- 期刊
台灣農藥污染所致之食物中毒：台北榮總毒藥物諮詢中心之病例分析
Food-Borne Pesticides Poisoning in Taiwan-Cases Analysis of Poison Control Center
摘要
背景：農藥污染引起之食物中毒在公共衛生及醫療上是一項重要的議題。本研究擬分析台北榮民總醫院毒藥物諮詢中心所接獲之台灣地區農藥污染食物中毒案例，作為急診同仁在第一線處理農藥誤食之病患時之參考。 材料與方法：以回溯性分析法收集台北榮民總醫院毒藥物諮詢中心自1986年7月至2003年6月，共十七年間接獲自台灣地區受農藥污染之食物中毒案例，分析造成中毒之主要藥物類別，中毒原因及病患之臨床表徵，並統計其與預後之相關性。 結果：自1986年到2003年十七年間，共收集80件農藥食物中毒事件，127名受害者。中毒藥物類別方面以巴拉刈 (25.2%)、醣磷類除草劑 (22.8%)、有機磷農藥 (22.1%) 及氨基甲酸鹽 (16.5%) 為主。在中毒原因方面則以不當儲存或運用所致之意外 (86.6%)及誤用 (13.4%)所導致之農藥性食物中毒為最主要原因。在中毒之嚴重度方面：無症狀占41.7%，輕微中毒者占44.1%，中度中毒者占8.7%，嚴重中毒者占3.1%，死亡2.4%。死亡的三名病患，其致病物質分別為巴拉刈、methomyl及coumaphos。造成中度以上中毒之農藥種類，主要為有機磷和氨基甲酸鹽等抗乙醯膽鹼類農藥。 結論：在台灣地區造成農藥性食物中毒之主要元兇為巴拉刈、醣磷類除草劑、有機磷農藥及氨基甲酸鹽等農藥。除非具有非常典型的臨床特徵，大部分農藥污染所致之食物中毒難以鑑別，以致於常造成診斷上的困難而延誤治療。中毒主要診斷依據為暴露病史、典型之中毒症狀及實驗室檢查。抗乙醯膽鹼類農藥，因農藥殘留性高、急性毒性大，所造成的食物污染中毒嚴重度可能較高。此外，臨床醫師應提高對非細菌性食物中毒之警覺性，政府機關也應正視此類問題，方能落實此類中毒之早期診斷及預防。
並列摘要
Objectives: Food poisoning due to misuse of pesticides has become an important issue in public hygiene and medical treatment. This study is carried out to analyze the cases of food-borne pesticides poisoning collected by Poison Control Center, Taipei Veterans General Hospital. The information can be used to assist the emergency staffs for the management of food poisoning resulting from contamination of pesticides. Method: We retrospectively reviewed the cases of food-borne pesticides poisoning collected by Poison Control Center from July 1986 to June 2003. The most common pesticides that were misused, reasons of intoxication and the clinical presentations of patients were analyzed with the correlation of prognosis made. Results: There were 80 incidents of food poisoning and 127 victims collected. The main etiologic agents were paraquat (25.2%), glyphosate (22.8%), organophosphate (22.1%) and carbamate (16.5%). The reasons of intoxication were accidentally ingestion of pesticide-residue food (86.6%) and misuse of pesticides (13.4%). The severities of intoxication were asymptomatic 41.7%, mild 44.1%, moderate 8.7%, severe 3.1%, and death 2.4%. The causative agent of three deceased were paraquat, methomyl and coumaphos. The pesticides causing above moderate poisonings were anticholinergic pesticides. Conclusion: In Taiwan the main culprits of food poisoning are paraquat, glyphosate, organophosphate and carbamate. Unless very typical clinical symptoms are visible, most cases of food poisoning resulting from misuse of pesticides cannot be easily ascertained. Consequently, difficulty in diagnosis often leads to delay in medical treatment. Clinical diagnosis is based on history, symptoms of pesticide poisoning and laboratory tests. Anticholinergic pesticides such as organophosphate and carbamate have high level of residue and intensity of poison, and hence higher probability of food poisoning of critical nature. Medical doctors should also be aware of food poisoning not caused by bacteria. Government agencies should also focus on the issue concerned to achieve prevention and early treatment.