# 一名8歲患有重度A型血友病的個案，在跌倒後出現右膝疼痛腫脹。護理師的優先處置為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375013&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: SIPC

## 題目

一名8歲患有重度A型血友病的個案，在跌倒後出現右膝疼痛腫脹。護理師的優先處置為何？

## 選項

1. 於膝部熱敷以緩解肌肉痙攣
2. 立即給予factor VIII濃縮劑;若有inhibitor改用bypassing agent **✔ 正確答案**
3. 關節穿刺抽血減痛
4. 給aspirin治療疼痛與發炎

**正確答案: 2**

## 解析

急性關節積血在重度血友病中的處理，首要是在數分鐘內使用凝血因子濃縮劑，先於影像檢查或止痛，以限制關節損傷。若已知有第八凝血因子抑制抗體，則使用繞道藥物（如 FEIBA 或重組第七凝血因子 rFVIIa），因為額外的第八凝血因子會被中和。RICE（休息、冰敷、加壓、抬高）應在補充凝血因子之後進行。熱敷會增加出血。常規關節積血應避免關節穿刺抽吸。阿斯匹靈（aspirin）與非類固醇消炎藥（NSAIDs）會抑制血小板並加重出血，止痛較宜使用 acetaminophen。

## 深入解析

Inhibitor篩檢:低效價可用高劑量factor;高效價需bypassing agent。Emicizumab即使有inhibitor仍可作預防。

## 臨床情境

膝腫脹、發熱、活動度下降。無外出血。有factor VIII inhibitor史。最近一次因子補充2週前。

## 重要概念

- **關節出血** — 關節腔內出血 — 重度血友病典型併發症。
- **因子抑制劑** — 中和注入因子之抗體。
- **Bypassing agent** — 繞過inhibitor阻斷之因子之治療(FEIBA、rFVIIa)。

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