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中華職業醫學雜誌

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篇名 職業性電傷害
卷期 17:1
並列篇名 Work-related electrical injuries
作者 胡文杰陳宣志蔡世傑邱敏綺李孟智陳俊傑
頁次 001-008
關鍵字 電傷害低伏特與高伏特傷害雷擊多重器官損傷electrical injurymultiple organ damagelightninglow voltage and high voltage injuryTSCI
出刊日期 201001

中文摘要

隨著電能廣泛使用,電傷害成為工業發展上越來越重要的課題。依台灣勞委會統計資料(民國90至96年),每年因電傷害導致傷病勞工平均約156.4人,殘廢約25.3人,死亡約為34.3人。雖然嚴重電傷害,大多發生在工作場所,但是只要有電器設施就可能產生。就危險性而言,交流電大於直流電三倍,因交流電會導致肌肉強直性痙攣,使觸電時間延長。電流傷害機轉包含:電流直接破壞身體組織或因電能轉化成熱能而導致組織損傷的直接傷害與電流導致強烈肌肉收縮而產生跌落等身體鈍挫傷的間接傷害。影響電傷害因子,包括電流型態、觸電時間、組織電阻、接觸電壓高低、電流強弱、電流經過路徑等。一般而言,垂直的電流傳導路徑(平行身體長軸)是最危險的電傷害類型;電傷害應視為多重器官傷害來評估且救護時應注意有否危害救護人員的可能,若重要維生器官有損傷,須小心評估或轉加護病房。照護原則依傷害型態與嚴重程度而有所不同,且
應小心可能的併發症;雖然醫療與手術不斷精進,明顯改善電傷害病患的預後,但就預防的觀點,幾乎所有電傷害都是可預防的,因此如何加強工作管理與用電安全規範,增進醫療人員、甚至基層勞工,對於電傷害處理原則瞭解,才能減少電傷害相關的失能與死亡。

英文摘要

As electric energy is used more extensively, electrical injuries become an increasingly important issue on industrial development. According to the statistical data of Taiwan’s Council of Labor Affairs(2001~2007), electrical injuries are responsible for an average of 156.4 injured
people, 25.3 disabled people, and 34.3 deaths annually. Although severe electrical injuries tend to occur primarily in the workplace, electrical injuries could occur anywhere if electrical apparatus is found. Alternating current(AC) is approximately three times more dangerous than
direct current(DC). Alternating current will cause muscles tetanic and prolong exposure duration. The tissue damage mechanism of electric current involves two aspects. One is direct injury which destroys the tissue by electric energy or transformed thermal energy. The other one
is indirect injury which causes severe muscle contraction complicated with blunt injury due to falling accidentally. Factors determining electrical injuries include: current type, exposure duration, resistance of tissue, voltage level, current intensity, pathway of current, etc. In general, the vertical pathway parallel to the axis of the body is the most dangerous type of electrical injury. Electrical injuries should be assessed as multiple organ damage and we must beware of any danger to rescue personnel. If vital organ damage is possible, we have to evaluate the patient carefully and refer him/her to the intensive care unit. The management principle of electrical injuries is different according to the injury type and degree of severity, and we should carefully evaluate any possible complications. With medicine and operation skill improving
greatly, the prognosis of electrically injured patients has improved immensely. But with regards to prevention, nearly all electrical injuries could be prevented. Therefore, strengthening and enforcing the safety electricity operation regulations and work standard rules, understanding
the management principle of medical personnel or even labors could actually reduce morbidity and mortality of electrically injured patients.

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