急診中毒病患之中毒嚴重度與相關因素分析-以北部某醫學中心為例

Abstract

目的：在臺灣，過去資料顯示中毒的發生率每千人約在 0.16 － 0.22 人之間，經常造成中毒者需要至急診就醫，甚至住院或死亡，因此想藉由科學研究方式，了解影響急診中毒病患嚴重程度的相關因子，進而做為臨床人員照護策略上的參考及相關公共衛生當局訂定中毒預防策略之用。 方法：本研究為前瞻性之觀察性研究，透過病歷資料回顧，收錄民國104年1月1日至105年12月31日因中毒至某醫學中心急診就醫之病患共1136例，並將病患之中毒嚴重度分為嚴重及輕微兩組，以邏輯回歸加以分析並計算勝算比，進而得知影響中毒嚴重度的因子。 結果：在病患來源方面，透過轉診就醫之病患中毒較嚴重的機會為自行就醫病患的2.33倍(95% C.I.:1.338-3.813)；中毒原因方面，蓄意中毒病患族群中毒較嚴重的機會為非蓄意中毒族群的2.9倍(95% C.I.:1.844-6.320)；中毒物質方面，農藥中毒的病患族群產生嚴重後果的機會為西藥中毒族群的2.09倍(95% C.I.:1.419-4.135)，生物毒素中毒族群產生嚴重後果的機會為西藥中毒族群的0.12倍(95% C.I.:-0.935-0.392)。 結論：透過轉診就醫、蓄意中毒、農藥中毒之病患族群產生嚴重後果的機會較高，臨床人員需要對這些中毒病患族群多加留意，可能需要住院甚至是住加護病房觀察；在公共衛生的觀點，因為農藥中毒產生嚴重後果的機會較高以及蓄意中毒病患族群大多數原因是自殺、自傷，因此透過政策對農藥取得管道的管制及對自殺、自傷之高危險族群進行自殺防治才能促進人民的健康，減少醫療上的支出。

Purpose: In Taiwan, the incidence of poisoned are 0.16-0.22 per 1000 people, and that usually caused emergency department visited and even hospitalization or death. Thus, the aim of this study was to explore the factors that affected the poisoning severity score(PSS) in poisoned people who visited emergency department by scientific research method, in order to help clinical employee developing their care strategy, and to help public health authorities making the policies for poisoning prevention. Methods: This is a prospective observational study, by using the medical chart review, and enrolled the poisoned people who visited the northern medical center in 1 January, 2015 to 31 December, 2016, total 1136 cases. And divided this 1136 cases into two groups (mild or severe) by poisoning severity score, then using the Logistic regression model to analyze and calculate odds ratios, finally, to determine the factors that affecting the severity of poisoning. Results: In the aspect of where patient came from, compared to the patients who came to emergency department directly, the patients who transferred from other hospital had 2.33 times chance to be the severe group (95% C.I.:1.338-3.813); In the reason of poisoning, compared to unintentional group, the intentional group had 2.9 times chance to be the severe group (95% C.I.:1.844-6.320); In the substances of poisoning, compared to medical medications group, the pesticide group had 2.09 times chance to be the severe group (95% C.I.:1.419-4.135), and the biotoxin group had 0.12 times chance to be the severe group (95% C.I.:-0.935-0.392). Conclusion: The patient who visited emergent department via other hospital referral, intentional poisoned, or pesticide intoxication had more chance to be the poisoned severe group, clinical care staffs should pay more attentions to those groups, they might need hospital admission or even intensive care unit for further care and management. In the aspect of public health, pesticide intoxication patients had more chance to be the severe group and almost all the reasons of intentional poisoned were suicide or self-harmed behaviors, thus, restricting the assess and availability of pesticide and early prevention strategies to high risk groups of self-harmed or suicide by policies making could improve people’s health and reduce the expenditure of medical care system.