# 一位接受高腫瘤負荷伯基特淋巴瘤誘導化療的個案，其檢驗數值顯示K 6.2、磷酸鹽 6.8、鈣 7.4、尿酸 11.0。護理師應預期哪些處置？（選擇所有適用者）

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374986&lang=zh-tw  
> language: zh-TW  
> subject: Reduction of Risk Potential  
> category: ROR

## 題目

一位接受高腫瘤負荷伯基特淋巴瘤誘導化療的個案，其檢驗數值顯示K 6.2、磷酸鹽 6.8、鈣 7.4、尿酸 11.0。護理師應預期哪些處置？（選擇所有適用者）

1

對升高的尿酸給予rasburicase IV

2

立即IV calcium chloride以矯正鈣7.4

3

若代謝惡化準備緊急透析

4

大量等張液以維持每小時尿量超過100 mL

5

以calcium gluconate、胰島素/葡萄糖、鉀結合劑處理K 6.2

## 解析

腫瘤溶解症候群處置：積極靜脈輸液以沖洗代謝物並維持尿量大於100毫升/小時，使用rasburicase降尿酸治療（當尿酸過高或風險高時，優先於allopurinol），依治療方案處理高血鉀，包括心臟穩定、促使鉀移入細胞內及移除，若持續則準備腎臟替代治療。腫瘤溶解症候群中的無症狀低血鈣通常不矯正，因為在高血磷狀態下給予鈣會造成磷酸鈣沉澱並使急性腎損傷惡化——鈣僅保留用於有症狀的低血鈣或高血鉀時的心肌細胞膜穩定。

## 深入解析

Cairo-Bishop準則定義TLS。最高風險:高WBC血液腫瘤、大腫塊淋巴瘤、治療前尿酸>7.5。

## 臨床情境

化療第2天。每小時尿量35 mL。EKG高聳T波。

## 重要概念

- **腫瘤溶解症候群** — 大量細胞破壞釋放K、P、尿酸 — AKI與心律不整風險。
- **Rasburicase** — 重組尿酸氧化酶 — 將尿酸轉為尿囊素。
- **Allopurinol** — 黃嘌呤氧化酶抑制劑 — 阻斷新尿酸生成,急性期不及rasburicase。

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