# 臨床情境 紅血球輸注開始 12 分鐘後，病人出現突發寒顫、嚴重下背痛、胸悶、低血壓、心搏過速與深紅色尿液，需要立即處理可能伴隨溶血與休克的嚴重輸血反應。 審查趨勢並選擇最佳的解釋和下一步計畫。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522661&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

臨床情境
紅血球輸注開始 12 分鐘後，病人出現突發寒顫、嚴重下背痛、胸悶、低血壓、心搏過速與深紅色尿液，需要立即處理可能伴隨溶血與休克的嚴重輸血反應。

審查趨勢並選擇最佳的解釋和下一步計畫。

| Time | Data |
| --- | --- |
| Reaction recognition | 血壓 82/48 mm Hg；心率 128/分；寒顫、下背痛和深紅色尿液 |
| After initial response | 輸血停止；開始使用新的生理食鹽水管路和支持性照護；血壓 98/60 mm Hg；心率 108/分 |
| Current laboratory trend | 尿量 12 mL/小時；肌酸酐升高；LDH 升高；結合珠蛋白降低；血漿和尿液中存在血紅素 |

Q1. 應如何解釋此趨勢？

反應已完全解決
溶血持續存在並伴隨急性腎損傷風險
這些發現僅表示局部靜脈刺激

Q2. 哪一個下一步計畫是適當的？

繼續支持腎臟灌注並連續監測尿液、腎臟和凝血功能
因為血壓改善而重新啟動紅血球輸注
等待無尿發生後再通知治療團隊

## 解析

血壓已改善，但尿量下降、肌酸酐升高、乳酸脫氫酶升高、結合珠蛋白降低和血紅素尿顯示持續的血管內溶血，伴隨腎臟損傷風險。腎臟灌注、凝血功能和尿量需要持續支持和再評估。

## 深入解析

快速回答
不要將部分血流動力學恢復誤認為溶血和腎臟風險已解決。

為什麼這是正確的
即使可疑成分已停止輸注，游離血紅素、休克和可能的瀰漫性凝血仍可能損害腎臟。

簡單類比或心像
將每次輸注視為一個受控的臨床系統：核實產品和通路、辨識變化的線索、停止可預防的暴露、穩定病人並確認反應。

記憶點
產品、通路、相容性、輸注線索、保護性措施和再評估。

NCLEX 決策規則
選擇能預防最即時輸注相關傷害的行動，同時保留血管通路和醫囑要求的診斷證據。

為什麼其他選項是錯誤的
重新啟動可疑產品、繞過安全裝置、強行通過阻塞管路或延遲再評估的選項，可能會將可逆的警訊轉變為嚴重的傷害。References
1CDC NHSN Hemovigilance Module Surveillance Protocol, January 2026Definitions and clinical patterns for acute hemolytic reaction, TACO, TRALI, and transfusion-transmitted infection
2CDC Clinical Guidance for Bacterial Contamination and Blood SafetyStop a suspected contaminated transfusion, preserve the unit, culture the patient, and investigate the residual component
3FDA-recognized Circular of Information for Blood and Blood ComponentsTransfusion reaction recognition, immediate discontinuation, product investigation, and supportive care

## 臨床情境

臨床情境
紅血球輸注開始 12 分鐘後，病人出現突發寒顫、嚴重下背痛、胸悶、低血壓、心搏過速與深紅色尿液，需要立即處理可能伴隨溶血與休克的嚴重輸血反應。

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