# 情境 55歲MRSA菌血症個案接受IV vancomycin。藥師開立trough。護理師何時抽trough?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375221&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 55歲MRSA菌血症個案接受IV vancomycin。藥師開立trough。護理師何時抽trough?

## 選項

1. 護理師計劃在第二次預定給藥前30分鐘抽取谷濃度檢體，因為相信在首次給藥後，藥物已達到足夠的治療濃度，而在下次給藥前抽血可反映監測所需的最低濃度。
2. 護理師計劃在第三次給藥完成後60分鐘抽取谷濃度檢體，因為此時機反映了藥物濃度達高峰時的峰值濃度，且是vancomycin治療監測的標準。
3. 下一劑前約30分鐘抽(通常第4劑前)，達穩定濃度並反映最低血清濃度；重度MRSA感染目標15~20 mg/L；現行指引漸傾向以AUC為基礎調量。 **✔ 正確答案**
4. 護理師計劃在開始vancomycin首次給藥前立即抽取谷濃度檢體，因為需要基礎藥物濃度來計算初始劑量並預測輸注後將達到的峰值濃度。

**正確答案: 3**

## 解析

Vancomycin為糖肽類抗生素，用於嚴重G(+)感染包含MRSA菌血症、心內膜炎、肺炎、皮膚軟組織與骨關節感染。療效與毒性間治療範圍狹窄，必須做治療藥物監測。Trough採血：達穩定濃度後(q12小時時通常第4劑前)，於下一劑前約30分鐘採血。各適應症trough目標：重症MRSA(菌血症、心內膜炎、腦膜炎、骨髓炎、重症肺炎)為15~20 mg/L；其他較輕感染10~15 mg/L。2020 ASHP/IDSA/PIDS/SIDP新指引建議AUC為基礎之給藥(目標AUC/MIC 400~600)，使用兩個點(peak與trough)或Bayesian軟體，因僅以trough可能過量造成AKI。護理職責：確保時間正確、申請單註明劑次與時間、回報醫師調整。第3劑後60分鐘為peak式(少見)；首劑時尚未達穩定；第2劑輸注期間採血無法解讀。

## 深入解析

Trough=穩定濃度後下劑前30分鐘。重症MRSA目標15-20 mg/L。AUC基準是新標準。

## 重要概念

- **vancomycin trough** — 下劑前30分鐘、達穩態、重症MRSA 15-20 mg/L、採血時間需精準
- **AUC-guided dosing** — 2020 ASHP/IDSA、AUC/MIC 400-600、Bayesian、減少AKI
- **MRSA bacteremia** — 甲氧西林抗藥性金黃葡萄球菌、菌血症、vancomycin重症適應症

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