Britten S, Palmer S H, Snow T M
Department of Orthopaedic Surgery, Royal United Hospital, Bath, UK.
Injury. 1996 Jun;27(5):321-2. doi: 10.1016/0020-1383(96)00007-1.
Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). In thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm, the minimum recommended cannula length, although in only two (4 per cent) was it greater than 4.5 cm, the length of cannula commonly used in the UK. As a 3 cm cannula would fail to reach the pleural cavity in over half of patients, we suggest that the recommended shortest length be increased to 4.5 cm. Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.
高级创伤生命支持指南建议使用长度为3至6厘米的套管针进行紧急胸腔穿刺术，以治疗危及生命的张力性气胸。通过超声测量了54名年龄在18至55岁之间患者在锁骨中线第二肋间的胸壁厚度，范围为1.3至5.2厘米（平均3.2厘米）。在31名患者（57%）中，胸壁厚度（CWT）大于3厘米，即推荐的套管针最短长度，尽管只有两名患者（4%）的胸壁厚度大于4.5厘米，而4.5厘米是英国常用的套管针长度。由于在超过半数的患者中，3厘米长的套管针无法到达胸膜腔，我们建议将推荐的最短长度增加到4.5厘米。使用4.5厘米套管针进行胸腔穿刺术失败后，应立即插入更长的套管针或进行确定性胸腔引流。
