# 護理師向長期使用omeprazole的個案說明延長使用的不良影響。護理師應強調哪一組風險？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391802&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

護理師向長期使用omeprazole的個案說明延長使用的不良影響。護理師應強調哪一組風險？

## 選項

1. 改善骨密度
2. 低鎂血症、維生素B12缺乏、C. difficile感染風險增加、髖部與脊椎骨折、CKD風險 **✔ 正確答案**
3. 降低血紅素A1c
4. 降低肺炎風險

**正確答案: 2**

## 解析

正確 (2)：長期PPI使用（>1年）與低鎂血症、B12缺乏、C. difficile感染增加、社區型肺炎、骨質疏鬆性骨折（髖部/脊椎）、間質性腎炎與CKD相關。應使用最低有效劑量，適應症解除時考慮降階或停用。(1,3,4) 方向錯誤。

## 深入解析

記憶提示 長期PPI =「Mg、B12、C.diff、CKD、骨折、肺炎」。每年檢查Mg、B12，並重新評估適應症。

## 臨床情境

情境 62歲女性，因GERD使用omeprazole 20 mg PO每日一次已5年。醫師要求進行長期PPI風險衛教。

## 重要概念

- **質子幫浦抑制劑** — 不可逆抑制壁細胞H+/K+ ATPase；如omeprazole、pantoprazole、esomeprazole、lansoprazole。
- **低鎂血症** — 長期PPI會降低鎂吸收；可能造成手足搐搦、癲癇、心律不整。
- **PPI降階停用** — 每年重新評估適應症；可行時降階至H2阻斷劑或必要時使用。

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