# 護理師查看一名因COPD長期使用茶鹼的個案，其血清茶鹼濃度為22 mcg/mL。護理師預期會評估到哪一組表現？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391782&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

護理師查看一名因COPD長期使用茶鹼的個案，其血清茶鹼濃度為22 mcg/mL。護理師預期會評估到哪一組表現？

## 選項

1. 噁心、嘔吐、顫抖、心搏過速，可能伴隨癲癇活動 **✔ 正確答案**
2. 心搏過緩、低血壓和嗜睡
3. 反射亢進、肌張力過高和陣攣
4. 針尖樣瞳孔和呼吸抑制

**正確答案: 1**

## 解析

正確 (2)：茶鹼治療範圍為10-20 mcg/mL。毒性（>20）會造成噁心、嘔吐、顫抖、心搏過速、躁動；>30可能出現癲癇與心律不整。(1) 與茶鹼刺激作用相反。(3) 為血清素症候群。(4) 為類鴉片毒性。

## 深入解析

記憶提示 茶鹼像「茶 + 咖啡」的刺激劑；毒性像咖啡因過量，會坐立不安、嘔吐、心跳快、癲癇。臨床指引 治療指數窄；在穩定狀態、調整劑量或加入交互作用藥物後要測濃度。

## 臨床情境

情境 65歲男性，因COPD使用茶鹼300 mg口服每日兩次已1年。今日谷濃度：22 mcg/mL（治療範圍10-20）。主訴新出現噁心與顫抖。

## 重要概念

- **茶鹼治療範圍** — 血清目標10-20 mcg/mL；部分文獻為降低毒性偏好5-15。
- **茶鹼毒性** — 先出現腸胃症狀，接著中樞神經症狀（顫抖、躁動、癲癇）與心血管症狀（心搏過速、心律不整）。
- **甲基黃嘌呤** — 包括茶鹼、胺茶鹼、咖啡因的藥物類別；具磷酸二酯酶抑制與支氣管擴張作用。

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