# 將三環抗憂鬱劑過量且 QRS 波群寬大的個案的每項措施歸類為「適用」或「不安全」。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=515765&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

將三環抗憂鬱劑過量且 QRS 波群寬大的個案的每項措施歸類為「適用」或「不安全」。

**1.** 支持氣道和通氣

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**2.** 開始持續性心電圖和血壓監測

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**3.** 給予醫囑碳酸氫鈉

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**4.** 使用經授權的苯二氮平類藥物治療癲癇

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**5.** 聯繫毒物中心

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**6.** 給予毒扁豆鹼治療譫妄

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**7.** 給予氟卡尼治療寬 QRS 波群

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## 解析

氣道支持、持續性心電圖監測、毒物中心諮詢、癲癇治療和碳酸氫鈉是適用的；在這種鈉通道阻斷劑表現中，毒扁豆鹼和 IA 或 IC 類抗心律不整藥物是不安全的。

## 深入解析

快速解答
治療鈉通道阻斷並預防癲癇發作和心律不整。

為何這是正確的
三環抗憂鬱劑過量後出現寬 QRS 波群、低血壓和癲癇發作，表示有危及生命的鈉通道阻斷。碳酸氫鈉和支持性毒理學照護是優先事項。

簡單類比或心像
打開阻塞的心臟鈉離子通道；不要再添加其他阻斷劑。

記憶點
TCA 後寬 QRS：碳酸氫鈉和監測。

NCLEX 決策規則
將解毒策略與傳導機制相匹配，並避免使用會惡化傳導或癲癇發作的藥物。

為何其他選項是錯誤的
毒扁豆鹼在 TCA 過量時可能引起危險的併發症，而額外的鈉通道阻斷型抗心律不整藥物會惡化傳導。References
1AHA Focused Update: Life-Threatening PoisoningPoison-center consultation, sodium bicarbonate, and high-dose insulin recommendations

## 臨床情境

TCA 過量反應
保護氣道、治療癲癇、追蹤 QRS 波群和血壓、給予醫囑碳酸氫鈉，並諮詢毒理學。

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