# 一名高腫瘤負荷的急性白血病個案即將開始誘導化療。哪些預防用藥可避免腫瘤溶解症候群？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391866&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名高腫瘤負荷的急性白血病個案即將開始誘導化療。哪些預防用藥可避免腫瘤溶解症候群？

## 選項

1. Calcium carbonate制酸劑
2. 積極IV補液加allopurinol（高風險或已發生TLS用rasburicase）；監測K、磷、尿酸、鈣與creatinine **✔ 正確答案**
3. 每日aspirin
4. 高蛋白飲食

**正確答案: 2**

## 解析

正確（2）：腫瘤溶解症候群是大量細胞崩解造成高血鉀、高血磷、高尿酸、低血鈣、AKI。預防為積極補液 + allopurinol（xanthine oxidase抑制劑）；高風險或已發生TLS時用rasburicase（重組urate oxidase），將尿酸轉成allantoin。G6PD缺乏者避免使用，因有溶血風險。（1、3、4）無關。

## 深入解析

記憶提示 TLS＝K升、P升、尿酸升、Ca降。預防用補液＋allopurinol，高風險加rasburicase。

## 臨床情境

情境 22歲男性新診斷ALL，WBC很高，開始誘導化療；TLS高風險。

## 重要概念

- **腫瘤溶解症候群** — 大量腫瘤細胞死亡釋放K、P與尿酸，造成AKI和心律不整。
- **Allopurinol 抗尿酸藥** — Xanthine oxidase抑制劑，減少尿酸形成，用於TLS預防。
- **Rasburicase 尿酸氧化酶** — 重組urate oxidase，將尿酸轉成allantoin；G6PD缺乏禁用。

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