# 新診斷小細胞肺癌病人漸進性面部腫脹、頸與胸壁靜脈擴張、前傾時呼吸困難加重。優先處置?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375011&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: MOC

## 題目

新診斷小細胞肺癌病人漸進性面部腫脹、頸與胸壁靜脈擴張、前傾時呼吸困難加重。優先處置?

## 選項

1. 置仰臥以促進頸靜脈回流
2. 將床頭抬高45度並準備緊急氣道管理 **✔ 正確答案**
3. 大量IV補液以稀釋腫瘤標記
4. 穿著彈性襪以重新導引血流

**正確答案: 2**

## 解析

縱膈腫塊致SVC症候群,靜脈回流受阻引起面部與上肢腫脹、胸壁側枝循環、呼吸困難。喘鳴與端坐呼吸提示氣道危險 — 抬高床頭降低靜脈壓並協助呼吸。需緊急會診腫瘤與放射腫瘤科。治療:放療、化療(尤以SCLC)、血管內支架。仰臥惡化靜脈鬱血。大量補液增加中央靜脈壓與水腫。彈性襪對SVC阻塞無效。

## 深入解析

Pemberton徵象:抬高雙臂時面部充血與喘鳴 — 床邊SVC評估。SCLC為最常見原因。

## 臨床情境

聽診有喘鳴。SpO2 92%(室氣)。清醒、定向力佳但焦慮。

## 重要概念

- **SVC症候群** — 上腔靜脈阻塞致上半身靜脈鬱血。
- **Pemberton徵象** — 抬手時面部充血與呼吸困難 — 提示SVC阻塞。
- **血管內支架** — 以導管置放之金屬支架以恢復惡性阻塞下之SVC通暢。

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