# 一名上消化道出血個案開始pantoprazole 80 mg IV bolus後接續8 mg/小時持續輸注。治療期間護理師的優先評估為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391804&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名上消化道出血個案開始pantoprazole 80 mg IV bolus後接續8 mg/小時持續輸注。治療期間護理師的優先評估為何？

## 選項

1. 計畫4小時後門診出院
2. 監測血紅素、血比容、血流動力學與持續出血徵象（黑便、吐血），並在72小時重新評估是否仍需IV治療 **✔ 正確答案**
3. 鼓勵每日飲用3公升自由水
4. 檢查光敏性皮疹

**正確答案: 2**

## 解析

正確 (2)：IV PPI在出血性潰瘍內視鏡止血後抑制胃酸，幫助血塊穩定。護理師監測Hgb/Hct、血流動力學、持續出血徵象與輸血需求。穩定72小時後通常轉為口服PPI。(1,3,4) 無關或不適當。

## 深入解析

記憶提示 UGIB使用IV PPI =「止酸、穩血塊」。72小時輸注後轉口服。內視鏡是一線，IV PPI為輔助。

## 臨床情境

情境 58歲男性，消化性潰瘍導致活動性上消化道出血；使用pantoprazole 80 mg IV bolus → 8 mg/小時持續IV。Hgb 8.5，正在輸血。

## 重要概念

- **上消化道出血** — 因消化性潰瘍或靜脈曲張造成吐血、黑便、血流動力學不穩。
- **IV PPI bolus方案** — 內視鏡止血後80 mg IV bolus → 8 mg/小時，共72小時。
- **降階轉換治療** — 穩定後IV PPI轉口服PPI；考慮H. pylori檢測。

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