# 轉移性攝護腺癌病人新發中背痛、雙下肢無力、起尿困難。立即優先處置?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374974&lang=zh-tw  
> language: zh-TW  
> subject: Management of Care  
> category: MOC

## 題目

轉移性攝護腺癌病人新發中背痛、雙下肢無力、起尿困難。立即優先處置?複選。

1

確認脊髓穩定性前嚴格臥床並維持logroll

2

放置尿管並評估餘尿量

3

等待門診腫瘤科追蹤再排影像

4

安排全脊柱緊急MRI並會診放射腫瘤科

5

依醫囑於MRI前給予高劑量IV dexamethasone

## 解析

惡性脊髓壓迫為腫瘤急症。功能保留以小時計:疑慮高時影像前先經驗性給予高劑量dexamethasone。常有跳躍病灶,須影像全脊柱。放射腫瘤或神外緊急會診。穩定性確認前以logroll嚴格臥床。尿瀦留提示自主神經侵犯,須評估。門診追蹤不適當 — 數小時內可發生不可逆癱瘓。

## 深入解析

馬尾症候群紅旗:鞍區麻木、尿瀦留、大便失禁、雙下肢無力。任一即須急診影像。

## 臨床情境

平躺時痛加重,坐姿緩解。前次PSA升高。疑脊髓壓迫已申請STAT MRI。

## 重要概念

- **脊髓壓迫** — 腫瘤或椎體塌陷壓迫脊髓 — 須緊急減壓。
- **Dexamethasone** — 類固醇,可減輕腫瘤相關脊髓水腫。
- **馬尾症候群** — 腰薦神經根壓迫 — 鞍區麻木、膀胱直腸功能異常。

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