# 一位近期接受clindamycin治療的病人出現大量水瀉、腹部絞痛和發燒。家屬詢問是否可以讓病人服用loperamide來緩解症狀。護理師的最佳回應是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391815&lang=zh-tw  
> language: zh-TW  
> subject: Crisis Intervention  
> category: PSI

## 題目

一位近期接受clindamycin治療的病人出現大量水瀉、腹部絞痛和發燒。家屬詢問是否可以讓病人服用loperamide來緩解症狀。護理師的最佳回應是什麼？

## 選項

1. Loperamide可安全用來減慢腹瀉。
2. 疑似C. difficile感染時應避免loperamide，因為可能加重毒素滯留並造成毒性巨結腸。治療需要口服vancomycin或fidaxomicin。 **✔ 正確答案**
3. 每4小時使用loperamide以最快見效。
4. 將loperamide與diphenoxylate合併以增強效果。

**正確答案: 2**

## 解析

正確 (2)：抗蠕動藥物（loperamide, diphenoxylate）禁用於疑似或確診的困難梭狀桿菌（C. difficile）感染、嚴重發炎性腸道疾病，以及伴有發燒的細菌性腸炎——它們會滯留毒素/細菌，並有導致毒性巨結腸的風險。CDI 治療：口服 vancomycin 或 fidaxomicin（根據現行 IDSA 指引，已取代 metronidazole 作為第一線用藥）。(1,3,4) 為危險選項。

## 深入解析

記憶提示 Loperamide =「停腸蠕動，也把毒素留在裡面」。CDI、嚴重IBD、發燒痢疾避免使用。過量也會QT延長。

## 臨床情境

情境 70歲女性，因牙科感染使用clindamycin後2週，出現大量水樣腹瀉、腹痛、發燒38.3°C。C. difficile檢驗待報告。

## 重要概念

- **洛哌丁胺** — 作用於腸道的mu-opioid致效劑；止瀉藥；侵襲性細菌性腹瀉/CDI需避免。
- **Clostridioides difficile感染** — 抗生素相關結腸炎；以口服vancomycin或fidaxomicin治療；避免抗蠕動藥。
- **毒性巨結腸** — 結腸大量擴張合併敗血症；loperamide和抗蠕動藥可誘發。

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