# 一名確診動脈瘤性蛛網膜下腔出血的個案送至神經加護病房。護理師應預期哪些處置？請選取所有適用者。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375079&lang=zh-tw  
> language: zh-TW  
> subject: Management of Care  
> category: MOC

## 題目

一名確診動脈瘤性蛛網膜下腔出血的個案送至神經加護病房。護理師應預期哪些處置？請選取所有適用者。

1

動脈瘤處理前維持收縮壓<160 mmHg,之後對血管痙攣允許較高血壓

2

以神經檢查與TCD監測血管痙攣(高峰第4-14天)

3

使用軟便劑以防Valsalva致再出血

4

於血管痙攣前預防性使用triple-H療法

5

21天每4小時口服nimodipine 60 mg

## 解析

動脈瘤性蛛網膜下腔出血的照護：尼莫地平（nimodipine）60毫克口服每4小時一次，持續21天，可減少因血管痙攣導致的不良神經學預後（此為對腦血管具選擇性的鈣離子通道阻斷劑）。在動脈瘤尚未處置前，血壓須控制在較低水平（收縮壓低於160毫米汞柱），以預防再出血；一旦出現症狀性血管痙攣，則在血管痙攣好發期（通常在第4至14天達高峰）會誘導較高的血壓。血管痙攣的監測包括連續神經學評估及經顱都卜勒超音波（TCD）。使用軟便劑及其他避免伐氏操作（Valsalva maneuver）的措施可降低再出血風險。目前不再建議常規使用預防性 Triple-H 療法（高血容、高血壓、血液稀釋）；僅在出現症狀性血管痙攣時才進行誘導正常血容量及提升血壓的處置。

## 深入解析

Hunt-Hess分級(1-5)評估嚴重度。現代照護:24-48小時內coil/clip、nimodipine、警覺血管痙攣。

## 臨床情境

Hunt-Hess 3級。Coil後第1天。BP 168/90、HR 78。清醒、輕度失語。

## 重要概念

- **蜘蛛膜下出血** — 出血至蜘蛛膜下腔 — 經典原因為動脈瘤破裂。
- **Nimodipine** — 腦血管選擇性鈣阻斷劑 — 降低血管痙攣不良後果。
- **腦血管痙攣** — SAH後4-14天延遲性動脈狹窄 — 引起缺血。

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