以健保資料庫分析2017-2021年抗蛇毒血清使用情形

Antivenom Usage Analysis Using National Health Insurance Research Database, Taiwan, 2017–2021

臺灣有6種常見且具醫療重要性的毒蛇，分別為龜殼花、赤尾鮐、百步蛇、雨傘節、飯匙倩及鎖鏈蛇。衛生福利部疾病管制署為國內唯一供應抗蛇毒血清的單位，其供應之抗蛇毒血清已涵蓋常見6種毒蛇。本研究目的為藉由分析2017–2021年健保資料庫抗蛇毒血清使用情形，以瞭解臺灣地區蛇咬傷情況。
結果顯示，2017–2021年平均每年使用抗蛇毒血清2,312劑，以使用抗龜殼花及赤尾鮐蛇毒血清佔78.8%最高，其次為抗雨傘節及飯匙倩蛇毒血清佔20%。2017–2021年因蛇咬傷使用抗蛇毒血清者共4,893人，平均每年使用人數為979人，使用人數中53.3%個案需要住院治療。使用個案特徵以男性為主佔67.7%，年齡層分佈主要是45–65歲中壯年族群，佔43.6%。使用血清種類以僅使用抗龜殼花及赤尾鮐蛇毒血清為主，佔82.9%。臺灣地區平均每年於8月份使用率最高，2月份使用率最低，平均年標準化使用率以臺東縣及花蓮縣為多，分別是每十萬分之23.4人及17.1人，其次是嘉義地區為每十萬分之11.7人。2017–2021年因蛇咬傷使用抗蛇毒血清者共有9人死亡，致死率為0.18%。
瞭解臺灣地區抗蛇毒血清使用相關資訊，不僅可作為國內抗蛇毒血清供應及儲備量之參考，亦可提供地方政府對於蛇咬傷好發月份及區域等相關資訊進行防治政策。

Taiwan has six common venomous snakes of medical importance: Trimeresurus stejnegeri, Protobothrops mucrosquamatus, Deinagkistrodon acutus, Bungarus multicinctus, Naja atra, and Daboia siamensis. The Taiwan Centers for Disease Control is the sole supplier of antivenoms in Taiwan, which cover all six common venomous snakes. The aim of this study was to analyze antivenom use from 2017 to 2021, based on the National Health Insurance Research Database, to understand snakebite occurrences in Taiwan.
An average of 2,312 doses of antivenom were used annually from 2017 to 2021, with the highest proportion (78.8%) being antivenom for P. mucrosquamatus and T. stejnegeri, followed by antivenin for B. multicinctus and N. atra (20%). A total of 4,893 persons received antivenoms because of snakebites during this period, with an average of 979 persons per year. Among them, 53.3% required hospitalization. Antivenin recipients were mainly male (67.7%), and 43.6% were aged 45–65 years; the most common type of antivenom used was antivenin of P. mucrosquamatus and T. stejnegeri only (82.9%). The average usage rates were highest in August and lowest in February. The average annual standardized usage rate was highest in Taitung County (23.4 persons per 100,000 population), followed by Hualien County and the Chiayi area (17.1 and 11.7 persons per 100,000 population). Even after using antivenoms, 9 persons died from snakebites during 2017–2021 (case fatality rate: 0.18%).
This analysis not only serves as a reference for domestic supply and reserves of antivenom, but also provides relevant information for local governments to formulate prevention and control policies for the seasons and regions with the most snakebites.