一位有肝硬化病史的病人因吐血入院。護理師預期醫師會開立哪種藥物以降低門靜脈壓力？
A client with a history of liver cirrhosis is admitted with hematemesis. Which medication should the nurse anticipate the physician will prescribe to reduce portal vein pressure?
- ASpironolactone螺內酯
- BOctreotide✓ 正解奧曲肽
- CVitamin K維生素K
- DLactulose乳果糖
肝硬化病人吐血通常是由於食道靜脈曲張破裂（Esophageal Varices）。處置的重點是降低門靜脈高壓以止血。奧曲肽（Octreotide）是一種生長抑素類似物，能選擇性地收縮內臟血管，減少流入門靜脈的血量，從而降低門脈壓力，是急性靜脈曲張出血的首選藥物。選項 D（Lactulose）用於降低血氨預防肝腦病變，而非止血；選項 C（維生素 K）雖有助於凝血功能，但不能降低壓力且作用較慢；選項 A（螺內酯）是長期管理腹水的利尿劑，並非急性出血期的首選降壓藥。臨床上需快速識別止血藥物的機轉。
Hematemesis in a client with cirrhosis is usually caused by rupture of esophageal varices. The cornerstone of management is to lower portal venous pressure to control bleeding. Octreotide, a somatostatin analog, selectively constricts splanchnic vessels, reduces blood flow into the portal vein, and thereby lowers portal pressure; it is the first-line agent for acute variceal bleeding. Option D (lactulose) is used to lower ammonia levels for prevention of hepatic encephalopathy, not for hemostasis; option C (vitamin K) supports clotting function but does not lower pressure and acts slowly; option A (spironolactone) is a diuretic used for long-term ascites management and not a first-line agent for lowering pressure in acute hemorrhage. Clinically, rapid recognition of the mechanism of hemostatic drugs is essential.
在美國 NCLEX 考試中，Octreotide 和 Vasopressin 常被一起考，但 Octreotide 因副作用較少（較少引起全身性血管收縮）而更常作為正確選項。台灣臨床實務中，醫師也普遍優先選用 Octreotide (Sandostatin) 作為一線用藥。