# 一名60歲的個案因革蘭氏陰性菌敗血症，正接受gentamicin 1.7 mg/kg每8小時靜脈注射的傳統給藥方式。醫師醫囑於第四劑前後監測峰濃度與谷濃度。護理師應計劃何時採集血液檢體？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375226&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名60歲的個案因革蘭氏陰性菌敗血症，正接受gentamicin 1.7 mg/kg每8小時靜脈注射的傳統給藥方式。醫師醫囑於第四劑前後監測峰濃度與谷濃度。護理師應計劃何時採集血液檢體？

## 選項

1. 第4劑前30分鐘抽trough，給藥；IV輸注結束約30分鐘後抽peak；傳統劑量全身革蘭氏陰性感染目標peak 5~10 mg/L、trough小於2 mg/L；每日一次延長間隔劑量採用不同的nomogram取樣流程。 **✔ 正確答案**
2. peak與trough於兩劑中段同時抽。
3. 劑後4小時抽peak、下劑前4小時抽trough。
4. gentamicin治療範圍寬不需測。

**正確答案: 1**

## 解析

胺基配糖體類抗生素（gentamicin、tobramycin、amikacin、streptomycin）為濃度依賴性殺菌抗生素，治療區間狹窄，需監測藥物血中濃度。有兩種給藥策略：(1) 傳統每日多次給藥——典型劑量為1至2 mg/kg每8小時；谷濃度於下一劑預定給藥前30分鐘抽血；峰濃度於30分鐘靜脈輸注結束後30分鐘抽血（若肌肉注射則為注射後60分鐘）；於第三或第四劑時達穩定狀態；目標峰濃度依適應症而定（全身性革蘭氏陰性菌感染為5至10 mg/L；嚴重感染可達8至10 mg/L），谷濃度應低於2 mg/L以減少毒性；(2) 延長間隔給藥（每日一次，「高劑量脈衝式」）——典型劑量為5至7 mg/kg每24小時，給藥後6至14小時監測單一藥物濃度並對照列線圖（Hartford），或於給藥後8至12小時隨機檢測濃度以確認廓清，目標為24小時谷濃度測不到；此策略可最大化濃度依賴性殺菌作用及抗生素後效應，同時限制腎毒性與耳毒性。兩種策略皆需監測腎功能（肌酸酐、尿量）及耳毒性警訊（聽力變化、耳鳴、眩暈）。若在給藥中途、給藥前同時抽取峰谷濃度，或完全不監測血中濃度，皆因治療區間狹窄而不安全。

## 深入解析

Trough = 下劑前30分鐘；Peak = IV輸注結束30分鐘後。減毒性目標trough小於2 mg/L。

## 重要概念

- **gentamicin peak/trough** — peak 5-10 mg/L、trough小於2 mg/L、30分前/後、第4劑達穩態
- **extended-interval dosing** — 5-7 mg/kg q24h、Hartford nomogram、降低腎/耳毒性、抗生素後效應
- **narrow therapeutic window** — 效果濃度與毒性濃度接近，需監測濃度，採血時間需精準

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