— 生理適應 · HARD · MCQ —
一名個案被診斷為急性呼吸窘迫症候群 (ARDS)。下列哪項評估發現最符合此病況的特徵？
A client is diagnosed with acute respiratory distress syndrome (ARDS). Which assessment finding is most characteristic of this condition?
- AHypercapnia with a low pH on arterial blood gas動脈血液氣體分析顯示高碳酸血症伴隨低 pH 值
- BProductive cough with thick, purulent sputum有痰咳嗽且痰液濃稠呈膿性
- CRefractory hypoxemia despite high concentrations of inspired oxygen✓ 正解儘管吸入高濃度氧氣，仍出現難治性低血氧
- DIncreased lung compliance and decreased tidal volume肺順應性增加且潮氣量減少
— Explanation · 中文詳解 —
ARDS 的典型特徵為頑固性低血氧，即便給予高濃度氧氣，病人氧合狀況仍難以改善，這是因肺泡微血管膜通透性增加導致肺水腫所致。D 錯誤：ARDS 導致肺順應性下降；C 為肺炎特徵；D 為換氣不足，雖可見於 ARDS 末期，但非病理核心特徵。
The hallmark of ARDS is refractory hypoxemia: oxygenation remains poor even with high concentrations of inspired oxygen, due to increased alveolar-capillary membrane permeability and resultant pulmonary edema. Option D is wrong because ARDS decreases lung compliance; option B describes pneumonia; option A (hypercapnia) may occur in late ARDS but is not the core pathophysiologic feature.
✦ 台美臨床差異
美台臨床皆重視呼吸機參數調整（如 PEEP 設定），但台灣對於 ARDS 肺保護策略的執行通常更依賴呼吸治療師與醫師的精細監控。