# 一名因糖尿病胃輕癱使用metoclopramide 10 mg QID達14週的個案，出現新的反覆咂嘴與伸舌。護理師的優先行動為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391808&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名因糖尿病胃輕癱使用metoclopramide 10 mg QID達14週的個案，出現新的反覆咂嘴與伸舌。護理師的優先行動為何？

## 選項

1. 暫停metoclopramide並通知醫師 — 遲發性運動障礙是帶黑框警告的嚴重副作用，超過12週風險增加 **✔ 正確答案**
2. 繼續治療並加用benztropine
3. 增加劑量以更好控制症狀
4. 安撫個案並觀察1個月

**正確答案: 1**

## 解析

正確 (2)：Metoclopramide有遲發性運動障礙黑框警告，可造成不可逆的不自主動作；使用超過12週、高齡與女性風險增加。應停藥並通知醫師。(1) Benztropine治療急性肌張力不全，不是TD；繼續用藥會增加傷害。(3) 增量會惡化。(4) 延遲可能造成永久性TD。

## 深入解析

記憶提示 Metoclopramide =「12週後要OFF」。遲發性運動障礙不同於急性肌張力不全。兒童與高齡者需最低劑量、最短期間。

## 臨床情境

情境 62歲女性，因糖尿病胃輕癱使用metoclopramide 10 mg PO QID × 14週。新出現咂嘴、伸舌、不自主臉部動作。

## 重要概念

- **Metoclopramide胃動力藥** — D2拮抗促胃腸蠕動藥，用於胃輕癱、GERD與止吐。
- **遲發性運動障礙** — 晚發的不自主重複動作；可能不可逆。
- **限期治療** — 除非效益明顯大於風險，metoclopramide不應超過12週。

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