# 一位病人在接受開腹結腸切除術後第1天。請檢視腸道功能趨勢並回答問題。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393506&lang=zh-tw  
> language: zh-TW  
> subject: Reduction of Risk Potential  
> category: ROR

## 題目

一位病人在接受開腹結腸切除術後第1天。請檢視腸道功能趨勢並回答問題。

| Time | Data |
| --- | --- |
| Post-op day 1 | 四個腹部象限皆無腸音。NG 抽吸引流膽汁樣液體 250 mL/8h。未排氣。以 PCA morphine 控制疼痛。 |
| Post-op day 2 | 腸音低下。NG 引流 180 mL/8h。尚未排氣。病人在協助下行走 2 次。 |
| Post-op day 3 | 四個腹部象限皆有活躍腸音。今早已排氣。NG 引流 80 mL/8h。可耐受冰片。 |
| Post-op day 4 | 腸音活躍。多次排氣。NG 已移除。可耐受清流質且無噁心。 |

Q1. 這個趨勢顯示什麼？

術後腸麻痺如預期逐漸恢復
腸麻痺惡化，需要再次手術探查
急性小腸阻塞
吻合處滲漏

Q2. 哪一組介入最能支持持續恢復？

嚴格臥床休息，只使用 IV opioid，NG tube 維持高負壓抽吸
早期漸進式下床活動、以多模式止痛減少 opioid、咀嚼口香糖作為 sham feeding、排氣恢復後移除 NG 並逐步進食
術後第 1 天開始積極灌腸和瀉劑
持續 opioid 輸注，讓病人舒適且保持不動

## 解析

該趨勢顯示預期的術後腸阻塞緩解情況：腸蠕動音在第2天恢復，第3天排氣，第4天開始進食清澈液體。優先護理措施：早期下床活動（對於腸阻塞緩解最具實證基礎的單一措施）、嚼口香糖（假飼刺激蠕動）、使用多模式止痛以減少鴉片類藥物使用、待排氣及腸道功能恢復後逐步進食。在腸阻塞緩解後仍持續鼻胃管抽吸會延遲恢復。

## 深入解析

大腸手術後~3日為正常；之後為延遲。3要素：早期下床、多模式止痛、嚼口香糖。

## 臨床情境

**開腹結腸切除術後第1日**。NG低壓間歇抽吸。Morphine PCA。評估腸功能恢復。

## 重要概念

- **術後腸阻塞** — 術後暫時性腸蠕動受損；大腸術3日內為預期。
- **偽進食(嚼口香糖)** — 刺激頭部-迷走神經期；縮短術後腸阻塞時間。
- **多模式止痛** — 以acetaminophen、NSAID、局部麻醉減少類鴉片負擔。

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