一位 45 歲男性急性胰臟炎病人突然出現呼吸困難與胸痛。其呼吸速率為 28 次/分，血氧飽和度（SpO2）為 89%（未使用氧氣）。護理師應首先懷疑哪種併發症？
A 45-year-old male client with acute pancreatitis reports sudden shortness of breath and chest pain. His respiratory rate is 28/min and SpO2 is 89% on room air. Which complication should the nurse suspect first?
- AAcute respiratory distress syndrome (ARDS)✓ 正解急性呼吸窘迫症候群 (ARDS)
- BPneumothorax氣胸
- CPulmonary embolism肺栓塞
- DCongestive heart failure充血性心臟衰竭
急性胰臟炎是引發急性呼吸窘迫症候群（ARDS）的高風險因素。胰臟發炎會釋放大量全身性發炎介質與蛋白水解酶，這些物質隨血液循環進入肺部，破壞肺泡毛細血管膜，導致非心因性肺水腫與嚴重低氧血症。臨床思路上，對於急性胰臟炎病人，若出現突發性呼吸窘迫且氧合下降，必須優先考慮 ARDS。肺栓塞雖然也可能，但胰臟炎與 ARDS 的病生理機轉直接相關，且 ARDS 是胰臟炎早期死亡的主要原因之一。早期識別與氧合支持是確保病人安全的關鍵。
Acute pancreatitis is a major risk factor for ARDS. Pancreatic inflammation releases systemic inflammatory mediators and proteolytic enzymes that damage the alveolar-capillary membrane, causing non-cardiogenic pulmonary edema and severe hypoxemia. When a pancreatitis patient develops sudden respiratory distress with poor oxygenation, ARDS is the first concern. While PE is possible, ARDS is more directly linked to pancreatitis pathophysiology and is a leading early cause of death.
在美國 NCLEX 考試中，強調 ARDS 作為胰臟炎「預期併發症」的識別；台灣臨床護理教育亦重視此點，但實務上醫師可能會先開立胸部 X 光以排除多種可能性，而美國護理思維更強調護理師應主動評估病理生理與風險的直接連結。