Jacob B, Wiedbrauck C, Lamprecht J, Bonte W
Institute of Legal Medicine, Heinrich Heine University Düsseldorf, Germany.
Dysphagia. 1992;7(1):31-5. doi: 10.1007/BF02493418.
Among 12,982 forensic autopsies, 78 cases of café coronary due to bolus impaction in the larynx (bolus death) were observed from 1947 to 1988. In all cases bolus material occluded the entry to the larynx; only once was a singular occlusion of the glottis observed. The bolus frequently extended into the mouth, trachea, and bronchial tree or esophagus. In all cases small amounts of aspirated material were observed in the deeper parts of the bronchial tree. The most commonly observed bolus was not masticated meat or a meat product. In adults and the elderly the bolus was often too large to pass the physiological narrowings of the hypopharynx. It was commonly lodged above the arytenoid cartilages. Forty-five of the bolus events were observed by bystanders. In 43 of the victims vital reactions were observed by bystanders or at the autopsy. This justifies the hope that many lives could have been saved had the right diagnosis and immediate therapy been initiated. The first step should be manual extraction or use of the Heimlich maneuver; in cases of failure of both attempts, immediate tracheotomy followed by hospitalization and bronchial lavage are indicated.
在1947年至1988年期间进行的12982例法医解剖中，观察到78例因喉内食团嵌塞（食团性死亡）导致的咖啡冠心病。所有病例中，食团物质均阻塞了喉部入口；仅观察到1例声门单一阻塞。食团常延伸至口腔、气管、支气管树或食管。所有病例在支气管树深部均观察到少量吸入物质。最常观察到的食团并非咀嚼过的肉类或肉制品。在成年人和老年人中，食团往往过大，无法通过下咽的生理性狭窄。它通常嵌顿在杓状软骨上方。45例食团事件有旁观者目睹。43例受害者的生命反应有旁观者目睹或在尸检时观察到。这证明了这样一种希望，即如果能进行正确诊断并立即进行治疗，许多生命本可挽救。第一步应是手动取出或使用海姆立克急救法；若两种尝试均失败，应立即进行气管切开术，随后住院并进行支气管灌洗。
