胃部上方闷堵有压迫感
“咳咳咳……水……水”小张一边捶胸,一边招手让他爸递水,这已经是小张被噎到的第N次了。
![](https://p0.ssl.img.360kuai.com/t0138037fe11b9e8b7f.jpg)
小张今年25岁,平时没啥大毛病,就是有个“坏习惯”,每次不是吃饭噎着,就是喝水呛着,为此老被他爸数落做事大大咧咧。
本来二人都没把这当回事,但有一次小张吃饭被噎到剧烈咳嗽,差点背过气去。老张赶紧带着儿子去医院检查,可做了喉镜、CT后,却没显示什么异常。
直到经验丰富的医生,让小张去查查脑科,才发现是延髓脑阻梗导致的吞咽困难。幸好发现得及时,经过溶栓治疗后,小张吞咽问题已得到解决。
![](https://p0.ssl.img.360kuai.com/t01fab629000fce6f2f.jpg)
想必大家都经历过吃饭噎到、喝水呛到的时刻,短短几秒钟足以让我们捶胸顿足、心惊胆战。
那么正常情况下,噎食、呛水到底是为什么呢?
很有可能是食物在咽喉部走岔了路。
咽喉部有两条并排的通道,一条是食道,开放给食物运输进胃,另一条是气道,用于空气流通,让我们呼吸。
而在这两条通道的交叉口上,有一个叫做会厌的“闸口管理员”,主要负责分流食物和空气。
![](https://p0.ssl.img.360kuai.com/t0136c1d55ff99ffe74.jpg)
平时会厌会保持向上状态,让气道打开,这样我们就能正常呼吸或说话。而在食物或水进入时,会厌则向下关闭,盖住气管,让它们能顺利经食道流入胃部。
可当我们进食太多、吞咽过快或边吃边说时,会厌来不及关闭,食物和水卡在咽喉部,就容易引起呛咳、噎食,甚至产生窒息感。
![](https://p0.ssl.img.360kuai.com/t0115c9a58976baa9cf.jpg)
当然,这种情况只是偶发现象,只要你不是餐餐狼吞虎咽,一般很少中招。
![](https://p0.ssl.img.360kuai.com/t01769898292f2e79c2.jpg)
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食物和水入口后,抵达的第一站就是食管。频繁呛水、噎食,最有可能是食道出了问题。
食道炎是常见炎症之一,发作时可能导致食管狭窄、溃疡,影响食物顺利通过食管,从而加大噎食呛水风险。
胃食管反流也常诱发噎食、呛水,这通常是因为食物、胃酸倒流到食管,引起食管肌肉痉挛,刺激食道黏膜所致。据《2020年中国胃食管反流病专家共识》统计,58.8%的胃食管反流患者不仅会出现反流症状,还会并发食道发炎与溃疡。
此外,食管气管瘘也可出现噎食、呛水症状,这是因为食管和气管之间形成了异常通道,食物和水误入气管。
![](https://p0.ssl.img.360kuai.com/t01dcbe07ac4ff3c198.jpg)
而最让人可怕的还有食道肿瘤,它可使食管变得狭窄,并发肿胀、炎症、出血等,从而导致噎食、呕吐。恶性食道肿瘤会发展成癌症,据《临床医师癌症杂志(CA)》发布,我国每年约有48万新增食管癌病例,37万例食管癌患者死亡。
![](https://p0.ssl.img.360kuai.com/t01f1be76d6b7e0d9ab.jpg)
呼吸道疾病也会间接影响人体进食,引发噎食、呛咳。
如咽喉炎、扁桃体炎、喉癌或喉间质肉瘤,常常会因咽喉肿胀,压迫食管,导致吞咽困难。
![](https://p0.ssl.img.360kuai.com/t014eb9cbdb9e433318.jpg)
当然,会厌先天发育异常、感染或创伤等也可能导致会厌囊肿,出现呼吸不畅、声音嘶哑、吞咽困难症状。
而除了咽喉肿胀压迫出来的,慢性阻塞性肺部疾病,比如哮喘、慢性支气管炎、肺气肿、支气管扩张症等,由于多发咳嗽、呼吸困难,也容易在吃饭喝水时呛到。
![](https://p0.ssl.img.360kuai.com/t0183e4b633862e39e2.jpg)
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大脑中枢性疾病,看似与进食问题无关。可一旦大脑发生病变,咽喉部的神经控制和肌肉协调出了问题,就很容易诱发噎食呛水。
![](https://p0.ssl.img.360kuai.com/t01a5fcbcff7e05381b.jpg)
据国际期刊《神经胃肠病学和运动学》统计,约20%-45%的脑卒中患者存在吞咽困难,这种症状被称为卒中后吞咽障碍(Stroke Dysphagia)。脑梗塞、脑出血、脑栓塞等脑卒中疾病,都可能出现频繁噎食呛咳,并伴有言语不清、声音嘶哑等表现。
此外,帕金森病也是中枢神经系统病变的一种,主要表现为躯体运动区功能受损,但也有超80%的患者伴随流口水、吞咽困难、便秘等消化道症状。
![](https://p0.ssl.img.360kuai.com/t01fcd6f4b18b29a014.jpg)
噎食、呛水有时并不是咽喉部本身或周围神经有毛病,而是上方的口腔问题“堵”住了食物与水下行。
比如口腔溃疡、牙龈炎、口腔手术留创,都可致口腔组织肿胀疼痛,甚至威胁口腔内神经感知和控制,从而影响咀嚼和吞咽。
![](https://p0.ssl.img.360kuai.com/t012c0e07ad0c754abe.jpg)
![](https://p0.ssl.img.360kuai.com/t0157fcc9f55c8d9333.jpg)
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工欲善其事,必先利其器。想要喝水不呛到,首先要挑对水杯。
习惯喝水哐哐往嘴里倒的人,建议选用带吸管的水杯,这样就能小口小口喝了。但口腔肌肉退化、吞咽控制差的老人,最好避免用吸管杯,应选择长嘴茶杯或U型水杯,既可控制饮水量,又可降低仰头饮水造成呛咳的风险。
![](https://p0.ssl.img.360kuai.com/t01e56278061cafa239.jpg)
另外,喝水水温最好不要超过40℃,多次慢喝为佳,而生气时、刚运动完不宜马上饮水。
![](https://p0.ssl.img.360kuai.com/t01dde998315e5beb7c.jpg)
果冻、坚果、麻花、糖果等小零食,吃的时候易被碎渣卡住,甚至整个噎住;带核水果(龙眼、樱桃、葡萄等)吃太快也可能被果核卡喉。
![](https://p0.ssl.img.360kuai.com/t015a0819cd1f270451.jpg)
吃一些难嚼食物也不能粗心大意,如人们常吃的芹菜、豆芽、韭菜,都是粗纤维蔬菜,很难嚼烂,吃得太快容易卡在食道。此外,吃大肉块时也最好切丁,水煮蛋不要整个吞掉。
长面条、年糕、汤圆、花生酱等食物虽然不难嚼,但也可能糊住喉咙,导致呼吸困难。
![](https://p0.ssl.img.360kuai.com/t01a3bdc5e4e0186afd.jpg)
另外,吃饭时最好保持安静,减少交谈与大笑,防止会厌下落不及时,使异物进入气管。
![](https://p0.ssl.img.360kuai.com/t013a9d51e0099b3ab3.jpg)
若发现自己有吞咽困难症状,除了及时排查有无其他疾病症状外,平时可多做吞咽训练,有意识地锻炼吞咽功能,如:
![](https://p0.ssl.img.360kuai.com/t0136a32994760e1ff7.jpg)
![](https://p0.ssl.img.360kuai.com/t01c237f8c23581fec8.jpg)
不慎呛食,严重可能5-10分钟致死。因此,只有掌握急救技巧,才能在黄金期挽救生命。
![](https://p0.ssl.img.360kuai.com/t01fb0fa636d9e47f04.jpg)
如以上方法都无效,应尽快拨打120急救电话,送院处理。
生命安全无小事,小小呛食、噎食需警惕。你是否经历过噎食、呛水的“生死一瞬”,欢迎在评论区留言分享下你的经验!
参考资料:
[1]. 孙文澜. 吃饭防噎生死相关的急救知识[J]. 健康博览, 2022, (11):17-19.
[2]. 王贞慧. 过年吃大餐,防噎要做好[J]. 保健医苑, 2022, (2):18-20.
[3]. 董桂银.选对杯子,老人少呛咳[J].家庭医药·快乐养生,2022,(5):54.
[4]. 莫鹏. 老年人总噎食查查食管[J]. 保健与生活, 2021, (15):19.
[5]. 唐煜明.六类食物处理后才能给孩子老人吃[J].康复,2020,(9):40.
[6]. 莫鹏. 揪出“祸端”防老人噎食[J]. 饮食与健康(下旬刊), 2019, (11)
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