臺灣南部某醫院急診溺水個案13例之臨床分析

Clinical Analysis of 13 Consecutive Drowning Cases in an Emergency Room in Southern Taiwan

目的：台灣地處熱帶，又非常適合從事各種水上活動，所以每年都有很多人，因而發生溺水意外事件。世界救生組織1990年統計指出台灣意外溺水人數居世界第三，每年約有六百多例溺水死亡案件。然國內目前對於溺水事件的流行病學研究仍不多，因此為了解台灣南部地區溺水之情形，乃收集本院急診溺水案例加以分析。材料與方法：本研究採回溯式研究，收集2004年至2007年3年間被送至本院急診室的溺水案例共13例。資料收集包括年齡、性別、溺水原因（自殺或意外事故）、事故發生地點、臨床症狀表現、各項急診檢驗檢查結果（血液、生化、到院時溫度、脈搏、血壓、X光）及併發症、住院天數、預後等。結果：收集之13例個案中，男女溺水比例相當；而溺水原因，則以意外佔大多數；溺水事件發生的地點以河川、水溝為最多，家中浴缸居次。溺水發生的季節呈四季平均分佈；淡水或海水溺水對於併發症及預後並沒有顯著差異。在溺水第一現場沒有施行心肺復甦術的患者似乎較容易出現併發症；最常見的併發症是吸入性肺炎。而溺水時間超過十分鐘、送達急診室時已昏迷者則較容易有併發症及不良預後。結論：持續加強水域安全教育與急救訓練乃溺水預防與急救的主要工作，希望能經由各界之努力而減少溺水事件的發生。

Background: Taiwan, located in a tropical zone, is suited for various water activities, and many drowning accidents happen every year. The death toll due to drowning is 600 per year. According to the World Life Saving Organization, Taiwan was ranked as the third leading country in the world for unexpected drowning in 1990. Epidemiological studies in Taiwan on this issue are few. We collected and analyzed data on three years of drowning cases sent to our emergency room. Material and method: We conducted a retrospective study by collecting data from the medical records of drowning cases in the emergency ward of our hospital from July 1, 2004 to June 30, 2007. The items included gender, age, cause of drowning (suicide or accident), place, first aid, clinical symptoms and laboratory data (blood, biochemistry, degree, pulse, blood pressure, X-rays), complications, hospitalization days, and prognosis. Result: We analyzed 13 drowning cases sent to our emergency room. The population of drowning was equal in gender distribution, and most cases were accidental. Rivers and bathrooms were the most probable drowning places. The drowning cases were distributed equally in the four seasons. There was no difference in complications and prognosis whether the cases happened in fresh water or sea water. The victims were more likely to have complications and a poor prognosis if there was no first aid CPR implementation. The most common complication was aspiration pneumonia. We found that victims with submersion times of more than 10 minutes were associated with a poor prognosis. Conclusion: Water activity safety education should be encouraged and first aid training should be implemented to reduce the occurrence of drowning events, and to improve the survival rate of drowning victims.