# 一名重症個案長時間接受propofol輸注後，出現代謝性酸中毒、橫紋肌溶解、高血鉀與心律不整。護理師優先應如何判讀？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391880&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名重症個案長時間接受propofol輸注後，出現代謝性酸中毒、橫紋肌溶解、高血鉀與心律不整。護理師優先應如何判讀？

## 選項

1. 這是預期藥效
2. 增加propofol以改善鎮靜
3. Propofol輸注症候群（PRIS）：停止輸注，改用其他鎮靜（midazolam/dexmedetomidine），提供支持療法，必要時包括血液透析 **✔ 正確答案**
4. 只加用albuterol處理高血鉀

**正確答案: 3**

## 解析

正確（2）：Propofol輸注症候群（PRIS）是長時間高劑量propofol（>48小時、>4 mg/kg/hr）的罕見但致命併發症。粒線體功能障礙會造成代謝性酸中毒、橫紋肌溶解、高血鉀、AKI、心衰竭。應停止propofol，改用鎮靜（midazolam、dexmedetomidine），並提供腎臟替代治療、升壓劑等支持療法。開始propofol前也要篩檢蛋/大豆過敏。（1,3,4）會惡化。

## 深入解析

記憶提示 Propofol =「白色遺忘飲」。注意蛋/大豆過敏 + 長時間高劑量 = PRIS。脂肪乳劑需追蹤TG。用於處置時起效與退效都很快。

## 臨床情境

情境 28歲男性，因ARDS在ICU以propofol 80 mcg/kg/min x 60小時鎮靜。新出現代謝性酸中毒、CK 18000、K+ 6.0、心律不整。

## 重要概念

- **Propofol鎮靜藥** — 脂肪乳劑型鎮靜麻醉藥；起效/退效快；需注意蛋/大豆過敏。
- **Propofol輸注症候群（PRIS）** — 長時間高劑量propofol導致的罕見致命症候群；與粒線體功能障礙相關。
- **Propofol三酸甘油脂監測** — 脂肪乳劑可能造成高三酸甘油脂血症與胰臟炎；長期使用需檢查TG。

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