# 一名急診成人病人疑似敗血症。BP 84/56、乳酸 4.2 mmol/L。下列何者為Surviving Sepsis 1小時組合應執行之介入?(複選)

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名急診成人病人疑似敗血症。BP 84/56、乳酸 4.2 mmol/L。下列何者為Surviving Sepsis 1小時組合應執行之介入?(複選)

1

辨識後1小時內開始廣效抗生素

2

低血壓或乳酸≥4時給予30 mL/kg平衡晶體IV bolus

3

等候最終血液培養結果後再開始抗生素

4

直到升壓劑滴定至MAP 65前暫停所有IV輸液

5

抗生素前自兩處抽取血液培養

## 解析

Surviving Sepsis 1小時組合需測乳酸、抗生素前血液培養、1小時內廣效抗生素、低血壓或乳酸≥4給予30 mL/kg晶體。升壓劑於輸液後MAP仍<65時加入,並非取代輸液。抗生素不可因等待培養結果而延遲。

## 深入解析

臨床判斷
Surviving Sepsis 1小時組合(2021): 乳酸測定、抗生素前血液培養、1小時內廣效抗生素、低血壓或乳酸≥4給30 mL/kg晶體、輸液後MAP <65仍持續加升壓劑。時效敏感 — 每延遲1小時死亡率上升。

記憶口訣
敗血症1小時: 乳酸-培養-抗生素-輸液-升壓劑

韓 vs 美
Surviving Sepsis Campaign為國際倡議,臺美韓多國採用。臺灣醫學中心亦運作敗血症組合儀表板;兩地皆以door-to-antibiotic時間為品質指標。

## 臨床情境

臨床指引
Surviving Sepsis Campaign 2021 1小時組合:
- 量乳酸;若初值>2需重測
- 抗生素前血液培養(不可因此延誤抗生素超過45分鐘)
- 1小時內廣效抗生素
- 低血壓或乳酸≥4給30 mL/kg平衡晶體
- 輸液後仍低血壓加升壓劑(norepinephrine第一線),MAP ≥65為目標

診斷標準(Sepsis-3):
- qSOFA ≥2: RR ≥22、意識改變、SBP ≤100
- 敗血性休克: 充分輸液後仍需升壓劑維持低血壓 + 乳酸 >2

注意
敗血症避用HES與合成膠體 — 增加死亡與AKI。大量輸液宜選平衡晶體(lactated Ringer或PlasmaLyte),勝於normal saline。

## 重要概念

- **Surviving Sepsis Campaign** — 2002年起的國際多專業敗血症死亡率降低倡議。每4年更新實證指引。1小時組合為護理主導的核心介入。
- **qSOFA分數** — Quick Sepsis-related Organ Failure Assessment。3項床邊評估: 呼吸≥22、意識改變、SBP≤100 mmHg。分數≥2需考慮敗血症並進一步評估。ICU外使用;ICU則用完整SOFA。
- **敗血性休克** — 充分輸液仍須升壓劑維持MAP ≥65 mmHg之持續低血壓+血清乳酸 >2 mmol/L。死亡率40-50%。需ICU級照護。

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