一位 40 歲女性於全甲狀腺切除術後第一天,護理師進行常規生命徵象評估。當為病人充氣血壓壓脈帶時,病人的手腕與手指突然痙攣並向內彎曲;病人並陳述「嘴唇周圍感覺麻木與刺痛」。依據上述臨床表現,護理師最可能懷疑哪一項電解質不平衡?
A 40-year-old female is on her first postoperative day after a total thyroidectomy. The nurse arrives to perform routine vital sign assessments. While inflating the blood pressure cuff on the client's upper arm, the client's wrist and fingers suddenly cramp and curl inwards. The client also reports, "The area around my lips feels numb and tingly." Based on these clinical manifestations, which electrolyte imbalance does the nurse most likely suspect?
- AHyperkalemia高血鉀
- BHypocalcemia related to inadvertent parathyroid gland injury or removal✓ 正解因意外損傷或切除副甲狀腺所致的低血鈣
- CHypercalcemia高血鈣
- DHyponatremia related to water intoxication因水中毒所致的低血鈉
本題評估甲狀腺切除術後常見的電解質併發症與相關臨床徵象。甲狀腺切除術中,位於甲狀腺背面的四顆副甲狀腺(parathyroid glands)可能因受損或被一併切除而導致副甲狀腺素(PTH)分泌不足,在術後數小時至數天內引發低血鈣(hypocalcemia)。鈣離子有穩定神經肌肉膜的作用,當血鈣下降時,神經肌肉興奮性增加,典型表現包括: (1)Trousseau's sign:血壓壓脈帶充氣加壓後出現腕部痙攣(carpal spasm); (2)Chvostek's sign:輕敲面神經處引起面部肌肉抽搐; (3)口周麻木與刺痛感(perioral paresthesia)。若進展嚴重,可能導致喉痙攣與呼吸窘迫,屬於緊急狀況。其他選項:高血鉀通常表現為心律不整與肌肉無力,無此特異性徵象;嚴重低血鈉以神經系統症狀(意識改變、癲癇發作)為主;高血鈣則表現為神經肌肉抑制(虛弱、嗜睡),與本題痙攣表現相反。
Hypocalcemia resulting from parathyroid injury increases neuromuscular excitability, which clinically presents as carpal spasms (Trousseau’s sign) when a blood pressure cuff is inflated. This immediate physiological response confirms the electrolyte imbalance rather than delayed signs like weight changes.
「甲狀腺切除 = 弄破副甲狀腺 = 導致缺點解鈣 = 打血壓帶手抽搐 (Trousseau) 與敲臉皮亂跳 (Chvostek)」。世界各地的內外科學基礎永遠把這套邏輯當作連鎖送分神題。