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系統識別號 U0026-2008201213481500
論文名稱(中文) 社區乙硫醇暴露及健康影響調查
論文名稱(英文) Outbreak of ethyl mercaptan exposure and health assessments in a community
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 100
學期 2
出版年 101
研究生(中文) 徐祥清
研究生(英文) Hsiang-Chin Hsu
電子信箱 s76994100@mail.ncku.edu.tw
學號 S76994100
學位類別 碩士
語文別 英文
論文頁數 63頁
口試委員 指導教授-郭浩然
口試委員-劉明毅
口試委員-葉宗烈
中文關鍵字 乙硫醇  群體心因性疾病 
英文關鍵字 Ethyl mercaptan  mass psychogenic illness 
學科別分類
中文摘要 背景:乙硫醇是一揮發性液體,人體暴露後可能會造成眼睛、皮膚、與黏膜組織的刺激性,在低劑量的暴露下會產生噁心、頭痛等症狀。由於其具類似大蒜之強烈臭味且嗅覺閾值為1 ppb,因此廣泛地用來作為液態瓦斯的臭味添加劑。台南市發生一起社區乙硫醇暴露事件中,一所國民小學內發現具症狀之群聚個案,因此我們進行一項調查,探討乙硫醇暴露事件之健康影響。
方法: 我們回溯此事件中所有通報台南市衛生局的就醫個案之醫療記錄,與收集臨床特徵與實驗室檢查結果。暴露資料來自於毒災應變隊採用的光離子檢測器之檢測結果。在暴露事件一個月後,以電話訪談方式追蹤通報個案的持續症狀與可能後遺症。此外,我們將毒物逸散來源的距離由近至遠來分為A、B、C三區,每區不同方位再分為四個象限,之後針對每個區域象限中的十位居民進行面訪,將所得到的資料進行統計分析。
結果:本次暴露事件中通報衛生局的人數為41位,皆來自於一國民小學,其中包含40位學生與1位老師。平均年齡為10歲,最常見的症狀包括頭暈(87.5%)、全身無力(50%)、噁心(47.5%)、呼吸困難(10%)與嘔吐(10%)。其臨床特徵和實驗室檢查結果在性別上並無顯著差異,暴露事件一星期後之追蹤並無發現持續症狀與後遺症。在121位的受訪居民中,有10位聞到氣味,其中6位在A區,4位在B區,盛行率越隨靠近逸散源有上升趨勢(p = 0.009);其中2位居民自訴症狀,盛行率亦隨靠近逸散源具上升趨勢(p = 0.041)。然而,此學校是位於B區,此區內並無其他通報衛生局的個案,受訪者中也無症狀。雖然此事件具群體心因性疾病的特徵,但它具有明確且可被偵測之物質,因此並不全然符合可被接受之定義。
結論:雖然確定乙硫醇是造成此次暴露事件的原因,然而個案所呈現的症狀並不能完全歸因於暴露所造成,表示可能有心理層面的影響因素存在。傳統上,群體心因性疾病被定義為集合症狀,但卻沒有實際造成的原因。但有許多個案例如本次事件所觀察到的健康影響並不能單純以暴露因素來論述。因此,我們希冀以“次群體心因性疾病”名詞包含此類有明確造成原因但其暴露只造成部分的健康效應之事件,以新名詞重新認定群體心因性疾病,藉以突顯處理此類事件的重要性。
英文摘要 Background: Ethyl mercaptan is a volatile liquid and may cause irritation of the eye, skin, and mucous membranes and lead to nausea and headache in humans in low-level exposures. Because of its extremely strong garlic-like odor with an odor threshold of 1 ppb, ethyl mercaptan is widely used as an odorant for liquefied natural gas. In an outbreak of exposure to ethyl mercaptan in natural gas in the Tainan City of Taiwan, a cluster of symptomatic victims were observed in an elementary school where the exposure level was low. Therefore, we conducted an investigation to study association between the health effects and the exposure to ethyl mercaptan.
Methods: We reviewed the medical records of all victims reported to the Bureau of Health of the Tainan City and collected the data on clinical characteristics and laboratory tests. The data on exposure levels were retrieved from Environmental Emergency Response Team, which were measured using a photoionization detector. A telephone follow-up was conducted on each reported victim one week after the incident to identify persistent symptoms and sequelae. In addition, we divided the area surrounding the exposure source into Zones A, B, and C from near to far from the source and divided each zone further into four regions according to the directions relative to the source. Ten residents were interviewed in each region after the incident to collect information for further analysis.
Results: A total of 41 victims were reported to the bureau, and all were from an elementary school, including 40 pupils and a teacher. The average age of the pupils was 10, and the most common symptoms were dizziness (87.5%), general weakness (50%), nausea (47.5%), dyspnea (10%), and vomiting (10%). There were no significant differences of clinical signs and biochemical test results between two genders. Neither persistent symptoms nor sequelae were reported one week after the incident. Ten of the 121 interviewees reported sensing the smell, including 6 in Zone A and 4 in the Zone B, and the prevalence had an increasing trend toward the sources (p = 0.009). Two additional symptomatic victims were identified among the 121 interviewees, and the prevalence also had an increasing trend toward the sources (p = 0.041). However, the school was located in Zone B, and there were no victims reported to the bureau, nor symptomatic victims identified in this zone. Whereas the incident had some features of mass psychogenic illness (MPI), it did not meet the generally accepted criteria, because there was an identifiable agent.
Conclusions: In this incident, although ethyl mercaptan was clearly the causal agent, the symptoms reported by the victims could not totally be attributed to the exposure to this agent, indicating effects of psychological factors. Traditionally, MPI is defined as a spectrum of symptoms without any identifiable actual causal agent. However, in many cases, like in this incident, the observed health effects cannot be explained solely by the exposure to the causal agent. We propose using the term of “secondary mass psychogenic illness” to include incidents in which there are identifiable agents but the exposure to the agent can account for only a part of the health effects. The recognition of the psychological factors through using this term can highlight the importance of treating these factors in the management of such incident.
論文目次 中文摘要 I
Abstract III
Contents V
Tables VII
Figures VIII
1. Background 1
1.1 Physical and chemical characteristics of ethyl mercaptan 1
1.2 Psychological effects of chemical exposures 2
1.2.1 Variable psychological phenomena 2
1.2.2 Impact on society 3
1.3 Presentation of chemical incident 4
2. Methods 6
2.1 Study subjects 6
2.2 Measurement of exposure 6
2.3 Measurement of health outcomes 7
2.4 Statistical analysis 8
3. Results 9
3.1 Health assessments of exposed victims 9
3.2 A one-week-later follow up 10
3.3 Interview assessment of residents 10
4. Discussion 11
4.1 Contradiction of the symptoms 11
4.2 Characteristics of MPI 12
4.3 Incompatible with MPI 13
4.4 Secondary mass psychogenic illness (SMPI) 14
4.5 Two variants of psychological effects 15
4.6 Odor assessment 16
4.7 Management and prevention of MPSI 18
4.8 Strength and limitations 19
5. Conclusions 21
6. References 22
7. Appendix 36
7.1 Review chart for medical records of all victims 36
7.2 Questionnaire of telephone follow-up for all victims after one week 38
7.3 Questionnaire of follow-up for residents interview after one week 40
7.4 Telephone Interview Record 42
7.5 Interview of the teacher 46
7.6 News of the chemical accident 54
7.7 Material Safety Data Sheet (MSDS) of ethyl mercaptan 55
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