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病例18-2017:一名呛噎事件后出现进食困难的11岁女童
Case 18-2017 — An 11-Year-Old Girl with Difficulty Eating after a Choking Incident


Jennifer J. Thomas ... 妇产科和儿科 • 2017.06.15

病历陈述


Lazaro V. Zayas医师(精神科):一名11岁女童因急性呛噎事件后出现进食固体食物困难和与之相伴随的体重减轻而至本院门诊就诊。

直至此次就诊前14日,患者一直体健。当时一块肉被嵌顿在19日前置入的正畸上颚扩张器中,患者认为她可能会呛噎。患者之后能够快速移除嵌顿的肉,但在接下来的7日里,据称患者对吞咽有一种强烈的恐惧,非常谨慎地进食,致使食物摄入量相应减少。呛噎事件发生后第7日,患者停止进食大部分的固体食物;此后,她只食用奶昔、液体膳食补充剂,偶尔也食用酸奶和燕麦粥。患者自诉不能进食固体食物,因为她觉得“害怕我不能充分地咀嚼固体食物,以免吞咽时呛噎”“我不知道如何像以前一样咀嚼”。在此次就诊的前一日,患者的牙齿矫正医师将上腭扩张器取出。然而,吞咽困难仍然存在;患者无法吞下小块鸡肉或一粒米饭。此次就诊当天,患者仅食用了一勺燕麦粥(患者以前乐意食用)、半罐液体膳食补充剂、少量水和果汁。患者的父母指出,她使用前牙咀嚼食物,但似乎无法将食物从口腔前部移至后部进行吞咽。自从2个月前进行检查以来,患者的体重减轻了1.4 kg,体质指数(BMI,体重[kg]除以身高[m]的平方)低于第一百分位数。患者的父母担心发生急性营养不良和脱水。他们要求本院的进食障碍临床研究计划(Eating Disorders Clinical and Research Program)门诊进行紧急诊治,并从那里将患者转诊到本院的青少年和年轻成年人医学(Adolescent and Young Adult Medicine)门诊。





作者信息

Jennifer J. Thomas, Ph.D., Kathryn S. Brigham, M.D., Sarah T. Sally, M.S., C.C.C.-S.L.P., Eric P. Hazen, M.D., and Kamryn T. Eddy, Ph.D.
From the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.), Pediatrics (K.S.B.), and Speech, Language, and Swallowing Disorders and Reading Disabilities (S.T.S.), Massachusetts General Hospital, and the Departments of Psychiatry (J.J.T., E.P.H., K.T.E.) and Pediatrics (K.S.B.), Harvard Medical School — both in Boston.

 

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