# 一位 74 歲患有 COPD 及 BPH 的男性，開始使用 umeclidinium 後，主訴新發生的排尿起始困難及排尿不盡感。護理師最適當的行動為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391779&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位 74 歲患有 COPD 及 BPH 的男性，開始使用 umeclidinium 後，主訴新發生的排尿起始困難及排尿不盡感。護理師最適當的行動為何？

## 選項

1. 通知處方者；umeclidinium的抗膽鹼作用可能加重BPH相關尿滯留，可能需要替代治療 **✔ 正確答案**
2. 停止所有氣喘/COPD藥物並觀察
3. 鼓勵每天限制水分少於1公升
4. 安撫病人這與藥物無關

**正確答案: 1**

## 解析

正確 (2)：長效抗膽鹼藥物（umeclidinium、tiotropium、aclidinium、glycopyrronium）可透過膀胱上的 M3 受體阻斷，加重 BPH 的尿滯留。當有嚴重 BPH 或已存在尿滯留時應謹慎使用／禁用。醫療提供者可能會改用單一 LABA 或 LABA/ICS 的處方。(1) 此為真實的副作用。(3) 限制液體攝入對 COPD 有害。(4) 停用所有治療會增加 COPD 惡化的風險。

## 深入解析

Memory Tip LAMA + BPH = 小心。抗膽鹼會放鬆detrusor並收縮內括約肌，使尿滯留惡化。開始前篩檢BPH/青光眼病史。

## 臨床情境

Scenario 74歲男性，COPD與BPH，使用umeclidinium 62.5 mcg daily 2週。新出現排尿遲疑、尿流弱、排不乾淨感。

## 重要概念

- **LAMA注意事項** — 閉角型青光眼、BPH/尿滯留、某些DPI載體的嚴重乳蛋白過敏。
- **尿滯留** — 無法排空膀胱；BPH時會被抗膽鹼藥加重。
- **逼尿肌放鬆** — M3阻斷降低膀胱收縮力，造成尿滯留。

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