# 情境 60歲個案準備接受手術預防性IV cefazolin前告訴護理師「20年前服amoxicillin後全身蕁麻疹」。最適當的護理行為為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375218&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 60歲個案準備接受手術預防性IV cefazolin前告訴護理師「20年前服amoxicillin後全身蕁麻疹」。最適當的護理行為為何?

## 選項

1. 一生拒絕所有β-內醯胺類抗生素，改用IV vancomycin。
2. 20年前蕁麻疹無關，未告知任何人逕予cefazolin。
3. 不再評估，預先給diphenhydramine後以全劑量投予cefazolin。
4. 記錄個案敘述的反應細節，與處方者及藥劑部溝通；現代cephalosporin與penicillin的交叉反應遠低於歷史估計(整體約1~2%，cefazolin因獨特側鏈最低)；依原反應嚴重度可選擇與過敏團隊會診後使用cefazolin或試驗劑量、若記錄為真正過敏性休克則改用非交叉的藥物，或進行簡短過敏評估。 **✔ 正確答案**

**正確答案: 4**

## 解析

歷史上penicillin與cephalosporin的交叉反應性曾估計達10%，但受到早期cephalosporin混有penicillin、第一代藥物較大側鏈相似、納入非IgE皮疹等因素干擾。現代資料整體約1~2%，與penicillin側鏈不同的cephalosporin更低(cefazolin獨特側鏈極低)。然而真正penicillin過敏性休克(蕁麻疹、血管性水腫、喘鳴、低血壓)仍須謹慎，與遠期皮疹不同。標準護理：(1) 詳述過敏史 — 反應種類、發生時間、嚴重度、處置 — 正確記錄；(2) 與處方者及藥劑部溝通，判斷原反應屬非嚴重(延遲性斑丘疹、腸胃症狀)或嚴重(IgE介導的過敏性休克或SJS/TEN)；(3) 非嚴重病史多可使用cefazolin及多數3~5代cephalosporin；嚴重IgE史則諮詢過敏科、可監測下試驗劑量或改用替代藥物(vancomycin、clindamycin或視適應症)；(4) 一律拒絕全部β-內醯胺類會奪去重要選項。拒絕全部β-內醯胺類、無視病史、未評估即先給diphenhydramine皆不恰當。

## 深入解析

Penicillin與cephalosporin交叉反應性被歷史高估。應記錄與溝通；勿在未評估下一律避免或一律使用。

## 重要概念

- **cefazolin** — 第一代cephalosporin，用於術前預防，獨特側鏈，與penicillin交叉極低
- **beta-lactam cross-reactivity** — 現代資料1-2%，依側鏈相似性，避免一律避免
- **allergy history detail** — 反應種類、時間、嚴重度、處置 — 判別IgE/非IgE/非過敏的關鍵

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