# 22歲脛骨骨折用長腿石膏,術後8小時鴉片無效疼痛加劇,被動伸足趾時加重。足趾蒼白且冷。優先處置?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375126&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PPT

## 題目

22歲脛骨骨折用長腿石膏,術後8小時鴉片無效疼痛加劇,被動伸足趾時加重。足趾蒼白且冷。優先處置?

## 選項

1. 通報醫師並準備緊急bivalve石膏與fasciotomy **✔ 正確答案**
2. 將腿抬高於心臟以減少水腫
3. 於患肢冰敷
4. 增加鴉片劑量並於1小時後再評估

**正確答案: 1**

## 解析

急性腔室症候群為骨科急症。早期核心徵象:疼痛超出傷情比例,被動伸展更痛。晚期(脈搏消失、癱瘓、蒼白)代表已發生缺血。腔室壓>30 mmHg或delta P(DBP-腔室壓)

## 深入解析

5P口訣:Pain(早期)、Paresthesia、Pallor、Paralysis、Pulselessness(晚期)。傷情不成比例的疼痛為最敏感早期徵象。

## 臨床情境

腔室壓42 mmHg。舒張壓76(delta P 34)。

## 重要概念

- **腔室症候群** — 筋膜腔室壓力上升致組織灌流受損。
- **Delta P** — 舒張壓減腔室壓 — 低於30 mmHg即腔室症候群。
- **筋膜切開術** — 切開筋膜以解除腔室壓 — 須於6小時內。

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