The Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara-City, Kanagawa 259-1193, Japan.
Injury. 2012 Jan;43(1):42-5. doi: 10.1016/j.injury.2010.11.022. Epub 2010 Dec 24.
Previous studies reported a high failure rate in relieving tension pneumothorax by needle thoracostomy, because the catheter was not sufficiently long to access the pleural space. The Advanced Trauma Life Support guideline recommends needle thoracostomy at the second intercostal space in the middle clavicular line using a 5.0-cm catheter, whereas the corresponding guideline in Japan does not mention a catheter length. It is necessary to measure the chest wall thickness (CWT) and determine the appropriate catheter length taking the differences of habitus in race and region into consideration. This study was designed to analyse CWT in Japanese trauma patients by computed tomography and to determine the percentage of patients whose pleural space would be accessible using a 5.0-cm catheter.
We performed a retrospective review of chest computed tomography of 256 adult Japanese trauma patients who were admitted to the level 1 trauma centre of Tokai University Hospital in Kanagawa, Japan between January and July 2008. In 256 patients, the CWT at 512 sites (left and right sides) was measured by chest computed tomography at the second intercostal space in the middle clavicular line. The frequency of measurement sites <5.0 cm was calculated simultaneously. The samples were divided according to gender, side (left and right), abbreviated injury scale (<3, ≧3), arm position during examination (up/down), and the existence or non-existence of associated injuries (pneumothorax, subcutaneous emphysema, and fracture of the sternum and ribs); the CWT of each group was compared.
The mean CWT measured in 192 males and 64 females was 3.06±1.02 cm. The CWT values at 483 sites (94.3%) were less than 5.0 cm. The CWT of females was significantly greater than that of males (3.66 cm vs. 2.85 cm, p<0.0001), and patients with subcutaneous emphysema had greater CWTs than those without it (4.16 cm vs. 3.01 cm, p<0.0001).
The mean CWT at the second intercostal space in the middle clavicular line was 3.06 cm. It is likely that over 94% of Japanese trauma patients could be treated with a 5.0-cm catheter.
先前的研究报告称，通过针式胸腔穿刺术缓解张力性气胸的失败率很高，因为导管不够长无法进入胸膜腔。高级创伤生命支持指南建议在中锁骨线的第二肋间隙使用 5.0 厘米长的导管进行针式胸腔穿刺术，而日本的相应指南并未提及导管长度。有必要测量胸壁厚度 (CWT)，并考虑种族和地区习惯的差异，确定使用 5.0 厘米长导管可触及的患者比例。本研究旨在通过计算机断层扫描分析日本创伤患者的 CWT，并确定使用 5.0 厘米长导管可触及胸膜腔的患者比例。
我们对 2008 年 1 月至 7 月期间入住日本神奈川县东海大学医院 1 级创伤中心的 256 例成年日本创伤患者的胸部计算机断层扫描进行了回顾性分析。在 256 例患者中，通过中锁骨线第二肋间隙的胸部计算机断层扫描测量了 512 个部位（左侧和右侧）的 CWT。同时计算了测量部位<5.0 厘米的频率。根据性别、侧别（左侧和右侧）、损伤严重程度评分（<3、≧3）、检查时手臂位置（上/下）以及是否存在合并损伤（气胸、皮下气肿和胸骨肋骨骨折）对样本进行分组；比较了每组的 CWT。
192 名男性和 64 名女性的平均 CWT 为 3.06±1.02 厘米。483 个部位（94.3%）的 CWT 值<5.0 厘米。女性的 CWT 明显大于男性（3.66 厘米比 2.85 厘米，p<0.0001），有皮下气肿的患者 CWT 大于无皮下气肿的患者（4.16 厘米比 3.01 厘米，p<0.0001）。
中锁骨线第二肋间隙的平均 CWT 为 3.06 厘米。日本创伤患者中，超过 94%的患者可能需要使用 5.0 厘米长的导管进行治疗。
