Bazemore P H, Tonkonogy J, Ananth R
University of Massachusetts Medical Center, Worcester.
Dysphagia. 1991;6(1):2-5. doi: 10.1007/BF02503456.
Deaths due to airway obstruction are more common in psychiatric inpatients than in the normal population. A dysphagia program was started in a 400 bed Massachusetts psychiatric hospital after 4 patients in 1 year died from asphyxia. In the year after the program was started, there were no deaths; however, 28 patients experienced 32 choking incidents. The 28 patients received clinical evaluations by speech pathologists, neurologists, psychiatrists, and internists. Of the incidents, 55% required use of the Heimlich maneuver to open the airway. Choking incidents could be classified into five types based on results of clinical examination: bradykinetic, dyskinetic, fast eating syndrome, paralytic, and medical. Twenty-one of the 28 patients were studied by videofluoroscopy and 86% of the videos were abnormal, showing aspiration in eight, webs in five, and delay in the oral phase in five. Patients with bradykinetic dysphagia (secondary to neuroleptic-induced extra-pyramidal syndrome [EPS]) and paralytic dysphagia appeared to experience a more severe form of choking.
气道梗阻导致的死亡在精神科住院患者中比在普通人群中更为常见。在马萨诸塞州一家拥有400张床位的精神病医院，1年中有4名患者死于窒息后，启动了一项吞咽困难治疗项目。该项目启动后的一年里，没有患者死亡；然而，有28名患者发生了32次窒息事件。这28名患者接受了言语病理学家、神经科医生、精神科医生和内科医生的临床评估。在这些事件中，55%需要使用海姆立克急救法来打开气道。根据临床检查结果，窒息事件可分为五种类型：运动迟缓型、运动障碍型、快速进食综合征型、麻痹型和内科型。对28名患者中的21名进行了视频荧光透视检查，86%的视频显示异常，其中8名存在误吸，5名存在蹼状结构，5名存在口腔期延迟。运动迟缓型吞咽困难（继发于抗精神病药物引起的锥体外系综合征[EPS]）和麻痹型吞咽困难的患者似乎经历了更严重的窒息形式。
