# 一位控制不良的葛瑞夫茲氏病個案，出現體溫40.1°C、心率168次/分、血壓162/96 mmHg、躁動，以及新發生的心房顫動。護理師應優先預期哪些處置？（選擇所有適用選項）

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375016&lang=zh-tw  
> language: zh-TW  
> subject: Physiological Adaptation  
> category: PA

## 題目

一位控制不良的葛瑞夫茲氏病個案，出現體溫40.1°C、心率168次/分、血壓162/96 mmHg、躁動，以及新發生的心房顫動。護理師應優先預期哪些處置？（選擇所有適用選項）

1

給予 aspirin 作為解熱和抗炎劑以控制症狀

2

以IV propranolol或esmolol控制交感症狀與心率

3

iodine(Lugol或KI)需在抗甲狀腺藥啟動至少1小時後給予

4

降溫並用acetaminophen,避免aspirin

5

以propylthiouracil或methimazole作為抗甲狀腺治療

## 解析

甲狀腺風暴之處置：β-阻斷劑（propranolol/esmolol）用於交感神經風暴，抗甲狀腺藥物（PTU 在懷孕及風暴中優先，因其亦阻斷T4轉化為T3；否則以 methimazole），碘劑用於阻斷荷爾蒙釋放，須在抗甲狀腺藥物後至少1小時給予（否則碘將作為合成基質），糖皮質激素（hydrocortisone 100 mg 每8小時）用於腎上腺壓力及阻斷轉化，積極降溫，並治療誘發因子（感染、手術）。ASPIRIN 禁忌——它會將甲狀腺素從甲狀腺結合球蛋白中置換出來，使風暴惡化。Acetaminophen 為首選解熱劑。

## 深入解析

Burch-Wartofsky>45 = 高度懷疑甲狀腺風暴。順序:β阻斷→抗甲狀腺→等1小時→碘→類固醇→降溫。

## 臨床情境

Burch-Wartofsky評分65(>45高度懷疑風暴)。Methimazole因腸胃不適停藥4天。

## 重要概念

- **甲狀腺風暴** — 失代償性甲亢 — 未治療死亡率高。
- **Burch-Wartofsky評分** — 甲狀腺風暴診斷評分 — >45高度懷疑。
- **Propylthiouracil** — 抗甲狀腺藥兼阻T4→T3轉換 — 風暴與妊娠首孕期優先。

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