# 一名58歲的肝硬化病人出現吐血，血紅素為6.8 g/dL。醫囑開立octreotide 50微克靜脈推注後，以每小時50微克持續輸注。治療期間最重要的監測參數是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375124&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## 題目

一名58歲的肝硬化病人出現吐血，血紅素為6.8 g/dL。醫囑開立octreotide 50微克靜脈推注後，以每小時50微克持續輸注。治療期間最重要的監測參數是什麼？

## 選項

1. 僅每日量體重。
2. 僅每小時量口溫。
3. 僅持續監測四肢微血管充填。
4. 心率、血壓、指尖血糖、膽囊痛/腸缺血徵象 — octreotide可能引發低/高血糖、心搏過慢、膽汁鬱積。 **✔ 正確答案**

**正確答案: 4**

## 解析

Octreotide是一種合成的體抑素類似物，用於急性靜脈曲張出血（使內臟血管收縮以降低門脈壓力）、嚴重腹瀉（類癌、VIPoma、傾倒症候群、化療引起）、肢端肥大症，以及腦下垂體腫瘤的輔助治療。在急性靜脈曲張出血，給藥方式為50微克靜脈推注後，以每小時50微克持續輸注，通常持續3至5天，並配合內視鏡結紮術、廣效性抗生素及濃縮紅血球輸注。輸注期間的關鍵監測包括：(1)心率和節律，因為心搏過緩和心律不整常見；(2)血壓，因為可能發生低血壓或高血壓；(3)指尖血糖，因為體抑素會抑制胰島素和升糖素，可能導致低血糖或高血糖，視病人情況而定——糖尿病患者尤其危險；(4)腹痛、右上腹壓痛、黃疸或脂肪便，可能表示膽汁鬱積、膽結石形成或胰臟炎；(5)腸胃道症狀（噁心、痙攣、脂肪瀉），罕見腸缺血；(6)皮下注射部位的注射反應；(7)持續出血的徵象（吐血、黑便、血流動力學、血紅素趨勢）以評估療效。單靠微血管回填時間、每日體重和體溫，無法涵蓋決定輸注期間護理決策的心臟代謝和膽道監測。

## 深入解析

Octreotide影響多個內分泌與消化軸——心血管(HR/BP)、代謝(BG)、膽道監測組合是NCLEX的標準答案。也須持續追蹤出血源以評估療效。

## 重要概念

- **octreotide** — somatostatin類似物，靜脈曲張出血、嚴重腹瀉、肢端肥大症，需監測HR/BG/膽汁
- **variceal bleeding** — 肝硬化併發症、門脈高壓、處置為octreotide加EBL加抗生素加輸血
- **biliary stasis** — 膽汁鬱積、膽石、octreotide長期使用併發症，須回報RUQ壓痛/黃疸

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