# 一位22歲患有鐮狀細胞疾病且處於血管阻塞危象的個案，出現逐漸加重的缺氧及新的雙側肺部浸潤。護理師應預期何項介入措施為最優先？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375010&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: ROR

## 題目

一位22歲患有鐮狀細胞疾病且處於血管阻塞危象的個案，出現逐漸加重的缺氧及新的雙側肺部浸潤。護理師應預期何項介入措施為最優先？

## 選項

1. 將IV輸液增至維持量2倍以改善灌流
2. 準備緊急紅血球換血 **✔ 正確答案**
3. 停氧因高FiO2加重鐮形化
4. 將PCA鴉片改為單獨口服acetaminophen

**正確答案: 2**

## 解析

嚴重的急性胸腔症候群（惡化的缺氧、新的浸潤、多肺葉侵犯）應以紅血球置換輸血治療，以快速將HbS百分比降至30%以下——輕度急性胸腔症候群則使用單純輸血。急性胸腔症候群是成人鐮狀細胞疾病的主要死因。超過維持量1至1.5倍的過度水化會加重肺水腫。氧氣治療目標為維持基礎血氧飽和度，不應移除。適當的止痛必須持續。

## 深入解析

ACS三聯徵:新浸潤+發燒+呼吸症狀。換血目標:HbS

## 臨床情境

VOC住院第2天。鼻導管6 L下SpO2 2小時內由95%降至84%。新發咳嗽、RR 32、體溫38.6°C。CXR新發雙下葉浸潤。

## 重要概念

- **急性胸部症候群** — SCD出現新肺浸潤合併呼吸症狀 — 急症。
- **換血** — 移除病人血液並以捐贈者RBC置換 — 迅速降低HbS%。
- **高黏滯** — 過度輸血致血液黏稠 — SCD有中風風險。

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