一位深部靜脈栓塞病人正在接受持續性靜脈肝素（Heparin）點滴治療。護理師發現病人的活化部分凝血活酶時間（aPTT）為 110 秒。護理師應優先採取哪項行動？
A client is receiving a continuous intravenous heparin infusion for deep vein thrombosis. The nurse notes that the client’s activated partial thromboplastin time (aPTT) is 110 seconds. Which action should the nurse take first?
- ANotify the provider to request a PT/INR level通知醫師要求檢測 PT/INR
- BAdminister Vitamin K as ordered依醫囑給予維生素 K
- CIncrease the infusion rate per protocol依照協議增加輸注速率
- DStop the heparin infusion✓ 正解停止肝素輸注
肝素（Heparin）的治療目標是將 aPTT 維持在正常對照值的 1.5 到 2.5 倍。一般 aPTT 正常值約為 30-40 秒，因此治療區間通常在 45-70 秒或 60-80 秒之間（視醫院規範）。當 aPTT 達到 110 秒時，代表血液過度抗凝，出血風險極高，屬於緊急情況。根據安全管理原則，首要動作是立即停止灌注（Stop the infusion），以防止病情惡化。雖然 protocol 通常會指引如何調整劑量，但在如此高值的數值下，暫停給藥是保護病人的第一道防線。接下來才是通知醫師。維生素 K 是 Warfarin 的解毒劑，而非 Heparin 的解毒劑（Heparin 解毒劑是 Protamine sulfate）。PT/INR 則是用於監測 Warfarin，對於 Heparin 監測不具特異性。
The therapeutic goal of heparin therapy is to maintain the aPTT at 1.5 to 2.5 times the normal control value. The normal aPTT is approximately 30–40 seconds, so the therapeutic range is typically 45–70 seconds or 60–80 seconds (depending on institutional protocol). When the aPTT reaches 110 seconds, the blood is excessively anticoagulated and the bleeding risk is extremely high, constituting an emergency. According to safety principles, the first action is to immediately stop the infusion to prevent further deterioration. Although protocols generally guide dose adjustments, when values are this elevated, holding the medication is the first line of protection. Notifying the provider follows. Vitamin K is the antidote for warfarin, not heparin (the heparin antidote is protamine sulfate). PT/INR is used to monitor warfarin and is not specific to heparin monitoring.
美國醫院普遍採用「Heparin Protocol」或「Nomogram」，護理師根據 aPTT 數值自行在 protocol 範圍內暫停、減量或調整，不需每次詢問醫師；台灣則多需由護理師先回報數值，由醫師下達調整劑量或停藥的醫囑，但緊急情況下護理師仍應具備先停藥再報備的批判性思考。