# 一名慢性心衰竭病人被處方metoprolol 25mg口服每日兩次。投藥前護理師執行評估,何項發現需暫停給藥並通知醫師?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一名慢性心衰竭病人被處方metoprolol 25mg口服每日兩次。投藥前護理師執行評估,何項發現需暫停給藥並通知醫師?

## 選項

1. 心尖脈搏 78次/分
2. 心尖脈搏 52次/分 **✔ 正確答案**
3. 訴輕度疲倦
4. 血壓 118/72 mmHg

**正確答案: 2**

## 解析

metoprolol等β阻斷劑會降低心率與收縮力。標準暫停基準為心尖脈搏低於60次/分或收縮壓低於90 mmHg。心尖脈搏52次/分低於門檻,需暫停並通知醫師。其餘發現皆在可接受範圍內。

## 深入解析

臨床判斷
β阻斷劑安全給藥需每次完整測量心尖脈搏1分鐘。暫停基準: HR <60 或 SBP <90。輕度疲倦是已知副作用,非暫停指標。

記憶口訣
β阻斷劑暫停: HR <60 或 SBP <90 — 心尖60秒

韓 vs 美
美國標準HR <60暫停通報。臺灣護理教學一致;部分機構以HR <50為絕對暫停。NCLEX採HR <60。

## 臨床情境

臨床指引
ACC/AHA心衰竭指引將β阻斷劑(metoprolol succinate、carvedilol、bisoprolol)列為HFrEF的Class I治療。緩慢加量。暫停基準: HR <60 或 SBP <90。突然停藥可能引發反彈性高血壓或心絞痛。

注意
勿為節省時間省略心尖評估。心律不整時橈動脈可能低估心率。β阻斷劑投藥前一律測心尖60秒。

## 重要概念

- **Metoprolol** — 選擇性β1腎上腺素阻斷劑。降低心率、收縮力、腎素分泌。為HFrEF、心肌梗塞後、慢性穩定性心絞痛之標準用藥。HR <60 或 SBP <90 即暫停。
- **心尖脈搏** — 於第5肋間鎖骨中線聽診測得之心率。強心劑、β阻斷劑給藥前需測量1分鐘以偵測不整脈。
- **心搏過緩** — 成人每分鐘心率低於60次。有症狀心搏過緩(暈眩、昏厥、低血壓)需介入。β阻斷劑導致之重度心搏過緩可使用atropine或glucagon。

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