護理師在監測腿部骨折病人的腔室症候群。下列哪項是最具決定性的症狀？
The nurse is monitoring a client for compartment syndrome after a leg fracture. Which is the most definitive symptom?
- ASwelling of the extremity肢體腫脹
- BWeak distal pulses遠端脈搏微弱
- CPain that is unrelieved by opioids and increases with passive stretch✓ 正解鴉片類藥物無法緩解且在被動伸展時加劇的疼痛
- DCoolness of the skin皮膚冰冷
腔室症候群 (compartment syndrome) 是一種骨折或創傷後可能發生的嚴重併發症，當肢體肌肉腔室內的壓力異常升高，導致組織灌流不足，進而影響神經和血管功能。儘管「5 Ps」（疼痛、蒼白、感覺異常、麻痺、無脈搏）是腔室症候群的經典症狀，但其中最早期且最具決定性的症狀是「對止痛藥無效的劇烈疼痛，且在被動拉伸患肢時疼痛加劇」。這種疼痛通常與骨折的嚴重程度不成比例，且即使給予鴉片類止痛藥也無法緩解。這是因為腔室內壓力升高導致肌肉缺血，引發的疼痛信號。護理師必須密切監測病人的疼痛反應，尤其是對止痛藥的反應，並評估被動拉伸時的疼痛，以便早期診斷和介入，避免永久性的神經血管損傷。
Intractable pain that worsens with passive stretching is the earliest and most definitive sign of compartment syndrome, resulting from increased pressure within the muscle compartment causing ischemia. Unlike swelling or coolness, which are non-specific, this specific pain pattern indicates urgent need for intervention to prevent permanent nerve and tissue damage.
美國護理師被訓練要極度警覺鴉片類藥物無效的疼痛；台灣臨床有時會先嘗試給予更多止痛藥而延誤診斷。