台灣中部某醫學中心急性農藥中毒的3年 回顧性流行病學研究

Epidemiology of acute pesticide poisoning from a medical center in central Taiwan：A 3-year retrospective study

張郁芬(Yu Fen Chang)

指導教授 ： 蔡行瀚

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00039

摘要

背景：農藥指農業中用於控制害蟲，微生物，真菌，雜草等之用藥。從1990年到2004年，台灣平均每年使用農藥為3.7萬噸，耗資1.4億美元。使用密度是日本的兩倍，韓國的三倍，高居亞洲之冠。在台灣平均每公頃耕地使用農藥量為47公斤，是歐洲排名最高的荷蘭的五倍。據世界資源研究所的調查，哥斯大黎加是世界上農藥使用密度最高的國家，平均金額為每公頃耕地51.2公斤。由世界衛生組織的最新統計顯示，全世界每年可能有一百萬人嚴重的意外農藥中毒，兩百萬人因蓄意農藥中毒住院。本研究的目的是統計分析三年內在台灣中部的急性農藥中毒患者院內死亡相關的一些因素。
方法：這是一個回顧性研究，從2008年6月至2011年5月被送往急診科的107例急性農藥中毒。對於病人的人口統計資料和常規實驗室相關檢驗進行分析。
結果：所有類型的農藥院內死亡率為18.7％。急性農藥中毒案例為每10萬人有49.54人。最常見的急性農藥中毒種類為類除蟲菊酯/擬除蟲菊酯類（19.6％），其次為氨基甲酸酯類（18.7％），草甘膦（15.9％），百草枯（15.0％），有機磷（12.1％），有機氮及雜環化合物（ 12.1％），殺鼠劑（3.7％），以及氯乙醇（2.8％）。百草枯有較高的死亡率，而殺鼠劑類沒有死亡的個案。死亡的患者年齡高於存活患者（P = 0.026），病患抵達醫院時有低體溫與死亡有關（P = 0.012）。鈉和鉀的血中濃度低以及酸中毒也與死亡有關（P = 0.005）。蓄意的農藥中毒也與較高的死亡率有關（P = 0.031）。喪偶及離婚者較單身和已婚者，其蓄意的比例較高 ( P= 0.019）。在蓄意急性農藥中毒情況下，男性在40-49歲和50-59歲組比女性來得多。大部份非蓄意急性農藥中毒者的年齡超過60歲。
結論：蓄意農藥中毒以及年齡較高與院內死亡率有關。政府應嚴格限制農藥使用的最大量，立法訂定購買農藥要有許可證，以及農藥供應商要回收殘餘空瓶。政府也應在社區制定一些支持系統，如自殺高風險族群監控網或關懷中心，以防止自殺。

關鍵字

急性農藥中毒，危險因子，巴拉刈，有機磷，流行病學

並列摘要

Pesticides are used in agriculture to control pests, microorganisms, fungi, weeds in the world. The average annual use of pesticides in Taiwan from 1990 to 2004 was 37,000 tons, costing USD 140 million, the using density was about twice that of Japan, three times of South Korea, ranking the highest in Asia. The average amount of pesticide use per hectare of cropland was 47 kilograms in Taiwan, 5 times that of Netherlands, which ranks the highest in Europe. According to World Resources Institute survey, Costa Rica is the country with the highest using density of pesticide in the world, the average amount is 51.2 kilograms per hectare of cropland. The latest estimate revealed that there may be 1 million serious unintentional pesticide poisoning cases each year worldwide by a WHO task group. Two million people hospitalized for intentional pesticide poisoning worldwide. In this study, we aim to find out some factors associated with the in-hospital fatality of patients with acute pesticide poisoning during a 3-year period in central Taiwan.
Methods: This is a retrospective study of 107 patients who were admitted to the emergency department (ED) with acute pesticide poisoning from June 2008 to May 2011. Patient demographics and routine laboratory workup were analyzed. Furthermore, the prevalence of types of pesticide between survival and in-hospital fatality groups was analyzed and the distribution of variables was reported.
Results: The overall in-hospital fatality rate of all types of pesticide was 18.7% (20 of 107). The rate of acute pesticide poisoning was 49.54 per 100,000 in Changhua Christian Hospital (CCH) emergency department. The most common pesticide category of acute pesticide poisoning was pyrethrin/pyrethoid (19.6%), followed by carbamate (18.7%), glyphosate (15.9%), paraquat (15.0%), organophosphate (12.1%), organic nitrogen and heterocyclic compounds (12.1%), rodenticide (3.7%), and chloroethanol (2.8%). The pesticide category was associated with fatality (p=0.013). Paraquat has a higher in-hospital fatality rate. There was no fatality case in rodenticide category. In-hospital fatality patients were older than survival patients (p=0.026) and lower body temperature on arrival was associated with fatality (p=0.012). Lower blood concentration of sodium and potassium were also associated with fatality. Acidosis was also associated with fatality (p=0.005). In-hospital fatality rate is higher in intentional cases than in unintentional cases (23.17% vs. 4.00%) (p=0.031). Widowed and divorced cases had higher percentage in intentional exposure than the single and married cases (p=0.019). In intentional acute pesticide poisoning, male was predominant in 40-49 and 50-59 year-old groups. The outflow of young male population in agricultural counties might be a reason. Most unintentional acute pesticide exposure cases were older than 60 years.
Conclusions: Intentional exposure and older age were associated with higher in-hospital fatality rate. The government should rigorously restrict the use of maximum pesticide use and legislate that purchase pesticides with a registration license, and the pesticide suppliers should recycle the remnants of empty bottles. The government should also develop some kinds of support systems in community to prevent suicide.

並列關鍵字

acute pesticide poisoning, risk factor, paraquat, organophosphate, epidemiology

參考文獻

14. 張瑋庭、朱基銘、白璐、賴建丞、劉淳羽、林佳欣、洪宇箴、簡戊鑑 臺灣1986-2007年自殺死亡趨勢

1. International code of conduct on the distribution and use of pesticides. Rome: Food and Agriculture Organization of the United Nations; 2003.

3. J. Jeyaratnam ACUTE PESTICIDE POISONING: A MAJOR GLOBAL HEALTH PROBLEM WORLD HEALTH STATISTICS QUARTERLY Vol. 43, No. 3, 1990, pages 139-44

4. JEYARATNAM, J. ET. AL. Survey of acute pesticide poisoning among agricultural workers in four Asian countries.

Bulletin of the World Health Organization, 65 (4): 521-527 (1987).