南臺灣之突然非預期死亡之研究

Abstract

以司法觀點，非自然死亡乃是不自然、不正常之死亡事件，尤其是突發非預期之情況，必須加以釐清原因。直至目前，臺灣仍然沒有相關報告。本研究為回溯性研究，收集由民國八十七年五月至八十九年六月在屏東地方法院檢察署，和由八十九年七月至九十三年二月在高雄地方法院檢察署，由於突然非預期死亡而懷疑是非自然死亡，而接受司法死因調查和屍體解剖之案例。個案之納入條件為(1)在司法調查後證實在死亡前12小時內有目擊證人證明個案仍然依舊存活；(2)死亡之原因無法以自然死亡或意外作有效解釋；(3)接受完整之解剖調查；(4)接受毒物學檢驗。每一位案例接受司法調查和解剖之步驟，皆按照法務部法醫研究所所訂之司法解剖之程序進行，綜合研判作出死因判定。共有180位案例因發生突然非預期死亡而接受司法解剖。這180位案例包括126位男性54位女性，除1位為泰國籍勞工外，其餘皆為本國籍，年齡由初出生至83歲。中(25-44歲)(42.2%)和壯年(45-64歲)(26.1%)族群是發生最高峰之層代，而醫院(55.0%)是最常見之發生場所。最常受影響之器官系統依次為心臟血管、神經、呼吸肺臟和消化胃腸道。以單一致死疾病作分析，最常見為蜘蛛網膜下出血，其他依序分別為急性上消化道出血和急性心肌梗塞。壯年族群主要為蜘蛛網膜下出血和急性消化胃腸道出血；而中年族群主要為心臟血管疾病。各年齡層之突然非預期死亡的原因互有異同，趨向為隨著年齡由青壯至中老年期，原因亦由蜘蛛網膜下出血和急性消化胃腸道出血漸次轉為以心臟為主之疾病。蜘蛛網膜下出血和急性消化胃腸道出血之高比例反映出臺灣民眾疾病之特別性。另外，感染為孩童和少年之突然非預期死亡的重要原因，不容忽視。

In judicial viewpoint, unnatural death is a form of unusual death that should be investigated, especially in an acute unexpected condition. However, there is no such study in Taiwan. This is a retrospective study to review the final result of the medicolegal autopsy cases of sudden unexpected death in the Southern Taiwan in the Pingtung and Kaohsiung Local District Court Prosecutor’s Office. From May 1998 to June 2000 at the Pingtung Local District Court Prosecutor’s Office and from July 2000 to February 2004 at the Kaohsiung Local District Court Prosecutor’s Office. All the autopsy records performed by the forensic pathologists and the death certificate of all the decedent were reviewed. All the procedure had followed the autopsy guidelines stated by the Institute of Forensic Medicine, Ministry of Justice, Taiwan. The criteria of sudden unexpected death was: (1)eye-witness persons being alive within last 12 hours; (2)inability in explanation of natural or accidental death after scene investigation: (3) performed comprehensive forensic autopsy and (4) full forensic toxicological analysis. A total of 180 cases were enrolled finally. They were 126 men and 54 women. All were residents in the Southern Taiwan, except one case was a foreigner from Thailand. Their age ranged from birth to 83 years. Peak was seen at 25-44 years (42.2%) and 45-64 years (26.1%), hospital (55.0%) is the vi most common site of death scene. The most frequent targets of sudden unexpected death in consequence were cardiovascular system, neurological system, respiratory system and alimentary tract. Subarachnoid hemorrhage was the single leading cause of death, followed by acute upper gastrointestinal bleeding and acute myocardial infarction. Subarachnoid hemorrhage and acute upper gastrointestinal bleeding were the leading causes in 25-44 years persons, whereas cardiovascular diseases in 45-64 years persons. A high frequency of subarachnoid hemorrhage and upper gastrointestinal hemorrhage in young and middle age in our series might reflect a specific disease pattern in Southern Taiwan. In addition, infection, that was a major cause of death in children and young people should not be neglected.