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✓ 正解動脈阻塞或血腫壓迫遠端肢體之血流
- 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與術後卧床休息相關之深層靜脈血栓形成 (DVT)
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（C 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。臨床思路：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。
Diminished distal pulses, pallor, and coolness following femoral artery catheterization indicate arterial occlusion or hematoma compression, compromising blood flow to the limb. This presents as acute peripheral ischemia, often characterized by the '5 Ps' (pulselessness, pallor, poikilothermia, paresthesia, and pain), requiring immediate notification of the provider.
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。