北台灣司法解剖之突然非預期性死亡的研究

A Study of the Sudden Unexpected Death of Forensic Autopsy in Northern Taiwan

10.6134/tjfm.2013.0501.01

張瀞云(Ching-Yun Chang)；孫家棟(Chia-Tung Shun)

北台灣地區 ； 司法解剖 ； 突然非預期性死亡 ； Northern area of Taiwan ； Forensic autopsy ； Sudden unexpected natural death

台灣法醫學誌

5卷1期（2013 / 06 / 01）

1 - 13

繁體中文

死亡為人生必經之階段，可以在預期中漸進式緩慢的呈現，或於無預警情況下突然發生。病患即使是住院期間在醫療密切關注下，仍有可能發生無法預期之快速死亡，對於社會及醫療體系無疑是項考驗與衝擊。此回溯性研究以台灣北部地區（基隆市、台北縣、台北市、桃園、新竹、苗栗）自2005到2006年兩年間因突然非預期性死亡原因接受解剖之個案進行分析，合計431人，其中男性313人（72.62％），女性118人（27.38％）。死亡地點以台北縣193件（44.78％）所佔比例最高。個案年齡分佈由出生一個月內新生兒到89歲，高峰在50～54歲（11.37％），18歲以上之成年人有361位，平均年齡為49.64 ± 15.55歲。依據人口年齡結構與死因交叉統計，以45～64歲中年人156位（36.19％）最多，其中因心臟血管系統死亡者有92位。單一死因比例最高為心冠狀動脈疾病95位（22.04％），其次為肥厚性心肌症38位（8.82％，含2位孩童），以及腦血管意外32位（7.42％，含1位孩童）。將死亡原因依系統分類，成年人以心臟血管疾病個案190人（52.63％）最多，其次為肝膽腸胃系統、代謝及內分泌疾病62位（17.17％）、中樞神經系統39位（10.80％）以及呼吸系統36位（9.97％）。70位18歲以下孩童，男女性比例為1：1.1，1～11個月大嬰幼兒佔48.57％最多，其次為1個月以下新生兒（15.73％）以及5～9歲孩童（11.44％），10～14歲個案僅2位，3歲則無猝死個案。死亡原因以嬰兒猝死症候群（Sudden infant death syndrome，SIDS）（30％）最多，其中3～6個月大嬰兒為好發族群，且12月到3月為主要發生死亡的時間。除SIDS外，肺炎為孩童突然非預期性死亡的主要原因（22.78％）。與先前研究的南台灣之突然非預期性死亡比較，男性同樣有較高發生率，死亡年齡分佈南部地區以25～44歲為主，北部地區則集中在40～59歲。單一死因之研究，南部地區最常見為蜘蛛網膜下腔出血，北部地區則以冠狀動脈疾病居多，此差異結果可能主要在於個案採樣方式不同，但南北地區之不同社會背景的差異性應該也是存在。

Death is the stage which the life must pass through. It can be expected to slow in progressive, or sudden without warning. Even patients hospitalized under the medical close care, there may be unanticipated rapid occurrence of such deaths. The social and health care system is undoubtedly the key challenges and impact from sudden unexpected death. This retrospective study of our analysis is based on the cases in northern Taiwan (Keelung, Taipei city and county, Taoyuan, Hsinchu, and Miaoli) who suffered from sudden unexpected natural death receiving forensic autopsy during 2005-2006. A total number of 431 sudden deaths (313 males and 118 females) with an age distribution from 0 days to 89 years were studied. Taipei County is the highest proportion of death (193 cases). The peak age distribution of deaths is in the 50-54 years old. There are 361 adults over the age of 18 with an average age of 49.64 ± 15.55 years. Based on the classified by the system, the leading cause of death was cardiovascular disease (190, 44.08%), followed by gastrointestinal system (62, 14.39%), central nervous system (39, 9.05%) and respiratory system (36, 8.35%). Via the cross statistical analysis of the population age structure and causes of death, most was middle-aged 45-64 years old (156, 36.19%) which 92 individuals died of the cardiovascular system. The highest frequent causes of sudden unexpected death were coronary arteries disease (95, 22.04%), hypertrophic cardiomyopathy (38 / including 2 children, 8.82%), and cerebrovascular accident (32 / including a child, 7.42%). There are 70 children under 18 years of age with sex ratio 1:1.059. The postneonatal infants (1 to 11 months) accounted for 48.57%, followed by neonatals and infants (15.73%) and children 5-9 years old (11.44%). The 10 to 14 years cases were 2 and a nadir around 3 to 4 years (no sudden death case). The cause of death was most by SIDS (30%) especially for 3-6 months infants, and the time of death is mainly in December to March. In addition, pneumonia is the main cause of sudden unexpected death in children (22.78%). The incidence of sudden unexpected death of northern Taiwan comparable with that of southern area previous studied was indicated male predominance. Age distribution of deaths to 25-44 years dominated the southern region, but the northern region was concentrated in the 40-59 years of age. Study of the highest frequent causes of sudden unexpected death, subarachnoid hemorrhage was the most common reason in the southern region, but in the northern region is replaced by coronary arteries disease. Different sampling methods may be made the difference, however, the difference of social backgrounds should also be considered.

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