Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2010 Aug;73(8):419-24. doi: 10.1016/S1726-4901(10)70090-3.
Choking incidents have long been recognized as a cause of death in people with mental illness. This study attempted to determine the rate of choking incidents and deaths among psychiatric inpatients and identify the risk factors associated with choking incidents. Some preventive measures are also suggested.
All choking incidents recorded over 3 years in 3 psychiatric wards of Chutung Veterans General Hospital (total of 210 beds) were retrospectively analyzed for demographic variables, psychiatric and medical diagnoses, and drug therapy at the time of the incidents.
During the 3-year period, 16 incidents were recorded, involving 11 patients at a rate of 1 incident every 451.4 months of hospitalization per person. Men were 3 times more likely to experience choking incidents than women, and the mean age of choking patients was higher than that of all patients (59.7 vs. 44.4 years). Among the 16 incidents, 3 fatal cases were noted, giving an annual choking death rate of 5.05 per 1,000 persons hospitalized. A high re-choking rate of up to 40.0% was noted, and patients with organic mental disorder had 3.4 times the choking incidence of all patients. The mean antipsychotic dosage of the choking cases was similar to that of all inpatients, but the mean hypnotic dosage of the fatal choking cases was significantly higher. Up to 62.5% of the choking accidents occurred at breakfast, and mantou (a type of steamed bun) was the most common food (9/16) that resulted in the accidents. Of the 11 patients, 9 were rated as "poor" or "very poor" with regard to self-care before the accidents.
Compared with studies in Western psychiatric inpatients, we have a lower choking incident rate but higher death rate due to choking. We found that older age, male sex, higher dosage of hypnotics, previous choking attacks, organic mental disorder, poor self-care, breakfast time and mantou were possible risk factors associated with choking, in which older age, poor self-care, and higher dosage of hypnotics for fatal cases were statistically significant.
噎食事件长期以来一直被认为是精神疾病患者死亡的原因之一。本研究试图确定精神科住院患者噎食事件和死亡的发生率，并确定与噎食事件相关的危险因素。同时还提出了一些预防措施。
回顾性分析了竹东荣民总医院 3 个精神科病房 3 年来（共 210 张病床）记录的所有噎食事件，分析了人口统计学变量、精神和医学诊断以及事件发生时的药物治疗。
在 3 年期间，共记录了 16 起事件，涉及 11 名患者，每人每 451.4 个月住院发生 1 起事件。男性发生噎食事件的可能性是女性的 3 倍，噎食患者的平均年龄高于所有患者（59.7 岁比 44.4 岁）。在 16 起事件中，有 3 例死亡，每年每 1000 名住院患者的噎食死亡率为 5.05%。高再噎食率高达 40.0%，器质性精神障碍患者的噎食发生率是所有患者的 3.4 倍。噎食病例的平均抗精神病药物剂量与所有住院患者相似，但致命噎食病例的平均催眠药物剂量明显较高。高达 62.5%的噎食事故发生在早餐时，馒头（一种蒸馒头）是导致事故最常见的食物（16/16）。在 11 名患者中，9 名在事故发生前被评为“差”或“极差”自理能力。
与西方精神科住院患者的研究相比，我们的噎食事件发生率较低，但因噎食导致的死亡率较高。我们发现，年龄较大、男性、催眠剂量较高、既往噎食发作、器质性精神障碍、自理能力差、早餐时间和馒头可能与噎食有关，其中年龄较大、自理能力差和致命病例催眠剂量较高具有统计学意义。
