# 一名肝硬化合併第2級肝性腦病變病人開始使用乳果糖。哪些護理行動反映適當管理？請選擇所有適用項目。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372852&lang=zh-tw  
> language: zh-TW  
> subject: Basic Care and Comfort  
> category: BCC

## 題目

一名肝硬化合併第2級肝性腦病變病人開始使用乳果糖。哪些護理行動反映適當管理？請選擇所有適用項目。

1

頻繁進行再定向，將時鐘與日曆置於視線範圍，限制夜間刺激以支持神經認知恢復。

2

至少每4小時評估撲翼樣震顫（asterixis）與意識程度變化，以偵測病情惡化。

3

監測血氨趨勢與電解質（尤其K+），因乳果糖造成的流失可導致低鉀血症。

4

長期限制飲食蛋白質攝取至最低量，以減少氨的產生並預防復發性腦病變。

5

以每日2-3次軟便為目標調整乳果糖，避免爆發性腹瀉，以平衡氨清除與水電解質流失。

## 解析

乳果糖治療肝性腦病變以每日2-3次軟便為目標 — 過量造成低鉀與脫水。頻繁神經評估、血氨與K+監測、再定向為核心護理。選項4錯誤 — 現行AASLD/EASL指引建議正常蛋白飲食（1.2-1.5 g/kg/日） — 嚴格限制蛋白將造成肌肉流失與預後惡化；僅短期暫時限制偶爾使用。

## 深入解析

乳果糖將腸道酸化並捕捉NH4+排出；過度調整會引起K+流失反加重腦病變。「不限制蛋白」是NCLEX最常出現的陷阱之一 — 舊教科書教的與現有證據相反。

## 臨床情境

**肝硬化病人**因**第2級肝性腦病變**（嗜睡、可見撲翼樣震顫、輕度定向力障礙）入院。醫師開立**乳果糖**並依治療反應調整。

## 重要概念

- **肝性腦病變** — 由腸道氨繞過衰竭肝臟所致之可逆性神經精神症候群。
- **撲翼樣震顫（Asterixis）** — 背屈手腕時之撲翼樣震顫；第2級腦病變之經典臨床標誌。
- **乳果糖調整** — 劑量調整至每日2-3次軟便；過度調整造成低鉀並加重腦病變。

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