臺灣桃園地區2001年至2011年一氧化碳中毒自殺死亡案件之分析

Intentional Carbon Monoxide Poisoning in Taoyuan County, Taiwan, 2001–2011

孫孝賢(Hsiao-Hsien Sun)

指導教授 ： 孫家棟

國立臺灣大學/醫學院/法醫學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10941

摘要

臺灣近十年來自殺率居高不下，一氧化碳自殺案件屢見於司法相驗中，甚至成為自殺方式的第二位，故有必要對一氧化碳中毒自殺死亡案件(包括燒炭及引汽車所排廢氣入車內)進行各項導因之分析，以做為自殺防治之參考。本研究利用2001-2011年臺灣桃園地區一氧化碳自殺死亡案件，經司法相驗後之調查資料，進行包括人口學、一氧化碳來源、燒炭地點、現場跡證及部分案件之血液毒物學檢驗之研究分析，結果發現11年來共有1183例一氧化碳自殺之死亡案例。一氧化碳自殺已成為桃園地區自殺方式之首選，占所有自殺死亡案件的29.3%，主要以男性(占72%)及25-44歲壯年族群(占65%)為主，與上吊之年齡層偏向45歲以上相較，顯現兩者有社會文化接受性之差異；至於一氧化碳之來源，選擇燒炭者占95.01%，燒炭地點以臥室或浴室為多數合併有81.3%，顯示燒炭者仍以便利為考量；另有26.9%燒炭者會以膠帶或衣物密封門窗，留遺書者有22.3%，兩者對死亡方式之研判極為重要；而經解剖或抽血以檢驗血液藥毒物反應者共有82例，結果一氧化碳血紅素平均濃度為65.3%，已達到教科書上一氧化碳血紅素50%之致死濃度，至少合併一種以上藥物使用者有75.6%，其中以含有酒精最多達50%，服用鎮靜安眠藥者有25.6%，顯示一氧化碳自殺者有相當之比例會服用酒精或鎮靜安眠藥以加速死亡或減輕中毒過程中之不適。由於解剖及抽血案例仍不多，希望能提高解剖及抽血比例，以進一步分析一氧化碳血紅素濃度及其他藥物分佈之情形。希望藉由本篇之研究可以提供檢警有關一氧化碳中毒死亡案件偵查上之相關經驗，並期盼相關之研究因子能提供給有關宣導單位參考，對自殺防治之推行上能有所助益。

關鍵字

臺灣 ； 自殺 ； 一氧化碳中毒 ； 燒炭

並列摘要

The kept rising suicide rate has been continued over the past decade in Taiwan. Among suicide manners, the intentional carbon monoxide (CO) poisoning cases are frequently encountered on judicial postmortem examination, even becoming the second suicide manner of death in Taiwan. It is necessary to analyze the risk factors of the intentional carbon monoxide poisoning cases (including charcoal burning and motor vehicle exhaust gas suicide) to provide the implications for suicide preventions strategies. We analyzed the intentional carbon monoxide suicide cases from 2001 to 2011 in Taoyuan County based on the record of judicial investigation, including demographic characteristics, source of carbon monoxide, scene evidences of death and the toxicological studies. The results showed that intentional carbon monoxide poisoning has become the leading suicide manner of death in Taoyuan County and accounted for 29.3% of all suicide cases. 72% of these cases were male and 65% of these deaths occurred among those 25-44 years of age, relative to the hanging cases frequently in 45 or above in age. It reflected the changes in socio-cultural acceptability in favor of the use of carbon monoxide poisoning as a method for suicide in younger age groups. As to the source of carbon monoxide, charcoal burning accounted for 95.01% of intentional carbon monoxide poisoning. Most of charcoal burning deaths (81.3%) chose restroom or bathroom for suicide place that showed the convenient concerned of the deaths. 26.9% of charcoal burning deaths sealed their restroom or bathroom interior with duct tape or clothes and 22.3% of the deaths left suicide notes. Duct tape and suicide notes are the very important scene evidences for the verdict of manner of death. 30 autopsy cases and 52 drew blood cases were studied for toxicology and the mean concentration of COHb was 65.3% that had reached the lethal level 50% indicated by the text book. In those cases (N=82), more than one kind of associated drugs were detected in 75.6% among them, ethanol were detected in 50% of deaths and sedative drugs were detected in 25.6% of deaths. It is well known that individuals who commit suicide may ingest large quantities of drugs and subsequently expose themselves to CO to increase the speed of death or to reduce the uncomfortableness during CO intoxication. Because of the small number of such cases, the conclusion was not so convincing and we hope more carbon monoxide intoxicated cases should do autopsy or drawing blood. This study may give some help in death investigations or judicial decisions to determine the facts of carbon monoxide suicide deaths, and reduction or even prevention of carbon monoxide suicide deaths.

並列關鍵字

Taiwan ； suicide ； carbon monoxide poisoning ； charcoal burning

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