# 重症肌無力症患者規律服用pyridostigmine,末次給藥45分鐘後出現漸進性無力、腹部痙攣、流涎、流淚。哪項評估最支持膽鹼性危象而非肌無力危象?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374963&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PA

## 題目

重症肌無力症患者規律服用pyridostigmine,末次給藥45分鐘後出現漸進性無力、腹部痙攣、流涎、流淚。哪項評估最支持膽鹼性危象而非肌無力危象?

## 選項

1. 給藥4小時後眼瞼下垂惡化
2. 瞳孔縮小、心搏過慢、分泌物增加 **✔ 正確答案**
3. 給予edrophonium後肌力改善
4. 由情緒壓力誘發的症狀

**正確答案: 2**

## 解析

膽鹼性危象由抗膽鹼酯酶過量引起。蕈毒鹼過量呈SLUDGE(流涎、流淚、排尿、排便、腹痛、嘔吐)合併瞳孔縮小與心搏過慢,多在給藥30-60分內。肌無力危象(用藥不足)於數小時後加重,edrophonium可改善。壓力可誘發兩者,不具特異性。

## 深入解析

鑑別重點:時間(1小時內 vs 數小時後)與蕈毒鹼SLUDGE型態。膽鹼性危象用阿托品逆轉,pyridostigmine暫停給藥。

## 臨床情境

因吞嚥困難加重住院。pyridostigmine 60 mg每4小時。瞳孔雙側2 mm、HR 54、BP 102/64。

## 重要概念

- **膽鹼性危象** — 抗膽鹼酯酶過量導致乙醯膽鹼過剩 — SLUDGE與肌無力。
- **SLUDGE** — 蕈毒鹼毒性縮寫:流涎、流淚、排尿、排便、腹痛、嘔吐。
- **Edrophonium** — 短效膽鹼酯酶抑制劑,歷史上用於鑑別兩種危象。

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