# 24歲病人因右側脛骨中段閉鎖性骨折入院並於6小時前裝置玻璃纖維長腿石膏。護理師連續記錄右下肢神經血管評估。請檢視趨勢並回答問題。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393496&lang=zh-tw  
> language: zh-TW  
> subject: Reduction of Risk Potential  
> category: ROR

## 題目

24歲病人因右側脛骨中段閉鎖性骨折入院並於6小時前裝置玻璃纖維長腿石膏。護理師連續記錄右下肢神經血管評估。請檢視趨勢並回答問題。

| Time | Data |
| --- | --- |
| 06:00 (cast applied) | 疼痛 4/10，遠端脈搏 2+，微血管回填

## 解析

趨勢顯示急性腔室症候群之經典6 Ps：漸進性疼痛(不成比例、嗎啡類無效)、壓力(腔室緊繃)、異常感覺、蒼白、隨後脈搏消失、癱瘓。行動：床邊立即剖開或移除石膏、抬高至心臟水平(切勿高於心臟 — 降低動脈血流)、保持中立位、即刻通知骨科醫師評估筋膜切開。腔室壓力>30 mmHg或delta壓力(DBP − 腔室壓)<30 mmHg確診。筋膜切開時機決定肌肉存活率。

## 深入解析

腔室症候群為NCLEX外傷經典陷阱。最具診斷性之表現為「相對於損傷不成比例之疼痛，嗎啡類無法緩解」 — 遠比晚期表現(脈搏消失、癱瘓)重要(後者意味不可逆損傷)。可疑肢體絕不可抬至高於心臟 — 加重缺血。

## 臨床情境

**24歲右脛骨中段閉鎖性骨折**；長腿玻璃纖維石膏**於6小時前裝置**。每小時神經血管評估記錄。即使按時給予hydromorphone疼痛仍升級。

## 重要概念

- **急性腔室症候群** — 閉鎖肌肉腔室內壓上升致灌流受損；外科急症。
- **6 Ps** — Pain(不成比例)、Pressure、Paresthesia、Pallor、Pulselessness、Paralysis — 早期Ps驅動診斷。
- **筋膜切開術** — 切開筋膜以解除腔室壓力；理想時機為症狀出現後6小時內。

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