一位 72 歲有高血壓病史的病人即將進行心導管檢查。為了降低顯影劑引起的腎病變風險，護理師採取哪項措施最關鍵？
A 72-year-old client with a history of hypertension is scheduled for a cardiac catheterization. Which nursing action is essential to reduce the risk of contrast-induced nephropathy?
- AEnsure adequate hydration prior to the procedure✓ 正解確保術前充分補水
- BDiscontinue all antihypertensive medications for 24 hours停用所有降血壓藥物 24 小時
- CAdminister prophylactic oral antibiotics給予預防性口服抗生素
- DPerform a baseline 12-lead ECG進行基線 12 導程心電圖檢查
顯影劑腎病變（CIN）是心導管檢查常見的併發症，特別是針對高齡或既有腎功能不全的病人。臨床核心機制在於顯影劑導致腎小管缺血及直接細胞毒性，因此確保腎臟在執行過程中有足夠的血流灌注至關重要。護理重點在於預防性補水，通常在檢查前後給予等張生理食鹽水，以稀釋顯影劑濃度並增加尿量，減少腎小管接觸毒性的時間。選項 C 針對感染預防，與腎功能無關；選項 B 可能導致病人術前血壓劇烈波動，增加術中風險；選項 D 為術前常規，但並非針對腎臟保護的關鍵措施。護理師應評估病人的尿量與體液平衡，並依醫囑嚴格執行補水計畫。
Contrast-induced nephropathy (CIN) is a common complication of cardiac catheterization, particularly in older adults and clients with pre-existing renal insufficiency. The core clinical mechanism is renal tubular ischemia and direct cellular toxicity from contrast media; therefore, ensuring adequate renal perfusion during the procedure is essential. The nursing focus is on prophylactic hydration, typically with isotonic normal saline before and after the procedure, to dilute the contrast concentration and increase urine output, thereby reducing the duration of tubular exposure to toxicity. Option C addresses infection prevention and is unrelated to renal function; option B may cause severe preoperative blood pressure fluctuations and increases procedural risk; and option D is a routine preoperative measure but is not the key intervention for renal protection. The nurse should assess the client's urine output and fluid balance and strictly follow the hydration plan as ordered.
美國醫院針對 CIN 風險病人通常有標準的 N-acetylcysteine 給藥或嚴格的 IV 補水 protocol，而台灣醫療環境多由醫師個別開立補水醫囑，護理師需主動監測入出量並確保術前液體補充足夠。