Common Factors Associated With Choking in Psychiatric Patients

精神病人嗆咳相關之常見因素

10.1097/jnr.0000000000000060

陳靜芳(Ching-Fane Chen)；陳昱芬(Yu-Fen Chen)；陳展航(Chin-Hong Chan)；藍祚鴻(Tsuo-Hung Lan)；羅爾維(El-Wui Loh)

嗆咳 ； 精神疾病 ； 抗焦慮劑 ； 咳嗽 ； 吞嚥困難 ； choking ； psychiatric ； anxiolytics ； cough ； swallow difficulty

The Journal of Nursing Research

23卷2期（2015 / 06 / 01）

94 - 100

英文

背景　嗆咳常見於精神疾病患者，也是精神疾病患者死亡的主要原因之一。目的　本研究探討精神疾病患者嗆咳之相關因素。方法　我們從病歷、會談記錄與檢查清單取得250名精神疾病患者之人口與醫療疾病資料，患者是否有進食咳嗽與吞嚥困難依據自陳判定。本研究所要探討的結果是服藥嗆咳與住院嗆咳經驗，統計方面以卡方檢定來探討依變項與所要探討的結果之間的關連；與服藥嗆咳有關的依變項，再以多元邏輯式迴歸來檢驗其貢獻。結果　50.8%個案表示本次住院期間有嗆咳狀況，有17.6%的個案被護理人員觀察到服藥嗆咳情形。卡方檢定顯示服用抗焦慮劑、食用半流體或流體食物、進食咳嗽與吞嚥困難，與病患服藥嗆咳有關。唯一和病患住院嗆咳經驗有關的依變項是進食咳嗽。進一步邏輯式迴歸發現，服用抗焦慮劑、進食咳嗽與吞嚥困難對服藥嗆咳同時保留於統計模式中，顯示此三個依變項對服藥嗆咳有獨立的貢獻；其優勢比各為12.8（p=.003）、16.7（p＜.001）及21.7（p=.001）。結論　本研究樣本之服藥嗆咳事件可能與服用抗焦慮劑、進食咳嗽與吞嚥困難有潛在相關。照護服用抗焦慮劑、進食嗆咳或吞嚥困難病史的精神疾病病患，應特別加留意防範以避免嗆咳事件。

Background: Choking is common among psychiatric patients and represents one of the main causes of death in this patient population. Purpose: We aimed to identify common factors associated with choking among psychiatric patients. Methods: The demographic information andmedical history of 250 psychiatric patients living in an acute psychiatricward were retrieved from medical charts, interview records, and check lists. Coughing while eating and swallowing difficulties were assessed based on patient self-reports. The main outcomes were choking while taking drugs (CTD) as observed by nursing staffs and choking experiences during hospitalization (CEH) as reported by the patients. Chi-square tests were used to examine the potential associations among the independent variables. Multiple logistic regression was used to further examine those independent variables found to be significantly associated with CTD to estimate their relative contributions. Results: CEHwas reported in 50.8%, and CTDwas observed in 17.6% of study participants. Use of anxiolytics, consuming a semiliquid or liquid diet, coughing while eating, and swallowing difficultieswere found to be associatedwith CTD. Coughingwhile eating was the only independent variable associated with CEH. Further logistic regression on the relationships between CTD and variables including the use of anxiolytics, coughing while eating, and swallowing difficulties showed the independent contributions of these variables in the model. The odds ratios were 12.8 (p=.003), 16.7 (p G .001), and 21.7 (p=.001) for each of the three respective variables. Conclusion: The use of anxiolytics, coughing while eating, and swallowing difficulties all potentially contributed to the choking events in our sample. Additional precautions should thus be taken in caring for psychiatric patients who use anxiolytics, who have a history of coughing while eating, or who exhibit swallowing difficulties to prevent choking events.

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