# 失代償性肝硬化病人新發腹水、腹痛、發燒38.4°C、意識混亂、撲翼性震顫。應預期處置?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375014&lang=zh-tw  
> language: zh-TW  
> subject: Management of Care  
> category: MOC

## 題目

失代償性肝硬化病人新發腹水、腹痛、發燒38.4°C、意識混亂、撲翼性震顫。應預期處置?複選。

1

診斷性穿刺並送細胞計數與培養

2

嚴格限蛋白於每日20 g以下

3

給予lactulose調整至每日3-4次軟便

4

腹水PMN超過250/mm3給予IV albumin

5

疑SBP經驗性給予IV cefotaxime或ceftriaxone

## 解析

失代償性肝硬化合併新腹水與發燒需診斷穿刺;PMN>250確診SBP — 經驗性ceftriaxone/cefotaxime。SBP需給IV albumin(第1天1.5 g/kg、第3天1 g/kg)以降低肝腎症候群與死亡率。肝性腦病以lactulose調整3-4次軟便/日±rifaximin。嚴格限蛋白為舊作法且加重營養不良 — 1.0-1.5 g/kg/日植物性蛋白為宜。

## 深入解析

SBP診斷:腹水PMN>250(單一準則)。注意肝腎症候群 — IV albumin具保護作用。

## 臨床情境

白蛋白2.4、INR 2.0、氨110。新發意識混亂。未曾穿刺。

## 重要概念

- **自發性細菌性腹膜炎** — 無明確來源的腹水感染 — 肝硬化常見併發症。
- **肝性腦病** — 氨清除受損致認知障礙 — lactulose、rifaximin。
- **撲翼性震顫** — 腕關節伸展時拍翼樣震顫 — 代謝性腦病徵象。

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