# 一位馬拉松跑者在 38°C 的高溫下倒下，直腸溫度 41.4°C，且意識狀態改變。優先的處置是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375128&lang=zh-tw  
> language: zh-TW  
> subject: NCLEX-RN  
> category: PA

## 題目

一位馬拉松跑者在 38°C 的高溫下倒下，直腸溫度 41.4°C，且意識狀態改變。優先的處置是什麼？

## 選項

1. 以冷水浸泡迅速外部降溫至核心溫度39°C **✔ 正確答案**
2. 給予acetaminophen 1000 mg口服
3. 以溫水擦浴逐漸降溫
4. 以dantrolene作為heat stroke之解毒劑

**正確答案: 1**

## 解析

運動型熱中暑（核心體溫超過 40°C 且合併神經功能障礙）應以快速降溫處置——冷水（或冰水）浸泡是運動型熱中暑的黃金標準（每分鐘降溫約 0.15–0.30°C）。目標：在 30 分鐘內使核心體溫降至 39°C 以下。若無法浸泡，可改用蒸發散熱（水霧噴灑加風扇）及在頸部、腋下、腹股溝放置冰袋等替代方案。退燒藥（acetaminophen、aspirin）無效，因為下視丘的體溫設定點並未升高。Dantrolene 用於治療惡性高熱，而非熱中暑（雖然有時用於抗精神病藥物惡性症候群）。

## 深入解析

classic vs exertional:classic=年長者環境性,首選蒸發降溫;exertional=運動員,首選浸泡。兩者皆需快速。

## 臨床情境

HR 148、BP 92/56、GCS 12。無HF或心臟病史。

## 重要概念

- **Heat stroke** — 核心溫度>40°C合併CNS功能障礙 — 體溫調節失敗。
- **冷水浸泡** — 勞動性heat stroke之黃金標準降溫。
- **蒸發降溫** — 噴水加風扇 — 無法浸泡時的替代法。

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