# 4名病人到達急診。哪一位之表現顯示為高血壓急症(而非高血壓亞急症)且需收入ICU進行靜脈降壓藥物調整？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373127&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PA

## 題目

4名病人到達急診。哪一位之表現顯示為高血壓急症(而非高血壓亞急症)且需收入ICU進行靜脈降壓藥物調整？

## 選項

1. BP 188/120、頭痛、無神經學缺損、尿量正常、無胸痛。4天前lisinopril用完。
2. BP 196/124、突發劇烈枕部頭痛、嘔吐、左眼視力模糊、意識混亂。 **✔ 正確答案**
3. BP 184/118、無症狀，於社區健檢發現。5年未就醫。
4. BP 172/108、無症狀、長期穩定使用降壓藥，最後門診於2週前。

**正確答案: 2**

## 解析

選項2具BP > 180/120加上器官損害(劇烈頭痛、嘔吐、視力模糊、意識混亂提示高血壓腦病變或腦出血)。屬高血壓急症需收ICU給予靜脈降壓藥(nicardipine、labetalol、clevidipine)調整，控制性降壓(首小時通常不超過25%)。選項1與3為高血壓亞急症(高BP但無器官損害) — 重新口服藥並門診追蹤。選項4不嚴重。

## 深入解析

急症與亞急症之唯一區分是器官損害 — 腦病變、ICH、心肌梗塞、剝離、AKI、視乳頭水腫、肺水腫、子癇前症。數字本身不定義急症。亞急症之快速降壓可能引起中風；即使真急症首小時亦不超過25%降幅。

## 臨床情境

檢傷護理師評估4位顯著血壓上升之病人。區分**高血壓急症**(BP > 180/120加上器官損害)與**亞急症**(同BP但無器官損害)決定處置場所。

## 重要概念

- **高血壓急症** — BP > 180/120加急性器官損害；收ICU與靜脈降壓藥調整。
- **高血壓亞急症** — 同樣BP上升但無器官損害；口服藥與門診追蹤即可。
- **靜脈nicardipine** — 靜脈鈣離子通道阻斷劑用於高血壓急症調整；可控且可預測之降壓。

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