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首页> 外文期刊>The Journal of trauma >Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?
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Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?

机译：针头胸腔切开术治疗创伤性患者的张力性气胸：什么尺寸的针头？

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BACKGROUND: A tension pneumothorax requires immediate decompression using a needle thoracostomy. According to advanced trauma life support guidelines this procedure is performed in the second intercostal space (ICS) in the midclavicular line (MCL), using a 4.5-cm (2-inch) catheter (5-cm needle). Previous studies have shown a failure rate of up to 40% using this technique. Case reports have suggested that this high failure rate could be because of insufficient length of the needle. OBJECTIVES: To analyze the average chest wall thickness (CWT) at the second ICS in the MCL in a trauma population and to evaluate the length of the needle used in needle thoracostomy for emergency decompression of tension pneumothoraces. METHODS: Retrospective review of major trauma admissions (Injury Severity Score >12) at the Foothills Medical Centre in Calgary, Canada, who underwent a computed tomography chest scan admitted in the period from October 2001 until March 2004. Subgroup analysis on men and women, <40 years of age and >/=40 years of age was defined a priori. CWT was measured to the nearest 0.01 cm at the second ICS in the MCL. RESULTS: The mean CWT in the 604 male patients and 170 female patients studied averaged 3.50 cm at the left second ICS MCL and 3.51 cm on the right. The mean CWT was significantly higher for women than men (p < 0.0001). About 9.9% to 19.3% of the men had a CWT >4.5 cm and 24.1% to 35.4% of the women studied. CONCLUSIONS: A catheter length of 4.5 cm may not penetrate the chest wall of a substantial amount (9.9%-35.4%) of the population, depending on age and gender. This study demonstrates the need for a variable needle length for relief of a tension pneumothorax in certain population groups to improve effectiveness of needle thoracostomy.
机译：背景：张力性气胸需要立即使用胸廓切开术减压。根据高级创伤生命支持指南，该过程在锁骨中线（MCL）的第二肋间隙（ICS）中使用4.5厘米（2英寸）导管（5厘米针头）进行。先前的研究表明，使用这种技术的失败率高达40％。病例报告表明，这种高故障率可能是由于针头长度不足所致。目的：分析创伤人群中MCL中第二个ICS的平均胸壁厚度（CWT），并评估用于紧急胸腔减压气胸减压的针头胸腔切开术中使用的针头长度。方法：回顾性回顾加拿大卡尔加里山麓医学中心的重大创伤入院（损伤严重度评分> 12），他们在2001年10月至2004年3月期间接受了计算机断层扫描胸部扫描。男性和女性的亚组分析先定义<40岁和> / = 40岁。在MCL中的第二个ICS处测得的CWT最接近0.01厘米。结果：研究的604名男性患者和170名女性患者的平均CWT在左第二ICS MCL处平均为3.50 cm，在右方为3.51 cm。女性的平均CWT明显高于男性（p <0.0001）。约9.9％至19.3％的男性CWT> 4.5厘米，而研究的女性为24.1％至35.4％。结论：视年龄和性别而定，4.5 cm的导管长度可能无法穿透大量人群（9.9％-35.4％）的胸壁。这项研究表明，在某些人群中需要使用可变长度的针头来缓解张力性气胸，以提高针头胸腔造口术的有效性。

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