# 一位28歲女性，依末次月經（LMP）推算妊娠7週，突然出現右下腹劇痛、暈厥，血壓88/56 mmHg，心率124次/分，血清hCG為4200，床邊超音波顯示子宮內無妊娠。護理師應預期哪些處置？（選擇所有適用者）

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375099&lang=zh-tw  
> language: zh-TW  
> subject: Reduction of Risk Potential  
> category: ROR

## 題目

一位28歲女性，依末次月經（LMP）推算妊娠7週，突然出現右下腹劇痛、暈厥，血壓88/56 mmHg，心率124次/分，血清hCG為4200，床邊超音波顯示子宮內無妊娠。護理師應預期哪些處置？（選擇所有適用者）

1

放置尿管監測尿量與復甦反應

2

備血型與交叉配對,預期輸血

3

建立兩條大口徑IV並準備緊急手術

4

對破裂異位妊娠以methotrexate治療

5

若Rh陰性給予RhoGAM

## 解析

破裂性子宮外孕合併血流動力學不穩定需要手術處理（腹腔鏡輸卵管造口術或輸卵管切除術），同時建立兩條大號靜脈管路，備血，放置導尿管以監測復甦狀況。Rh陰性的個案需接受抗D免疫球蛋白。Methotrexate適用於穩定的未破裂子宮外孕，且hCG低於5000、無胎兒心跳活動、腫塊小於3.5公分的情況——不適用於破裂或不穩定的狀況。及時進行手術止血是決定存活率的關鍵。

## 深入解析

風險因子:既往PID、既往異位、受孕時帶IUD、輸卵管手術、IVF。育齡女性腹痛加hCG陽性即懷疑異位。

## 臨床情境

FAST有自由液。PID與輸卵管手術病史。Hb 9.4。

## 重要概念

- **子宮外孕** — 胚胎著床於子宮腔外 — 輸卵管最常見。
- **Methotrexate** — 葉酸拮抗劑 — 穩定未破裂異位之藥物治療。
- **Rho(D)免疫球蛋白** — 預防Rh陰性孕婦接觸Rh陽性血液之同種免疫。

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