一位 55 歲男性在以右側股動脈為入路的緊急心導管手術（PCI）後返回心臟降階病房。護理師執行術後每 15 分鐘的周邊循環評估時，發現右側足背動脈脈搏明顯減弱、右下肢皮膚冰冷且蒼白，左側足背動脈脈搏正常。這些發現最可能代表哪一項併發症？
A 55-year-old male returns to the cardiac step-down unit after an emergency cardiac catheterization (percutaneous coronary intervention, PCI) using the right femoral artery as the access site. During the routine 15-minute post-procedure peripheral assessment, the nurse palpates a markedly diminished dorsalis pedis pulse on the right foot compared with a strong pulse on the left, along with coolness and pallor of the right lower extremity. Which complication do these findings most likely indicate?
- ASystemic sepsis from contamination of the catheter equipment因導管設備污染引起之全身性敗血症
- BArterial occlusion or hematoma compressing arterial flow to the distal limb動脈阻塞或血腫壓迫遠端肢體之血流正確答案
- CNormal vasoconstriction caused by local anesthetic at the groin puncture site由鼠蹊部穿刺點局部麻醉引起之正常血管收縮
- DDeep vein thrombosis (DVT) related to post-procedure bed rest與術後臥床休息相關之深層靜脈血栓形成 (DVT)
- B動脈阻塞或血腫壓迫遠端肢體之血流
心導管術後（Post-cardiac catheterization）的關鍵併發症為穿刺處出血、血腫（Hematoma）壓迫，或斑塊／血栓脫落造成動脈阻塞（Arterial occlusion）。當股動脈血流受阻時，遠端肢體灌流不足，會出現典型的『5P 徵象』：脈搏減弱或消失（Pulselessness）、蒼白（Pallor）、冰冷（Poikilothermia/Coolness）、感覺異常（Paresthesia）與疼痛（Pain）。本題病人單側遠端脈搏減弱、皮膚蒼白冰冷，且與健側脈搏不對稱，是急性周邊動脈缺血的典型表現，必須立即通知醫師處理（B 為正解）。 選項 C 錯誤，局部麻醉不會造成單側遠端肢體蒼白冰冷且脈搏減弱，這已超出正常生理反應範圍。選項 D 錯誤，深部靜脈栓塞（DVT）的典型表現為患肢腫脹、發紅、發熱與疼痛，是靜脈回流受阻的表現，與動脈缺血的蒼白冰冷無脈完全相反。選項 A 錯誤，全身性敗血症會引起發燒、低血壓與全身性的灌流不足，無法解釋孤立性的單側遠端脈搏減弱。臨床推理：護理師發現此情況應立即通知醫師、評估穿刺部位有無血腫或出血、並記錄遠端脈搏品質與時間。
- A因導管設備污染引起之全身性敗血症
全身性敗血症會出現發燒、低血壓與全身灌流不足，無法解釋孤立的單側遠端脈搏喪失，並非此情境的最可能診斷。
- B · 正確答案動脈阻塞或血腫壓迫遠端肢體之血流
股動脈插管後出現遠端脈搏減弱、肢體蒼白與冰冷，提示動脈阻塞或血腫壓迫遠端血流，是術後急性肢體缺血的典型徵象，需立即通知醫師。
- C由鼠蹊部穿刺點局部麻醉引起之正常血管收縮
局部麻醉不會造成單側肢體蒼白、冰冷與遠端脈搏減弱，這些屬於動脈灌流不足的徵象，不能視為正常反應。
- D與術後臥床休息相關之深層靜脈血栓形成 (DVT)
DVT 是靜脈回流受阻，典型表現為肢體腫脹、發紅、發熱與壓痛，與動脈缺血的蒼白冰冷無脈完全相反。
心臟科黃金鐵律：心導管做完後，每 15 分鐘的焦點絕對不是只看鼠蹊部有沒有流血，而是一定要去對稱性地觸摸「遠端足背動脈脈搏 (Pedal pulse)」以防止發生恐怖的動脈血管死鎖。全宇宙適用。
English explanation
Option B is correct because a markedly diminished distal pulse with pallor and coolness in the accessed leg indicates acute peripheral arterial ischemia from arterial occlusion or a hematoma compressing femoral arterial flow. Obstructed flow after cardiac catheterization may result from puncture-site bleeding or hematoma compression, or from dislodged plaque or thrombus. Characteristic findings include a weak or absent pulse, pallor, coolness, paresthesia, and pain. The unilateral pulse difference from the unaffected leg makes this an emergency requiring immediate physician notification, assessment of the puncture site for bleeding or hematoma, and documentation of distal pulse quality and timing. Option C is incorrect because local anesthesia does not explain unilateral distal pallor, coolness, and a diminished pulse. Option D is incorrect because deep vein thrombosis typically causes swelling, redness, warmth, and pain from impaired venous return, not the pale, cool arterial pattern. Option A is incorrect because systemic sepsis causes fever, hypotension, and generalized poor perfusion rather than an isolated unilateral decrease in a distal pulse.
最近修訂：2026-10-05