Pneumothorax
Pneumothorax caused by improper acupuncture, acupuncture is the most common accidents, one of the physical damage, it is accounted for the first incidence. In China ancient medical borrow in this many records. Such as those on the symptoms of pneumothorax, “Su asked ban on gill” pointed out: “thorn Quepen in retraction, air vent, it Keni. …… Assassination re stuck in the lungs, as Keni Yang annum. …… Thorn armpit threat between retraction, people cough. “” Universal Relief “also said:” In the chest of various points can not hurt, hurt that it is boring to. ” Pneumothorax, such as severe injury or disposed of improperly, often cause serious consequences. Therefore, “Su asked seasons from thorn inverse theory” are: “thorn internal organs …… died of lung three days,” said. Country from 1954 [1] first reported the accident sent a pneumothorax, a hundred cases have been reported so far. When the actual number is far more than this. Western countries and Japan, are also emerging such incidents. Although mild pneumothorax in common, but there are a considerable part of moderate to severe pneumothorax, including pneumothorax and fluid pneumothorax. According to statistics, at home and abroad due to pneumothorax number of cases of deaths accounted for 5.4% of the total number of cases. Shows that even under conditions of modern medical treatment, the mortality rate is also not low. Above, should arouse acupuncture practitioners are highly valued.
[Injury]
Needlestick injuries are caused by traumatic pneumothorax pneumothorax. It is a pathological process acupuncture needle puncture or cut too deep lung tissue, lung puncture caused by a large laceration, the lung pleura and alveolar damage, the gas from the break into the pleural cavity, lung tissue at break can form a valve, inhale, air enters the pleural cavity; exhale, the air can not be discharged, causing the product gas cavity, pleural cavity negative pressure disappears, lung retraction force in accordance with its collapse, the formation of pneumothorax. Resulting in rapid increase in intrathoracic pressure and lung collapse under pressure. With a similar incidence of spontaneous pneumothorax.
Needlestick injuries caused by pneumothorax, because of its degree of severity of injury, and the original disease, etc., are generally divided into two types of closed and hypertension. Such as rip little healthy lung tissue, mostly closed pneumothorax; such as severe injury or existing emphysema and other diseases who cracks forming unidirectional valve, high-pressure pneumothorax can occur. If punctured blood vessels can be combined pneumothorax. Few can pose serious open pneumothorax.
Improper why acupuncture pneumothorax, especially severe pneumothorax? It has been found, often clinically thoracentesis for some patients, in the lung tissue at the lower chest without the needle does not lead to pneumothorax, but there may be complicated by lung disease at the puncture, it is apparent that such pneumothorax is caused by a lung injury. However, only a small acupuncture needles stabbed lungs generally do not cause significant pneumothorax. Such as thoracotomy, sometimes careless handling can break lungs as a result, the lungs leaks stop soon, this is due to lung elastic tissue retraction at rapid closure of the stab it. So, in the end is what causes it? Caused severe pneumothorax acupuncture thoracotomy patients found not just stab damage the lungs, but a longer gap, gap formation, and may chest acupuncture needle penetration after the operation to change the direction of the needle , the greater the possibility is piercing the chest of the relationship between the tip and the lung surface displacement occurred with the breath of its cut, because the wound is large, large amounts of gas into the chest which caused severe pneumothorax. In addition, lesions in the lungs, on the basis of its existing injury, the more severe pneumothorax. Such as emphysema, due to its intra-alveolar pressure, coupled with poor lung tissue retraction force, once punctured, then the leak quickly faster to heal than normal lung tissue difficulties; If the patient has lung big bags, tip be punctured when it burst, with this as the needle through the balloon can burst phenomenon, may be formed at a big bag one-way valve, causing hypertensive pneumothorax; surgery is sometimes found that the visceral pleura and the wall laminin, adhesions traction on both sides of the lung tissue gap, so that cracks open, free access to the pleural cavity gas, forming open pneumothorax [2].
Causing pneumothorax, mostly lack of knowledge of anatomy and acupuncture for beginners. The specific reason the following aspects.
First, the point of reason: According to the anatomy, in the back of the tenth thoracic vertebra above, side chest above the ninth rib, chest seventh rib above, and supraclavicular fossa, the points on the edge of the sternal notch, may be due to improper acupuncture which led to pneumothorax. Therefore, the ancients had a “chest thin cake,” saying, warned non-deep puncture.
Public reports have occurred pneumothorax points are: days of the conflict, Dingchuan, a large loom, throttle, Feishu, Xinyu, Geshu diaphragm off, Gaohuangshu, shoulder Chen, H., possession of God, God seals, Cloud Gate, in government, big bag, Quepen, on the door, neck arms, shoulders well, Qu Yuan, soul door, Noir tendons.
Of particular note is that the realm of the lung and pleura in the upper thoracic apex above the first rib or more, while the lower right side is higher and the apex anteriorly, the inner end of the clavicle than sit immediately above the 1 ~ 3cm. Greater degree of lung lower edge of the float, medium exhale, perspective found that its activities under the front edge of the cartilage from the sixth starting out to milk the midline, with the seventh rib on the edge of the intersection, and finally inwards with eleven thoracic spinous process levels.
So, take the shoulder well, Quepen, neck shoulder and neck acupuncture arm, etc., even if the needle shallow pneumothorax may also occur. Meanwhile bile Yu, Yang Gang and other points, although the vertebrae in the back near eleven, but as a moderate degree of patient breathing, acupuncture too deep can damage the lungs.
Second, the pathological causes: lung lesions in state, primarily in the event of emphysema, lung volume increases, alveolar tension increased, not only easy to cause pneumothorax, the consequences are often severe. Manifested in the following aspects.
(A) involving acupuncture increased: emphysema, lung overexpansion, and even lung lower bound down, the volume increase of up to twice the normal diaphragmatic decline. At this point, acupuncture Danshu, spleen triple burner Yu, Shenshu the dove tail and upper abdomen, not, bearing full, etc., can lead to pneumothorax.
(Two), thorn Road shorter: emphysema, chest muscle atrophy, and the formation of barrel chest, resulting in shorter spines road, even at the regular size acupuncture, also tend to hurt the lungs.
(Three), difficult to heal rift: such patients, alveolar pressure, lung tissue elasticity is poor, once punctured not immediately healed cracks forming valve, rip open exhale, inhale rip off the air only which can not be discharged into the pleural cavity, resulting in pleural pressure was gradually increased, gradually compress the ipsilateral lung and even completely collapse.
(Four), compensatory function difference: lung lesions, due to compensatory function is poor, can aggravate pneumothorax syndromes. It was observed that, since the original formation of pulmonary heart disease has been dysfunction, often in the lung is compressed from 10 to 20%, can occur danger.
Third, the reason for the action
This is the most important reason, mainly including the following aspects.
(A), acupuncture too deep: Where in the back of the tenth thoracic vertebra, lateral chest in the ninth rib, anterior chest above the seventh rib, and the supraclavicular fossa, sternal notch on the edge of the points (including the shoulder well), if acupuncture too deep or direction is incorrect, there is likely to hurt the lungs. Especially for some old emaciated, emphysema and other chronic chest disease patients, chest and back in acupuncture should be particularly careful. First, lack of understanding of the anatomy of the chest depth. The determination of the anterior chest wall tissue thickness: above the nipple, adult 1.2 ~ 1.5cm, children 0.7 ~ 1.0cm; papilla, adult 0.8 ~ 1.0cm, children 0.5 ~ 0.8cm, lateral chest wall soft tissue thickness, about 0.6 adult ~ 0.8cm, children 0.5 ~ 0.7cm. Showed that compared with the anterior chest wall under the nipple nipples thin, lateral chest wall over the anterior chest wall is thin, and the child is more thinner than adults. If more than the depth, there is the risk of pneumothorax. Now on 15 adult male body measured from the bladder through the back surface of various points to the chest, abdominal wall distance, listed below.
As can be seen from the above table, the inside of the bladder through the back line from Feishu to shenshu between lateral line from the soul families to Chi room between the body wall are thin. The outer lines of each hole from the surface to the posterior wall of the abdominal cavity distance is more than the inside line of each corresponding hole is shorter. Therefore, in acupuncture should give full consideration to this point. In this table and Table two number noted there are some differences, but broadly similar for clinical reference purposes. )
Secondly, failed to grasp the good direction of the needle is also one of the causes of pneumothorax. Chest and back of the points obliquely or flat spines generally appropriate. To get a sense of satisfaction and efficacy of needle straight assassination more difficult to control the proper depth.
Finally, the needle charge when using hands, muscle layer thinning due to pressure, gill Road accordingly shorter. In addition, the application of warm needle chest and back may also be due to needle Jiayi cone, proficiency is not enough, only pay attention to fingertip force, to the neglect of this action can also be driven needle stabbing deep, causing pneumothorax.
(Two), needle too thick, way too heavy: the chest with needle acupuncture acupoints properly, can aggravate symptoms of pneumothorax, causing extensive subcutaneous emphysema and pneumomediastinum. Originally appropriate but OK acupuncture needle depth insertion provided significantly more than the depth of twisting, also can increase the chance of lung damage, the occurrence of pneumothorax.
(Three), improper posture: In the standing position, or other untenable position of the needle, prone to pneumothorax. This is because the position is difficult to fix, piercing needle body within the organization pulling in the muscle contraction activities also will be under, and lung damage.
(Four), after the needle tank: such as acupuncture has lung injury, this time cupping, often rapidly worse. This has been reported by many units, we have learned in this respect: one elderly patients with emphysema, I pin hole diaphragm shut after feeling chest discomfort, that is, in the hole pulling a cupping (needle plus cupping). Soon, the patient suddenly collapsed. The diagnosis of severe pneumothorax, rescue one week beginning of danger, in January after cured. In particular, after the needle still cupping pneumothorax caused delay occurs, such as a male patient, 56 years of age. Patients with asthma have been for 50 years, went to a hospital acupuncture, piercing in Trey Feishu 0.5 to 1 inch, the needle cupping 10min. Go to pot after the needle body has increased. After the needle sick to go home, about three o’clock, and suddenly palpitation, shortness of breath, chest tingling and sweating. Admission examination: The patient showed acute tolerance, left upper, middle breath sounds disappear, the left lung shu Department has 0.1 ~ 0.2cm Size of fresh bleeding scab spot, surrounded by tenderness. Left lung X-ray examination proved traumatic pneumothorax. Treatment: After oxygen rescue, empty needle extraction and use Yin lungs, lower gas modulating asthma medicine, hospital 51 days cured [3].
Fourth, can vary: patients with fat, thin, young and old, in others, such as acupuncture without distinction, with the same depth, but also an important reason for pneumothorax. Such as the elderly, the chest muscles developed, especially in thin old man, his trapezius, rhomboid muscle and shoulder muscles to mention there are different degrees of atrophy. In such cases, such as a conventional deep lungs can also be injured.