# 個案使用oxymetazoline鼻噴劑每4小時一次已2週，現在表示鼻塞比開始前更嚴重。護理師最適當的解釋為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391792&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

個案使用oxymetazoline鼻噴劑每4小時一次已2週，現在表示鼻塞比開始前更嚴重。護理師最適當的解釋為何？

## 選項

1. 感冒惡化了，請更頻繁地繼續使用噴劑。
2. 改用更長效的局部鼻充血解除劑並無限期使用。
3. 很可能是鼻竇感染，需要口服抗生素。
4. 你出現藥物性鼻炎（反彈性鼻塞）。停止鼻噴劑，改用生理食鹽水沖洗或鼻用類固醇；症狀應在1-2週內改善。 **✔ 正確答案**

**正確答案: 4**

## 解析

正確 (2)：局部鼻充血解除劑（oxymetazoline、phenylephrine鼻噴劑）使用超過3-5天會造成藥物性鼻炎，也就是受體下調導致的反彈性鼻塞。治療為停止噴劑（立即停用或單側鼻孔逐步減量）、生理食鹽水沖洗與鼻用類固醇；通常1-2週內改善。(1) 會惡化循環。(3) 會延續循環。(4) 沒有感染證據。

## 深入解析

記憶提示 局部鼻充血解除劑 =「最多3-5天」規則。超過就可能藥物性鼻炎。口服pseudoephedrine不造成反彈性鼻塞，但有全身副作用。

## 臨床情境

情境 38歲男性，因感冒鼻塞使用oxymetazoline鼻噴劑q4h共2週。現在即使持續使用，鼻塞仍惡化，且需要更頻繁使用。

## 重要概念

- **藥物性鼻炎** — 長期使用局部鼻充血解除劑造成的反彈性鼻塞；以停藥和鼻用類固醇治療。
- **局部鼻充血解除劑** — Oxymetazoline、phenylephrine鼻噴劑，只能短期使用（≤3-5天）。
- **鼻用類固醇** — Fluticasone、mometasone、budesonide，是慢性過敏性鼻炎與反彈鼻塞恢復的一線治療。

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