# 一名79歲病人因Parkinson震顫使用trihexyphenidyl，因新發混亂、尿滯留與口乾住院。護理師最適當的解釋是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391761&lang=zh-tw  
> language: zh-TW  
> subject: Crisis Intervention  
> category: PSI

## 題目

一名79歲病人因Parkinson震顫使用trihexyphenidyl，因新發混亂、尿滯留與口乾住院。護理師最適當的解釋是什麼？

## 選項

1. 泌尿道感染的非典型表現，造成譫妄及尿滯留，並因全身性疾病導致脫水而出現口乾。
2. 老年人正常的年齡相關變化，包括膀胱張力減弱導致尿滯留、唾液分泌減少，以及偶發性混亂。
3. Trihexyphenidyl造成的抗膽鹼毒性；Beers Criteria建議高齡者避免抗膽鹼性抗Parkinson藥 **✔ 正確答案**
4. 抗精神病藥物惡性症候群的早期表現，是trihexyphenidyl的已知副作用，伴隨自律神經不穩定及混亂。

**正確答案: 3**

## 解析

正解 (2): 混亂、口乾、尿滯留、便秘、視力模糊的組合是典型抗膽鹼毒性。Beers Criteria強烈建議高齡者避免抗膽鹼性抗Parkinson藥（trihexyphenidyl, benztropine），因會增加譫妄、跌倒與認知下降風險；較安全選項如carbidopa-levodopa或amantadine較佳。(1) 不是正常老化。(3) PE表現不同。(4) NMS需發燒、僵硬與自律神經不穩。

## 深入解析

Memory Tip 抗膽鹼毒性 = 熱、乾、紅、瞳孔大/看不清、混亂、尿不出：高熱、乾燥、潮紅、散瞳、譫妄、尿滯留。

## 臨床情境

Scenario 79歲男性，Parkinson病，使用trihexyphenidyl 4 mg/日，因新發混亂、尿滯留、口乾、便秘、視力模糊入院。

## 重要概念

- **抗膽鹼負擔** — 多種藥物累積的抗膽鹼作用；高齡者有明顯認知風險。
- **Beers Criteria** — AGS列出的65歲以上可能不適當藥物清單；包含抗膽鹼性抗Parkinson藥。
- **抗膽鹼毒性** — 過度muscarinic阻斷造成的熱、乾、紅、視力模糊、混亂、尿滯留症候群。

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