# 一名個案24小時前接受高劑量methotrexate，尿pH 6.5且MTX濃度仍高。優先護理介入是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391865&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名個案24小時前接受高劑量methotrexate，尿pH 6.5且MTX濃度仍高。優先護理介入是什麼？

## 選項

1. 停止leucovorin
2. 減少IV輸液以延緩清除
3. 再次給methotrexate
4. 繼續按時leucovorin rescue，並確保以sodium bicarbonate積極IV補液，使尿pH維持 >7.0 **✔ 正確答案**

**正確答案: 4**

## 解析

正確（2）：高劑量MTX需leucovorin（folinic acid）rescue以預防嚴重骨髓抑制與黏膜炎。以IV bicarbonate讓尿pH >7可增加MTX溶解度，預防腎小管沉澱與AKI。持續至MTX

## 深入解析

記憶提示 Methotrexate是葉酸拮抗劑；救援是leucovorin。尿液鹼化到pH >7。毒性濃度時，glucarpidase可用酵素不活化MTX。

## 臨床情境

情境 14歲骨肉瘤，高劑量methotrexate後24小時；尿pH 6.5，MTX濃度仍高。Leucovorin rescue進行中。

## 重要概念

- **Leucovorin rescue（亞葉酸救援）** — Folinic acid繞過dihydrofolate reductase阻斷，救援正常細胞。
- **尿液鹼化** — IV sodium bicarbonate維持尿pH >7，防止MTX在腎小管沉澱。
- **Glucarpidase 解毒酵素** — MTX清除延遲合併AKI時使用的酵素救援，適用毒性濃度。

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