# 一位使用bevacizumab治療轉移性結腸癌的個案，主訴嚴重腹痛及血性腹瀉。護理師的優先判讀為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391869&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位使用bevacizumab治療轉移性結腸癌的個案，主訴嚴重腹痛及血性腹瀉。護理師的優先判讀為何？

## 選項

1. 從生物製劑立即改成化療
2. 一般痔瘡
3. 預期中的腸胃副作用
4. 懷疑腸胃道穿孔，緊急通知醫療者、暫停bevacizumab、準備影像檢查與可能手術；也評估高血壓、蛋白尿與血栓事件 **✔ 正確答案**

**正確答案: 4**

## 解析

正確選項(2)：Bevacizumab（抗血管內皮生長因子）會影響傷口癒合；黑框警語包括：胃腸穿孔、嚴重出血、血栓、高血壓、蛋白尿、傷口裂開。嚴重腹痛加上血性腹瀉需擔憂穿孔的可能性 — 為緊急情況。(1,3) 非優先考量範疇。(4) 屬治療計畫，非急性處置。

## 深入解析

記憶提示 Bevacizumab阻斷VEGF，要看高血壓、蛋白尿、出血、血栓、腸穿孔與傷口癒合；手術前後需停藥。

## 臨床情境

情境 60歲男性使用bevacizumab第8週；新發嚴重腹痛、血便腹瀉、BP 168/98。

## 重要概念

- **Bevacizumab 抗VEGF** — 抗VEGF藥物；有腸胃道穿孔等多項黑框警示。
- **抗血管新生不良反應** — 高血壓、蛋白尿、出血、血栓、腸胃道穿孔、傷口癒合障礙。
- **術前停藥** — 手術前4-6週停用，傷口癒合後再恢復。

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