clarify the relationship between exposure and disease based on occupational medicine diagnosis criteria and the evidence of case diagnosis, and secondly, to emphasize the prevention concepts of regular physical examinations of workers and improvement of the workplace to minimize occupational cardiovascular events.

並列關鍵字

occupational cardiovascular disease ； diagnosis criteria of occupational medicine ； occupational factors ； cardiovascular factors