# 成人病人連續抽搐6分鐘。醫師要求護理師預期一線藥物治療。護理師應準備何項藥物？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373126&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PA

## 題目

成人病人連續抽搐6分鐘。醫師要求護理師預期一線藥物治療。護理師應準備何項藥物？

## 選項

1. 靜脈phenytoin 20 mg/kg負荷劑量立即。
2. 靜脈lorazepam 4 mg於2分鐘內；若5-10分鐘後仍抽搐可重複1次。 **✔ 正確答案**
3. 靜脈mannitol 1 g/kg以降低顱內壓。
4. 皮下注射epinephrine 0.3 mg。

**正確答案: 2**

## 解析

癲癇重積 = 連續發作≥5分鐘(或反覆未恢復基線)。第一線為靜脈benzodiazepine — lorazepam 4 mg IV(無靜脈通路時midazolam 10 mg IM)。Phenytoin/fosphenytoin為發作持續時之第二線。Mannitol與epinephrine不用於癲癇重積。氣道、氧氣、側臥與靜脈通路同步進行。

## 深入解析

階段記憶：benzo → fosphenytoin/levetiracetam/valproate → propofol或midazolam持續輸注(難治)。Lorazepam 4 mg IV為最常考之第一線答案。時間關鍵 — 每分鐘抽搐增加併發症與難治性。

## 臨床情境

**成人病人連續強直陣攣性發作6分鐘** — 符合**癲癇重積**標準。以側臥與抽吸維持氣道。已建立靜脈通路。

## 重要概念

- **癲癇重積** — 連續發作≥5分鐘或反覆發作未恢復基線；醫療急症。
- **靜脈lorazepam** — 第一線benzodiazepine；4 mg IV於2分鐘內，可重複1次。
- **Fosphenytoin（第二線）** — Benzo失敗後20 mg PE/kg IV負荷劑量；較IV phenytoin較少低血壓。

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