# 在開始輸注濃縮紅血球十分鐘後，個案出現寒顫、發燒、劇烈背痛、呼吸困難及紅色尿液。優先的處置順序為何？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391883&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

在開始輸注濃縮紅血球十分鐘後，個案出現寒顫、發燒、劇烈背痛、呼吸困難及紅色尿液。優先的處置順序為何？

## 選項

1. 因低血壓而追加PRBC
2. 立即停止輸血，在IV hub處拆下管路，以新管路接生理食鹽水維持IV，通知醫療提供者與血庫，將剩餘血品 + 管路 + 新檢體送回，監測休克/DIC/AKI並依流程治療 **✔ 正確答案**
3. 繼續輸注並給acetaminophen
4. 將速率降為一半並觀察

**正確答案: 2**

## 解析

正確 (2)：典型的急性溶血性輸血反應（ABO 血型不合）——寒顫、發燒、腰部／背部疼痛、低血壓、血紅素尿、呼吸困難、瀰漫性血管內凝血、急性腎損傷。立即停止輸血，拔除輸血套管（不可僅夾住管路），以新的輸液套管使用生理食鹽水維持靜脈輸注，通知醫師，送交血袋及新的血液／尿液檢體進行檢驗，提供支持性照護。(1,3,4) 繼續讓個案暴露於致命性抗原中。

## 深入解析

記憶提示 急性溶血 = 15分鐘內「發燒 + 側腹痛 + 紅尿 + 休克」。停止-拆管-生食-通知-送檢。與發熱性非溶血反應區分：只有發燒，沒有溶血徵象。

## 臨床情境

情境 50歲女性，PRBC輸注10分鐘後新出現畏寒、38.6°C發燒、嚴重背痛、呼吸困難、紅色尿，血壓下降。

## 重要概念

- **急性溶血性輸血反應** — ABO不合造成血管內溶血；可致DIC、AKI；未立即處理可能死亡。
- **停止-拆管-生食維持** — 停止輸血、拆下管路（不只是夾住），用新管路接生理食鹽水維持IV。
- **輸血反應類型** — 急性溶血、發熱性非溶血、過敏/過敏性休克、TRALI、TACO、敗血症性、延遲性溶血。

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