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因意外損傷或切除副甲狀腺所致的低血鈣正確答案
- CHypercalcemia高血鈣
- DHyponatremia related to water intoxication因水中毒所致的低血鈉
- B因意外損傷或切除副甲狀腺所致的低血鈣
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。
- A高血鉀
高血鉀以心律不整與全身性肌肉無力為主要表現,並不會出現由血壓壓脈帶誘發的特異性腕部痙攣。
- B · 正確答案因意外損傷或切除副甲狀腺所致的低血鈣
甲狀腺切除術中若副甲狀腺受損或被一併切除,會導致術後低血鈣。低血鈣使神經肌肉興奮性升高,表現為 Trousseau's sign 陽性(腕部痙攣)與口周刺痛,符合本病人臨床表現,故為正解。
- C高血鈣
高血鈣降低神經肌肉興奮性,通常導致肌肉無力與嗜睡,與本題的肌肉痙攣表現相反。
- D因水中毒所致的低血鈉
嚴重低血鈉造成腦細胞水腫,主要表現為意識改變或癲癇發作,而非由血壓壓脈帶誘發的局部腕部痙攣。
「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。
English explanation
Option B is correct because inadvertent injury to or removal of the four parathyroid glands during thyroidectomy can reduce parathyroid hormone secretion and cause hypocalcemia within hours to days after surgery. Calcium stabilizes neuromuscular membranes, so reduced calcium increases neuromuscular excitability. Wrist and finger cramping during blood pressure cuff inflation is Trousseau's sign, while numbness and tingling around the lips are perioral paresthesia; both are characteristic findings of hypocalcemia. Chvostek's sign, facial muscle twitching after tapping over the facial nerve, is another typical finding. Severe progression can cause laryngospasm and respiratory distress and is an emergency. Option A is incorrect because hyperkalemia usually causes cardiac dysrhythmias and muscle weakness rather than these specific signs. Option C is incorrect because hypercalcemia causes neuromuscular suppression, including weakness and drowsiness, which is opposite to the observed spasms. Option D is incorrect because severe hyponatremia primarily causes neurologic manifestations such as altered consciousness and seizures.
最近修訂：2026-08-27