護理師照護一位髖關節置換術後病人，哪項護理措施能最有效地降低深層靜脈栓塞（DVT）風險？
A nurse is caring for a client who is post-operative following a hip arthroplasty. Which action by the nurse most effectively reduces the risk of deep vein thrombosis?
- AApply warm compresses to the lower legs在下肢應用熱敷
- BMaintain bed rest for 48 hours維持卧床休息48小時
- CMassage the lower extremities to improve circulation按摩下肢以促進循環
- DEncourage early ambulation as prescribed✓ 正解依指示鼓勵早期下床活動
髖關節置換術後病人因手術創傷、長期臥床及血管內皮受損，是深層靜脈栓塞（DVT）的高危險群。根據 Virchow's triad（血液淤滯、血管壁損傷、血液高凝狀態），預防 DVT 的核心在於打破這三個致病因子。早期下床活動（Early ambulation）能透過小腿肌肉泵作用（Muscle pump），促進血液回流，防止深層靜脈血液淤滯，是目前公認最有效且符合成本效益的護理措施。其他選項如長期臥床會惡化血液淤滯；按摩下肢極可能導致已形成的血栓脫落引發肺栓塞（PE），屬禁忌動作；熱敷對預防栓塞並無實證支持。
Clients undergoing hip arthroplasty are at high risk for deep vein thrombosis (DVT) due to surgical trauma, prolonged immobility, and vascular endothelial injury. According to Virchow's triad (venous stasis, vessel wall injury, and hypercoagulability), DVT prevention focuses on breaking these three contributing factors. Early ambulation uses the calf muscle pump to promote venous return and prevent deep venous stasis, and is currently the most effective and cost-effective nursing intervention. Prolonged bed rest, by contrast, worsens venous stasis; massaging the lower extremities may dislodge an existing thrombus and cause pulmonary embolism (PE) and is contraindicated; and warm compresses have no proven role in preventing thromboembolism.
台美臨床在術後復健觀念已趨一致，皆強調「加速康復外科」（ERAS）概念，鼓勵儘早下床。但在美國，術後會更積極結合機械性預防（如 SCDs 氣壓式循環輔助器）與藥物預防（如低分子量肝素 LMWH）。