# 一名COPD高齡病人每次接受albuterol霧化後都出現心悸與HR 130。醫師改為levalbuterol。最可能的預期效益是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名COPD高齡病人每次接受albuterol霧化後都出現心悸與HR 130。醫師改為levalbuterol。最可能的預期效益是什麼？

## 選項

1. 比albuterol更強的整體支氣管擴張
2. 將陣發性心房顫動轉為竇性節律
3. 降低肺炎風險
4. 只給予具活性的R-isomer，以達到支氣管擴張並減少心搏過速與顫抖 **✔ 正確答案**

**正確答案: 4**

## 解析

正解 (2): Albuterol是R-isomer（活性）與S-isomer（不活性、可能促炎）的racemic mixture。Levalbuterol是純化R-isomer，目的在於提供相似支氣管擴張，同時理論上較少beta-1相關副作用如心搏過速與顫抖。對有心臟共病者可能有用。(1) 不是更強。(3) 無關。(4) 沒有抗心律不整作用。

## 深入解析

Memory Tip Levalbuterol = pure R-isomer，可能更好耐受。注意：比albuterol昂貴許多，臨床效益通常有限。

## 臨床情境

Scenario 72歲男性，COPD與心房顫動。Albuterol霧化造成心悸、HR 130。醫師改用levalbuterol 1.25 mg nebulizer。

## 重要概念

- **Levalbuterol** — 單一R-isomer beta-2 agonist；對出現心搏過速者可作為racemic albuterol替代。
- **Racemic mixture** — Albuterol含R-isomer（活性）與S-isomer（可能促炎）。
- **心臟共病** — AF、CHF、CAD；可考慮levalbuterol或謹慎監測albuterol。

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