# 一位因重度子癇前症接受靜脈輸注硫酸鎂的待產婦女，變得混亂，深部肌腱反射消失且呼吸每分鐘10次。護理措施的優先順序為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391764&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位因重度子癇前症接受靜脈輸注硫酸鎂的待產婦女，變得混亂，深部肌腱反射消失且呼吸每分鐘10次。護理措施的優先順序為何？

## 選項

1. 立即停止magnesium輸注，給予calcium gluconate IV並通知醫師 **✔ 正確答案**
2. 開始持續oxytocin輸注
3. 因呼吸抑制給予naloxone
4. 增加magnesium輸注以加深鎮靜

**正確答案: 1**

## 解析

正確 (2)：深部肌腱反射消失、呼吸次數 7-10 mEq/L）。優先措施：停止輸注，給予解毒劑 葡萄糖酸鈣 1 g 靜脈注射超過 3 分鐘，維持呼吸道/呼吸，通知醫師。持續監測反射、呼吸次數、尿量及血清鎂。(1) 增加鎂會加劇毒性。(3) 納洛酮（Naloxone）是反轉鴉片類藥物。(4) 催產素（Oxytocin）會使血壓惡化，且無特定適應症時禁用於重度子癇前症的處理。

## 深入解析

Memory Tip Magnesium toxicity進展：DTR消失 → 呼吸下降 → 心跳停止。解毒劑 = calcium gluconate。CPG 子癇前症治療濃度4-7 mEq/L；監測DTR、RR、尿量≥30 mL/hr。

## 臨床情境

Scenario 32歲G2P1、36週，重度preeclampsia，使用magnesium sulfate 2 g/hr IV。新出現混亂、DTR消失、RR 10/min、SpO2 92%。

## 重要概念

- **Magnesium toxicity** — 血清magnesium過高造成DTR消失、呼吸抑制、混亂，最終可心跳停止。
- **Calcium gluconate解毒劑** — IV calcium可逆轉magnesium toxicity造成的神經肌肉阻斷。
- **Preeclampsia magnesium目標** — 重度preeclampsia/eclampsia預防癲癇時，治療血清magnesium為4-7 mEq/L。

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