# 一名建築工人被困在倒塌的瓦礫下6小時後獲救。他意識清楚，大腿大範圍水腫且尿液呈茶色。護理師應預期哪項處置為立即優先？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375055&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PPT

## 題目

一名建築工人被困在倒塌的瓦礫下6小時後獲救。他意識清楚，大腿大範圍水腫且尿液呈茶色。護理師應預期哪項處置為立即優先？

## 選項

1. 以1-1.5 L/小時等張晶體液積極輸液並監測尿量 **✔ 正確答案**
2. 給予IV KCl補充推估流失
3. 於受傷肢體上方繫止血帶以防毒素釋放
4. 等待肌酸酐回到基線後再給輸液

**正確答案: 1**

## 解析

擠壓症候群導致大量肌球蛋白釋放，有急性腎損傷（AKI）風險及危及生命的高血鉀症。立即優先措施為積極輸注等張晶體溶液（初始1-1.5公升/小時，目標尿量200-300毫升/小時），以沖刷肌球蛋白並預防AKI。靜脈注射葡萄糖酸鈣可穩定高血鉀症下的心肌細胞膜，隨後以胰島素/葡萄糖及β-致效劑將鉀離子移入細胞內，而鉀結合劑或透析則可移除鉀離子。添加氯化鉀是禁忌。止血帶不適用且可能加重缺血。限制輸液會惡化AKI及高血鉀症。

## 深入解析

以bicarbonate鹼化尿液仍爭議 — 現行指引以積極等張輸液為主。Mannitol已非常規。

## 臨床情境

K 6.4、肌酸酐2.4、CK 88,000。EKG高聳T波。

## 重要概念

- **橫紋肌溶解** — 骨骼肌分解 — 釋放肌紅蛋白、K、P、CK。
- **肌紅蛋白尿** — 尿中肌紅蛋白致茶色或紅棕色。
- **壓砸症候群** — 大量肌肉損傷的全身影響 — AKI、高鉀、休克。

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