# 一位護理師正在為非何杰金氏淋巴瘤的病患開始第一次rituximab輸注。輸注進行30分鐘時，病患出現發燒、寒顫、呼吸困難和低血壓。優先的處理措施為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391867&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位護理師正在為非何杰金氏淋巴瘤的病患開始第一次rituximab輸注。輸注進行30分鐘時，病患出現發燒、寒顫、呼吸困難和低血壓。優先的處理措施為何？

## 選項

1. 等待30分鐘再評估
2. 提高輸注速率以更快完成劑量
3. 停止輸注，以生理食鹽水維持IV通路，通知醫療者，依流程給追加抗組織胺/類固醇/epinephrine，並監測腫瘤溶解症候群 **✔ 正確答案**
4. 鼓勵口服水分

**正確答案: 3**

## 解析

正確 (2)：Rituximab 具有 FDA 加框警語關於嚴重輸注反應（細胞激素釋放症候群）—最常見於第一次給藥的30-120分鐘內。停止輸注，以生理食鹽水維持靜脈輸液，通知醫師，依嚴重度給予額外抗組織胺/類固醇/腎上腺素。緩解後，以50%速率重新開始輸注。監測高腫瘤負荷病患的腫瘤溶解症候群。(1,3,4) 危險。

## 深入解析

記憶提示 Rituximab第一劑容易血壓下降；慢速輸注並確認APAP、diphenhydramine、steroid前置用藥。治療前需篩檢B肝再活化。

## 臨床情境

情境 58歲男性NHL接受第一次rituximab輸注。已給acetaminophen + diphenhydramine + steroid前置用藥。30分鐘後：38.5°C、寒顫、呼吸困難、BP 88/52。

## 重要概念

- **Rituximab 抗CD20抗體** — 抗CD20單株抗體，用於B細胞淋巴瘤、RA、血管炎；有輸注反應警示。
- **細胞激素釋放症候群** — 生物製劑輸注時細胞激素急升造成的急性發炎反應。
- **B型肝炎再活化** — Rituximab可使潛伏HBV再活化，治療前需篩檢。

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