# 一名58歲長期服用atorvastatin 40 mg/日的病患10天前因高三酸甘油酯加上gemfibrozil。病患現出現嚴重瀰漫性肌肉疼痛、無力、深可樂色尿。護理師應優先預期哪項檢查？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372708&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一名58歲長期服用atorvastatin 40 mg/日的病患10天前因高三酸甘油酯加上gemfibrozil。病患現出現嚴重瀰漫性肌肉疼痛、無力、深可樂色尿。護理師應優先預期哪項檢查？

## 選項

1. 高敏感度 C 反應蛋白和紅血球沉降速率
2. 空腹血脂分析，包含低密度脂蛋白和三酸甘油酯水平
3. Creatine kinase（CK）及基本代謝套組（含K與creatinine） **✔ 正確答案**
4. 完整的肝功能檢查組，包含 AST、ALT 和鹼性磷酸酶

**正確答案: 3**

## 解析

嚴重瀰漫性肌痛、無力、可樂色尿＋statin＋fibrate併用為橫紋肌溶解症典型表現。優先檢查為CK（常>10倍上限，有時>10,000 U/L）及基本代謝套組 — 偵測致命併發症高K血症（心停止）與myoglobin引發的AKI。選項4 LFT可作為基線但非立即優先。選項3血脂套組與此急性事件無關。選項1 CRP/ESR為非特異性指標，非優先。

## 深入解析

Statin-fibrate併用（特別是atorvastatin/simvastatin＋gemfibrozil）透過CYP介導的藥物交互作用大幅提升橫紋肌溶解症風險（gemfibrozil抑制OATP1B1與CYP2C8，阻止肝臟攝取與代謝statin）。臨床三徵：肌肉疼痛（瀰漫且嚴重）、無力、深色尿（myoglobin尿，常被描述為「茶色」或「可樂色」）。急性危險：(1)受損肌肉釋出細胞內K+→高K血症致突發心律不整；(2)myoglobin沉積腎小管→急性腎損傷。優先檢查：CK、BMP（K、Cr）、尿myoglobin、ECG。初步處置：停用相關藥物、積極等張靜脈輸液（200~300 mL/hr目標尿量）、監測並處理高K、AKI無反應時準備透析。

## 臨床情境

**58歲病患**長期服用**atorvastatin 40 mg/日**，**10天前加上gemfibrozil**治療高三酸甘油酯。現出現**嚴重瀰漫性肌肉疼痛**、**無力**、**深可樂色尿**。

## 重要概念

- **橫紋肌溶解症** — 骨骼肌急性破壞釋出細胞內成分（CK、myoglobin、K+）至循環。原因：藥物交互作用（statin+fibrate）、外傷、長期不動、高熱、抽搐。診斷數據：CK>正常上限5~10倍。
- **Statin-Fibrate藥物交互作用** — Statin（atorvastatin、simvastatin）＋gemfibrozil合併使用透過抑制OATP1B1載體與CYP2C8代謝，大幅提高statin血漿濃度，倍增肌病變與橫紋肌溶解風險。Fenofibrate交互作用風險較低，需合併治療時通常較被偏好。
- **Myoglobin引發的急性腎損傷** — 釋出的myoglobin於腎小管沈積，形成色素誘發AKI。積極等張靜脈輸液以達200~300 mL/hr尿量為預防核心。未治療可能需透析，死亡率明顯上升。

## 相同主題題目

- [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=zh-tw)
- [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=zh-tw)
- [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=zh-tw)
- [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=zh-tw)
- [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=zh-tw)
- [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=zh-tw)
- [An 80-year-old male with heart failure is prescribed digoxin 0.125 mg daily. During mornin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372686&lang=zh-tw)
- [A 38-year-old female with rheumatoid arthritis is being discharged with a new prescription…](https://mymerci.kr/pages/nclex_q.php?qn_id=372687&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=372708&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=372708&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=372708&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=372708&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=372708&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_