胸壁厚度测定对战现场张力性气胸穿刺减压的意义研究

Significance of chest wall thickness measurement to the needle decompression of tension pneumothorax on the battlefield

目的对某部官兵胸壁厚度进行测量,以提高目前战现场胸腔穿刺减压救治张力性气胸成功率和降低意外损伤风险。方法测量某部480名官兵身高和体重,通过胸部CT测量左右第2肋间锁骨中线、第4肋间腋前线和第5肋间腋前线6个部位的胸壁厚度。结果第2肋间锁骨中线胸壁厚度为(3.48±0.83)cm,第4肋间腋前线胸壁厚度为(2.73±0.69)cm,第5肋间腋前线胸壁厚度为(2.39±0.64)cm。胸壁厚度超过5.0 cm的情况,左侧第2肋间锁骨中线占7.3%,右侧第2肋间锁骨中线占5.6%,右侧第4肋间腋前线占1.8%。女性较男性胸壁厚,差异有统计学意义(P<0.05)。胸壁厚度与体重指数呈正相关性(P<0.05)。结论目前使用的套管针进行穿刺,成功率能够保证,但损伤风险也较大,特别是在左侧气胸时。本研究结果需要在出现张力性气胸的患者中得到验证。

Objective To measure chest wall thickness(CWT),with a view to increase the success rate of tension pneumothorax by needle decompression on the battlefield and reduce the risk of accidental injury.Methods Measurement of height and weight was made in the 480 military personnel.Chest CT was used to measure CWT at the the second intercostal space‐midclavicular line(ICS2‐MCL)and the fourth and fifth intercostal space‐anterior axillary line(ICS4/5‐AAL)on both the right and left sides.Re⁃sults The CWT measured at the ICS2‐MCL was(3.48±0.83)cm,the CWT measured at the ICS4‐AAL was(2.73±0.69)cm,and the CWT measured at the ICS5‐AAL was(2.39±0.64)cm.The CWT greater than 5 cm was at the ICS2‐MCL on the left(7.3%),at ICS2‐MCL on the right(5.6%),and at the ICS4‐AAL on the right(1.9%).The CWT of the female was thicker than that of the male(P<0.05).The CWT was positively correlated with body mass index(P<0.05).Conclusion Puncture with current needles could achieve relatively high success rate,but with high risk of injury,especially in left pneumothorax.The results of this study require further validation in patients with tension pneumothorax.