— 生理適應 · MEDIUM · SATA —
護理師照護一位肺葉切除術後帶有胸管的病人，哪些發現需立即報告醫師？（選所有適合的）
A nurse is caring for a client with a chest tube following a lobectomy. Which findings should the nurse report to the healthcare provider? (Select all that apply.)
- AContinuous bubbling in the water seal chamber✓ 正解水封瓶持續冒泡
- BTotal drainage of 150 mL in the first hour✓ 正解第一小時總引流達 150 mL
- CFluctuation of the fluid in the water seal chamber with respiration水封瓶內的液面隨呼吸波動
- DSubcutaneous emphysema near the insertion site✓ 正解插入部位附近有皮下氣腫
- EAbsence of tidaling after 3 days3 天後無液面波動
— Explanation · 中文詳解 —
胸管照護的重點在於維持密閉系統。A 代表氣胸洩漏，需查找原因；B 顯示術後出血過多（超過 100 mL/hr 即屬異常）；D 皮下氣腫代表氣體滲入皮下組織，需警惕氣胸惡化。C 為正常呼吸波動；E 代表肺部復張完全，胸管可考慮移除。
Continuous bubbling in the water seal chamber indicates an air leak, excessive drainage suggests hemorrhage, and subcutaneous emphysema signals air leakage into tissues, all requiring immediate provider notification. In contrast, tidal fluctuation with respiration is a normal sign of patency, and its absence after several days typically indicates full lung re-expansion.
✦ 台美臨床差異
台灣胸腔外科術後照護較嚴謹，胸管引流量監測常配合每小時詳細記錄，美國則可能較仰賴自動化引流系統。