# 情境 52歲個案於甲狀腺全切除後18小時主訴口周圍與指尖麻木，Chvostek與Trousseau陽性，離子化鈣0.92 mmol/L。處方醫師開立calcium gluconate 1 g IV。護理師執行的投予方式為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375125&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 52歲個案於甲狀腺全切除後18小時主訴口周圍與指尖麻木，Chvostek與Trousseau陽性，離子化鈣0.92 mmol/L。處方醫師開立calcium gluconate 1 g IV。護理師執行的投予方式為何?

## 選項

1. 抽吸1 g calcium gluconate到一個附有22號針頭的3 mL注射器中；使用Z字型注射法注射深部於腹臀肌，以確保快速吸收並避免皮膚刺激。
2. 經周邊20號導管以緩慢IV推注方式給予未稀釋的1 g calcium gluconate，時間超過30至60秒，隨後以10 mL 0.9% sodium chloride沖洗，同時監測心搏過緩和刺痛感是否緩解。
3. 抽吸1 g calcium gluconate和50 mEq sodium bicarbonate到一個50 mL注射器中；透過Y型接頭相容的IV輸液管輸注超過20分鐘，以同時矯正低血鈣和代謝性酸中毒。
4. 以D5W 50~100 mL稀釋、經暢通大口徑IV於10~20分鐘內輸注、連續心電圖監測、評估外滲、檢測血鈣、鎂與QT延長ECG。 **✔ 正確答案**

**正確答案: 4**

## 解析

甲狀腺全切除術後因副甲狀腺意外被切除或缺血造成的術後低鈣為最常見且危及生命的併發症。離子化鈣低於1.0 mmol/L(或總鈣低於8 mg/dL)時出現症狀：口周與指尖麻木、Chvostek陽性(輕拍臉頰引發顏面抽動)、Trousseau陽性(血壓帶充氣致手腕痙攣)、肌肉抽搐、喉痙攣、抽搐、QT延長與torsades。症狀性急性低鈣處置：(1) calcium gluconate 1~2 g IV，於D5W 50~100 mL稀釋(NS亦可)，10~20分鐘輸注 — 絕不可IV push(會造成心搏徐緩或心臟停止)；(2) 採用暢通大口徑周邊或中央靜脈，calcium為血管刺激物，外滲將造成嚴重組織壞死(處置：停藥、回抽、必要時使用hyaluronidase)；(3) 連續心電圖監測，追蹤QT；(4) 檢驗離子化鈣、總鈣、鎂(低Mg會延續低Ca，必須補充)、白蛋白、磷酸；(5) 因會沉澱，禁與sodium bicarbonate或含磷酸液體混合。禁止IM鈣注射。後續治療：口服鈣加維生素D，必要時calcitriol，並追蹤PTH，預備喉痙攣的氣道管理。

## 深入解析

IV calcium gluconate必稀釋、慢輸注、走大口徑路加上心電圖監測。NCLEX兩大陷阱為快速push與和sodium bicarbonate混合(沉澱)。

## 重要概念

- **calcium gluconate IV** — 低鈣首選IV，須稀釋10~20分鐘，心電圖監測，血管刺激物，禁與NaHCO3混合
- **Chvostek and Trousseau** — 輕拍臉頰引發顏面抽動(Chvostek)、血壓帶誘發手腕痙攣(Trousseau)，是低鈣的床邊徵象
- **post-thyroidectomy hypocalcemia** — 副甲狀腺受損，於24~48小時發生，喉痙攣風險，須監測離子化鈣、鎂、PTH

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