# 個案因慢性便秘每天使用senna已6個月，現在需要增加劑量才有同樣效果。護理師最佳衛教為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391812&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

個案因慢性便秘每天使用senna已6個月，現在需要增加劑量才有同樣效果。護理師最佳衛教為何？

## 選項

1. 再加入另一種刺激性瀉藥以增加效果。
2. 無限期繼續增加劑量。
3. 只有嚴重便秘時才改用senna。
4. 慢性使用刺激性瀉藥會造成耐受性與瀉藥依賴。請與醫療人員討論以滲透性瀉藥如polyethylene glycol、纖維和足夠水分逐步調整。 **✔ 正確答案**

**正確答案: 4**

## 解析

正確 (2)：長期使用刺激性瀉藥（senna、bisacodyl）會造成耐受性與瀉藥依賴（結腸低張）。改用滲透性瀉藥如PEG、lactulose，搭配足夠水分與膨脹性瀉藥如psyllium，並增加活動。(1,3,4) 會惡化循環。

## 深入解析

記憶提示 瀉藥階梯 =「膨脹性 → 滲透性 → 刺激性（只間歇用）→ lubiprostone/linaclotide」。避免長期每日刺激性瀉藥。

## 臨床情境

情境 58歲女性因慢性便秘每日使用senna達6個月；表示同樣效果需要更高劑量。

## 重要概念

- **刺激性瀉藥** — Senna、bisacodyl；活化腸道蠕動，但長期使用會造成依賴。
- **滲透性瀉藥** — PEG、lactulose、sorbitol；將水拉入腸道，較適合慢性使用。
- **膨脹性瀉藥** — Psyllium、methylcellulose；需足夠水分，是慢性便秘第一線。

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