護理師照護一位發生腹水的肝硬化病人。哪項檢驗值最可能是這種液體移行的原因？
A nurse is caring for a client with cirrhosis who has developed ascites. Which laboratory value is the most likely cause of this fluid shift?
- AIncreased serum bilirubin血清膽紅素增加
- BElevated ALT/ASTALT/AST 升高
- CDecreased prothrombin time凝血酶原時間縮短
- DDecreased serum albumin✓ 正解血清白蛋白降低
肝硬化導致腹水（Ascites）的機轉主要與血漿膠體滲透壓下降有關。肝臟是合成白蛋白（Albumin）的唯一器官，當肝功能衰竭時，血清白蛋白濃度降低，血管內的膠體滲透壓隨之下降，導致水分從血管內滲透到組織間隙及腹腔。此外，門脈高壓（Portal Hypertension）也會增加流體靜力壓，加劇腹水的形成。臨床思路上，護理師應監測白蛋白水平，並觀察有無低血容跡象（因液體移位至第三空間）。治療可能包括限制鈉攝取、使用利尿劑或輸注白蛋白。ALT/AST 升高反映肝細胞受損，但非腹水的直接機轉。
The mechanism by which cirrhosis causes ascites is mainly related to decreased plasma colloid osmotic pressure. The liver is the only organ that synthesizes albumin; when liver function fails, serum albumin decreases, lowering vascular colloid osmotic pressure and causing fluid to seep from the vessels into the interstitial space and peritoneal cavity. In addition, portal hypertension increases hydrostatic pressure, exacerbating ascites formation. Clinically, the nurse should monitor albumin levels and watch for signs of hypovolemia (since fluid shifts to the third space). Treatment may include sodium restriction, diuretics, or albumin infusions. Elevated ALT/AST reflects hepatocellular damage but is not the direct mechanism of ascites.
兩地臨床理路一致。美國 NCLEX 考試中，處理腹水常考「腹腔穿刺術（Paracentesis）」的護理，例如術前需排空膀胱（避免誤刺）及術後監測血壓（預防低血容休克）。