回顾性分析吞咽障碍患者发生窒息的相关因素及防范措施

A retrospective analysis of the risk factors for choking in patients with dysphagia

目的分析吞咽障碍患者发生窒息的相关因素，并探讨有效的预防及干预措施。方法回顾1996年9月1日至2014年8月31日期间在中山大学附属第三医院康复科发生窒息的吞咽障碍患者临床资料，分析其相关危险因素，包括性别、年龄、意识状态、误吸性质、进食途径、食物性状和窒息发生原因等。结果共有8例吞咽障碍患者发生窒息，占吞咽障碍患者总数的0．17％；其中男6例，女2例；儿童、青少年、中年人、老年人分别占25．0％、12．5％、37．5％、25．0％；75．0％的患者处于清醒状态，25．0％的患者意识模糊；显性误吸的患者占37．5％，隐性误吸的患者占62．5％；经口进食患者为6例，鼻胃管注食患者为2例；窒息患者中进食固体食物、半固体食物、流质者分别占50．O％、25．0％、25．0％；8例窒息患者抢救成功2例，死亡6例。结论吞咽障碍患者窒息的危险因素包括隐性误吸、经口进食固体及半固体食物等，窒息发生后的抢救成功率较低，应高度重视上述危险因素，并制订应急预案，为进一步处理争取时间。

Objective To explore effective precautions and interventions for choking in dysphagia patients. Methods Clinical data on f dysphagia patients hospitalized from September 1, 1996 to Aug 8, 2014 were retrospectively analyzed to correlate choking with gender, age, consciousness, type of aspiration, food-intake pathway and food texture. Results Only 0.17% of the patients （n = 8） were found to have choked, and 6 of them were men. Children, teenagers, the middle-aged and the aged constituted 25%, 12.5%, 37.5% and 25% of the patients respectively. 75% were conscious and 62.5% displayed silent aspiration. 6 cases used oral intake and 2 used nasogastric tube feeding. Among the 8 choking patients, half ate solid food, 2 semisolid and 2 liquid food. Six survived and 2 died. Conclusion The risk factors for choking include silent aspiration and oral intake of solid or semisolid food. The successful rescue rate for choking is relatively low, so clinicians should be aware of and try to eliminate these risk factors.