# 甲狀腺切除後個案Chvostek徵象陽性、口周麻、Ca 7.2 mg/dL。經末梢IV優先選哪一種鈣製劑？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391828&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

甲狀腺切除後個案Chvostek徵象陽性、口周麻、Ca 7.2 mg/dL。經末梢IV優先選哪一種鈣製劑？

## 選項

1. 經末梢IV給葡萄糖酸鈣，外滲時較不易造成組織壞死；calcium chloride保留給緊急狀況的中心靜脈通路 **✔ 正確答案**
2. 經末梢IV給calcium chloride
3. IV氯化鉀
4. 只給口服鈣片

**正確答案: 1**

## 解析

正確（2）：葡萄糖酸鈣較適合末梢IV，組織刺激較低。Calcium chloride元素鈣約3倍，但外滲會造成嚴重壞死，通常保留給心搏停止等中心靜脈急救使用。（1）有組織傷害風險。（3）急性有症狀低血鈣需IV。（4）藥物錯誤。

## 深入解析

記憶提示 低血鈣：Chvostek是敲臉引起臉抽動，Trousseau是血壓袖帶引起腕手痙攣。末梢IV選葡萄糖酸鈣，中心靜脈急救才用calcium chloride。

## 臨床情境

情境 48歲女性甲狀腺切除後，Chvostek徵象陽性、口周麻、Ca 7.2 mg/dL。已有末梢IV。

## 重要概念

- **葡萄糖酸鈣** — 末梢IV較常選用的鈣製劑；組織毒性較低。
- **氯化鈣** — 元素鈣較多，但外滲可能造成嚴重組織傷害，通常需中心靜脈。
- **Chvostek/Trousseau 徵象** — 敲臉出現臉部抽動、血壓袖帶誘發手足痙攣，都是低血鈣徵象。

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