Section of Trauma and Acute Care Surgery, Department of Surgery, George Washington University, United States.
Injury. 2013 Sep;44(9):1183-5. doi: 10.1016/j.injury.2013.03.027. Epub 2013 Apr 23.
Needle thoracostomy is the emergent treatment for tension pneumothorax. This procedure is commonly done using a 4.5cm catheter, and the optimal site for chest wall puncture is controversial. We hypothesize that needle thoracostomy cannot be performed using this catheter length irrespective of the site chosen in either gender.
A retrospective review of all chest computed tomography (CT) scans obtained on trauma patients from January 1, 2011 to December 31, 2011 was performed. Patients aged 18 and 80 years were included and patients whose chest wall thickness exceeded the boundary of the images acquired were excluded. Chest wall thickness was measured at the 2nd intercostal (ICS), midclavicular line (MCL) and the 5th ICS, anterior axillary line (AAL). Injury severity score (ISS), chest wall thickness, and body mass index (BMI) were analyzed.
201 patients were included, 54% male. Average (SD) BMI was 26 (7)kg/m(2). The average chest wall thickness in the overall cohort was 4.08 (1.4)cm at the 2nd ICS/MCL and 4.55 (1.7)cm at the 5th ICS/AAL. 29% of the overall cohort (27 male and 32 female) had a chest wall thickness greater than 4.5cm at the 2nd ICS/MCL and 45% (54 male and 36 female) had a chest wall thickness greater than 4.5cm at the 5th ICS/AAL. There was no significant interaction between gender and chest wall thickness at either site. BMI was positively associated with chest wall thickness at both the 2nd and 5th ICS/AAL.
A 4.5cm catheter is inadequate for needle thoracostomy in most patients regardless of puncture site or gender.
胸腔针穿刺术是治疗张力性气胸的紧急治疗方法。该手术通常使用 4.5cm 导管进行，而胸壁穿刺的最佳部位存在争议。我们假设，无论选择哪种性别，使用这种导管长度都无法进行胸腔针穿刺术。
回顾性分析 2011 年 1 月 1 日至 2011 年 12 月 31 日期间所有在创伤患者中获得的胸部计算机断层扫描（CT）扫描。纳入年龄在 18 岁和 80 岁之间的患者，并排除了胸壁厚度超过所获取图像边界的患者。在第 2 肋间隙（ICS）、锁骨中线（MCL）和第 5 肋间隙前腋线（AAL）测量胸壁厚度。分析损伤严重程度评分（ISS）、胸壁厚度和体重指数（BMI）。
共纳入 201 例患者，其中 54%为男性。平均（SD）BMI 为 26（7）kg/m²。在整个队列中，平均胸壁厚度在第 2 ICS/MCL 为 4.08（1.4）cm，在第 5 ICS/AAL 为 4.55（1.7）cm。整个队列中有 29%（27 名男性和 32 名女性）的第 2 ICS/MCL 处的胸壁厚度大于 4.5cm，45%（54 名男性和 36 名女性）的第 5 ICS/AAL 处的胸壁厚度大于 4.5cm。在两个部位，性别与胸壁厚度之间均无显著交互作用。BMI 与第 2 和第 5 ICS/AAL 的胸壁厚度均呈正相关。
大多数患者无论穿刺部位或性别如何，4.5cm 导管都不足以进行胸腔针穿刺术。
