一位45歲女性前來急診室時跛行著。她在經歷了一場令人精疲力竭且擁擠的 14 小時國際航班後，抱怨有嚴重的右小腿痛。護理師主動觀察個案的右腿。哪一組教科書級的臨床評估發現具體指示了極度深嵌的深部靜脈栓塞（DVT）的高風險潛力？而在現代，哪一項過時的手動評估手法現在被嚴格視為絕對禁忌？
A 45-year-old female presents to the emergency department limping, complaining of severe right calf pain after completing a grueling 14-hour cramped international flight. The nurse actively observes the client's right leg. Which set of textbook clinical assessment findings specifically indicates a high-risk potential for a deeply lodged Deep Vein Thrombosis (DVT), and which outdated manual assessment maneuver is now strictly contraindicated?
- ATingling, burning needle-like neuropathic pain shooting down both feet equally; contraindicated: Directly applying a tightly sealed warm compress.雙腳均勻出現刺痛、灼熱感及針刺樣神經病變疼痛；禁忌：直接敷貼緊密封閉的熱敷包
- BBilateral leg paleness with profound foot coldness; contraindicated: Performing vigorous deep deep-tissue massage on both calves.雙腿蒼白且足部極度冰冷；禁忌：對雙側小腿進行劇烈的深層組織按摩
- CUnilateral calf swelling (edema), localized warmth, and prominent erythema; contraindicated: Forcibly performing Homan's sign (dorsiflexing the foot).單側小腿腫脹（水腫）、局部發熱及明顯紅斑；禁忌：強制執行霍曼氏徵象（足背屈）正確答案
- DPulsating calf bruises combined with a complete loss of the pedal pulse; contraindicated: Elevating the affected leg relentlessly above the heart.搏動性小腿瘀斑伴隨足背脈搏完全消失；禁忌：持續將患肢抬高超過心臟水平
- C單側小腿腫脹（水腫）、局部發熱及明顯紅斑；禁忌：強制執行霍曼氏徵象（足背屈）
本題測驗深層靜脈栓塞（DVT）的臨床評估重點，以及已被淘汰的評估手法。長時間久坐不動使下肢靜脈血流滯留，血栓多形成於單側小腿深層靜脈；靜脈回流受阻使血液與組織液積滯患肢，形成教科書級的「單側」腫脹水腫（unilateral swelling）、局部發炎造成的熱感（warmth）與發紅（erythema），正是選項C的描述，故C為正解。至於Homans徵象（用力將腳板背屈以誘發小腿疼痛），現行臨床已不再使用，主因是其敏感度與特異度都過低：陽性不足以確診，陰性也無法排除DVT；此外對患肢施力（用力背屈、按摩擠壓）亦有使血栓鬆脫之疑慮。DVT的確診應依賴加壓式靜脈超音波，並配合D-dimer與Wells評分。確診後在有效抗凝之下應鼓勵早期下床活動，不需長期臥床。選項B的雙側蒼白合併足部冰冷屬動脈灌流不足；選項A的雙足對稱針刺灼熱感屬周邊神經病變；選項D的搏動性瘀血合併足背脈搏完全消失屬動脈損傷表現，皆非DVT。
- A雙腳均勻出現刺痛、灼熱感及針刺樣神經病變疼痛；禁忌：直接敷貼緊密封閉的熱敷包
神經病變性的刺痛與灼熱感強烈指向系統性糖尿病神經損傷，這與靜脈血栓物理上阻塞所引發的痠痛腫脹形成強烈對比。
- B雙腿蒼白且足部極度冰冷；禁忌：對雙側小腿進行劇烈的深層組織按摩
冰冷、蒼白的四肢明顯標記的是毀滅性的周邊『動脈』阻塞，這讓肢體缺氧，與靜脈阻塞所帶來發燙、積水且紅腫的症狀恰好相反。
- C · 正確答案單側小腿腫脹（水腫）、局部發熱及明顯紅斑；禁忌：強制執行霍曼氏徵象（足背屈）
被深深塞住的腿部靜脈阻擋了靜脈回流，獨特地引起孤立的單側發紅、發熱與腫脹。霍曼氏徵象被嚴格禁止，因為強行拉伸腫脹的肌肉會暴力地讓血塊脫落衝進肺部。
- D搏動性小腿瘀斑伴隨足背脈搏完全消失；禁忌：持續將患肢抬高超過心臟水平
失去足背脈搏是完整的動脈供應衰竭之另一項特徵，而非靜脈引流衰竭。抬高 DVT 患肢實際上通常是被鼓勵的，而非禁止。
「廢除 Homan's Sign」是過去十幾年來全球醫護界共通的最強烈心臟血管指引。只要看到選項有「折腿 (Dorsiflexion)」或「幫單側腫脹處按摩揉一揉(Massage)」，這絕對是害死病人的陷阱，直接劃掉。
English explanation
This question tests recognition of DVT and the contraindicated assessment maneuver. DVT typically occurs in one lower extremity (immobility is a major risk factor). Because the deep vein is obstructed, blood pools in the affected limb, producing unilateral swelling (edema), localized warmth, and erythema. The key goal is to prevent pulmonary embolism by not dislodging the clot. Homan's sign (forcibly dorsiflexing the foot to elicit calf pain) is contraindicated because the physical compression of the calf can dislodge the clot and cause a fatal pulmonary embolism. Option B's bilateral pale/cold limbs describes arterial occlusion; option A describes neuropathic pain (e.g., diabetic neuropathy).
最近修訂：2026-05-16