# 一位服用 sirolimus 的腎臟移植個案，預定接受選擇性腹股溝疝氣修補手術。護理師最適當的行動為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391875&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位服用 sirolimus 的腎臟移植個案，預定接受選擇性腹股溝疝氣修補手術。護理師最適當的行動為何？

## 選項

1. 不需要改變藥物
2. 停用所有免疫抑制藥1個月
3. 術前將sirolimus劑量加倍
4. 通知醫療提供者；sirolimus會影響傷口癒合，許多移植計畫會在術前停用並以其他藥物銜接，待傷口癒合後再恢復 **✔ 正確答案**

**正確答案: 4**

## 解析

正確選項 (2)：Sirolimus（mTOR 抑制劑）會顯著損害傷口癒合並增加傷口裂開的風險—大多數方案會在手術前暫停使用 sirolimus，並以其他藥物（鈣調神經磷酸酶抑制劑 + MMF）作為過渡直到傷口癒合。此外亦會引起高血脂、口腔潰瘍、蛋白尿、間質性肺病。(1,3,4) 錯誤。

## 深入解析

記憶提示 mTOR抑制劑（sirolimus、everolimus）=「傷口癒合慢 + 血脂升高」。手術前後常需暫停。可用於抗排斥，也用於部分癌症。

## 臨床情境

情境 55歲男性，腎臟移植後1年，正在使用sirolimus 西羅莫司；下個月安排選擇性疝氣修補術。

## 重要概念

- **mTOR抑制劑** — Sirolimus、everolimus；mammalian target of rapamycin抑制劑，會妨礙傷口癒合。
- **Sirolimus術前停用** — 選擇性手術前停用；以CNI + MMF銜接；傷口癒合後恢復。
- **Sirolimus不良反應** — 高血脂、蛋白尿、口腔潰瘍、間質性肺病。

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