# 一位患有鐮刀型紅血球疾病的18歲個案因血管阻塞危象入院，主訴嚴重背部與腿部疼痛，疼痛指數為9分（滿分10分）。哪些措施是適當的？請選擇所有正確的選項。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374972&lang=zh-tw  
> language: zh-TW  
> subject: Reduction of Risk Potential  
> category: ROR

## 題目

一位患有鐮刀型紅血球疾病的18歲個案因血管阻塞危象入院，主訴嚴重背部與腿部疼痛，疼痛指數為9分（滿分10分）。哪些措施是適當的？請選擇所有正確的選項。

1

SpO2低於基線時才補充氧氣

2

於疼痛關節冷敷以減輕發炎

3

以維持量1-1.5倍給予等張晶體液

4

胸部X光與持續SpO2監測以篩檢急性胸部症候群

5

以常規醫囑或PCA開始IV鴉片類止痛

## 解析

血管阻塞危象需要積極的止痛（靜脈注射鴉片類藥物，常使用病人自控式止痛）、等張輸液，給予維持量的1至1.5倍（過量輸液會加重急性胸腔症候群的肺水腫）、以胸部影像及脈搏血氧飽和度篩檢急性胸腔症候群，以及缺氧時給予氧氣。冷敷是禁忌的，因為血管收縮會加重鐮刀化——應優先使用溫敷包。常規給予血氧正常的個案補充氧氣會抑制紅血球生成，因此不建議；氧氣治療應以基礎血氧飽和度為目標。

## 深入解析

ACS三聯徵:新發肺浸潤+發燒+呼吸症狀。成人SCD死因第一。嚴重時預期換血。

## 臨床情境

體溫38.4°C、HR 118、RR 22、SpO2 95%、痛9/10。Hb 7.6、網狀紅血球12%。最近住院3個月前。

## 重要概念

- **血管阻塞性危象** — 鐮形紅血球阻塞微循環引起缺血性疼痛。
- **急性胸部症候群** — SCD出現新肺浸潤合併呼吸症狀 — 急症。
- **Hydroxyurea** — 增加胎兒血紅素以減少VOC發作頻率。

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