民國103～108年車禍相關致死案例探討

本研究係收集法務部法醫研究所民國103～108年受理案件中，經案情偵查、相驗、解剖、法醫病理、法醫毒物、死亡原因、死亡方式等統計分析，探討國內車禍案件與藥物之關係，提供政府在車禍管制及藥物使用施政之參考。民國103～108年間法醫毒物車禍相關案件計有295件，近三年檢出案件數為前三年的2.3倍，顯示車禍案件有漸增之趨勢。分析本所103～108年六年間經核派法醫解剖之案件，且經法醫綜合研判為與車禍相關死亡案件共295件中，男性252件（85.4%），女性43件（14.6%），顯示男性案件遠高於女性；男性平均年齡52.6 ± 17.1歲，女性為50.4 ± 17.7歲，整體案件中，年齡的分布在14～95歲之間，平均值±標準差為52.2 ± 17.3歲，而年齡集中於40～69歲。死亡方式以意外死亡比例最高，計有256件（86.8%）、自然死亡23件（7.8%）、死因未確認待司法調查有16件（5.4%）。經過統計103至108年發生使用酒精後駕駛或藥物與酒精併用後駕駛之交通事故，單純使用酒精後駕駛肇事的有70件，而藥物與酒精併用後駕駛而肇事的則有51件。經過各案件所使用的藥物類別統計後，鎮靜安眠藥檢出項次為162次、酒精121次、毒品共84次：毒品包含安非他命類、愷他命類、卡西酮類等。在295件案件中，在83案死者檢體中檢出鎮靜安眠藥，而藥物與酒精併用案件中，與酒精併用的藥物類別各案件數分別為：鎮靜安眠藥33件、毒品26件、抗精神病藥16件、心血管用藥15件、肌肉鬆弛劑9件、抗組織胺8件、腸胃用藥6件、糖尿病用藥5件、鎮痛解熱藥4件、支氣管擴張劑3件、鴉片類3件，而抗癲癇藥與治療帕金森氏症各1件，顯示在酒駕的車禍案件中與鎮靜安眠藥併用的案件數最多。本篇研究除了分析酒駕造成之死亡車禍，更進一步說明藥駕是運輸事故死亡案件之另一大宗，嚴重度及重要性不容忽視。

關鍵字

車禍；相關致死案件；法醫毒物分析；流行病學分析

並列摘要

Driving under the influence of drugs is a public health concern and global traffic safety. Car accidents are the serious problems in Taiwan. There is a growing scientific evidence concerning the use of alcohol, illegal drugs and driving. In this report, two hundred and ninety-five postmortem reports of road accident deaths in Taiwan have been reviewed from 2014 to 2019. Postmortem blood samples were routinely screened using liquid-liquid extraction (Toxi-tubes® A), followed by GC/MS, LC/ion-trap/MS, and/or LC-QTOF/MS with automated library search protocol. Drugs were quantified by LC-MS/MS or GCMS/ MS using deuterated analog internal standards and alcohol was quantified by HS/GC/FID. Among 20,105 toxicological cases during the 2014-2019 periods in our institute, 295 cases were corresponding to car accidents. Yearly distributions of these car accidents cases were: 2014, 22; 2015, 34; 2016, 34; 2017, 94; 2018, 50; 2019, 61. Among the 295 postmortem cases reviewed, the mean age of the car accidents-related fatalities was 52.2, ranging from 14 to 95, while 252 (85.4%) of these deaths were men and 43 (14.6%) were women. The manners of death for these cases were accident (256 or 86.8%), natural death (23 or 7.8%), and uncertainty (16 or 5.4%). Sedative drugs and hypnotics (n = 162), alcohol (n = 121), and illicit drugs (n = 84) were the most commonly companion compounds presented in car accidents-related cases. While more drivers are being tested and found drug-positive, it shows that prescription drugs may be occurring among fatally drivers. Driving under the influence of prescription drugs is a growing traffic concern. The epidemiological research gives some information to show the condition of car accidents in Taiwan.