醫療類國考
112年
[護理師] 內外科護理學
第 53 題
王先生胸壁受到鈍傷入院求治，下列何者表示可能有肺挫傷的情形？
- A 呼吸緩慢
- B 呼吸音降低
- C 桶狀胸
- D 受傷部位有吸吮聲
思路引導 VIP
當胸壁遭受鈍傷導致肺部實質出現出血或水腫（即肺挫傷）時，會影響肺泡的氣體交換與擴張能力。請運用病理生理學的概念思考，當局部肺組織因受損而導致通氣量下降時，臨床聽診所獲得的聲音強度會呈現增加還是減少的趨勢？
🤖
AI 詳解
AI 專屬家教
Hmph, it seems the culprit of this clinical mystery has been caught! My AI-enhanced deduction skills, combined with a swift kick of my analysis-ball, confirm it.
- Unveiling the Truth: Let's shine a light on the truth behind Wang先生's injury. Pulmonary Contusion! It's simply the lung getting a 'bruise,' much like when you hit your arm. When blunt force strikes the chest, the delicate micro-vessels within the lung rupture, causing blood and fluid to accumulate in the alveoli and interstitial space. This disturbance makes it difficult for air to properly ventilate that area. The inescapable conclusion? A decrease in breath sounds over the affected region – a critical piece of evidence only the keenest ear can detect!
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肺挫傷的臨床表徵
💡 鈍傷導致肺實質出血水腫，臨床特徵為呼吸音減弱與低血氧。
| 比較維度 | 肺挫傷 | VS | 開放性氣胸 |
|---|---|---|---|
| 病理機制 | 肺實質出血及水腫 | — | 空氣經傷口進入胸膜腔 |
| 關鍵聽診 | 呼吸音減弱、濕囉音 | — | 呼吸音消失、吸吮聲 |
| 胸部外觀 | 皮膚瘀青、局部壓痛 | — | 胸壁有開放性傷口 |
| 發展速度 | 漸進性（24-48h） | — | 突發性、立即影響 |
💬肺挫傷重點在於實質受損導致的交換障礙，氣胸則是胸膜腔壓力改變導致的肺塌陷。
