# 情境 70歲使用75 mcg/小時fentanyl透皮貼片個案於家中發生呼吸抑制。EMS給予鼻噴naloxone 4 mg後呼吸恢復。45分鐘後到ED時再次嗜睡、RR 9。為防止持續renarcotization護理師預期的介入為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375178&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## 題目

情境 70歲使用75 mcg/小時fentanyl透皮貼片個案於家中發生呼吸抑制。EMS給予鼻噴naloxone 4 mg後呼吸恢復。45分鐘後到ED時再次嗜睡、RR 9。為防止持續renarcotization護理師預期的介入為何?

## 選項

1. 長效鴉片最終會代謝完，從第一劑naloxone後等24小時。
2. 帶一支鼻噴naloxone回家以備未來使用。
3. 移除fentanyl貼片並清除皮膚殘餘藥物、重複IV naloxone、通常依前一小時有效bolus的2/3每小時開始持續IV輸注，並於貼片depot效應下持續監測RR、SpO2、capnography與鎮靜至少12~24小時。 **✔ 正確答案**
4. 為維持止痛再貼第二片fentanyl。

**正確答案: 3**

## 解析

長效鴉片 — fentanyl透皮貼片(移除後仍有12~24小時depot)、methadone (t½ 15~60h)、緩釋oxycodone/morphine、與未解決暴露源(仍黏貼的貼片、非法fentanyl同類藥) — 比單次naloxone作用久。Naloxone半衰期短(30~90分鐘)，故renarcotization可預期。院內處置：(1) 解除持續鴉片源 — 移除並丟棄fentanyl貼片，清潔皮膚殘餘藥物，停其他輸注，詢問其他鴉片使用史；(2) 如Q2再度進行IV naloxone漸進；(3) 通常以前一小時有效bolus的2/3每小時開始持續IV輸注，每小時重新評估與調整；(4) 貼片移除後因depot效應監測至少12~24小時，含RR、SpO2、持續capnography、鎮靜(POSS)與BP；methadone過量需24~48小時；(5) 必要時轉SC naloxone或延長住院計畫；(6) 疼痛計畫 — 突然停藥會引發戒斷與疼痛，故採多模式替代、緩慢調鴉片、必要時轉成癮醫學科；(7) 記錄與event report。等待、貼第二片或單支鼻噴出院皆不安全。

## 深入解析

長效鴉片加上短效naloxone等於可預期的renarcotization。移除來源、重複bolus、開始持續輸注、監測12~24小時。

## 重要概念

- **fentanyl patch depot** — 移除後12-24小時殘留，持續吸收，過量時先移除並清潔
- **naloxone infusion calculation** — 前一小時有效bolus的2/3每小時，每小時依臨床反應調整
- **extended monitoring** — fentanyl貼片12-24小時、methadone 24-48小時、POSS、RR、capnography、BP

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