— 生理適應 · MEDIUM · MCQ —
一位肝硬化病人正在接受乳果糖 (lactulose) 治療。護理師應監測哪項治療效果？
A client with cirrhosis is receiving lactulose. The nurse should monitor for which therapeutic effect?
- ADecreased ascites腹水減少
- BDecreased ammonia levels✓ 正解血中氨濃度降低
- CIncreased urine output尿量增加
- DImproved appetite食慾改善
— Explanation · 中文詳解 —
肝硬化病人常有肝性腦病變，主因是腸道氨 (ammonia) 未被肝臟代謝而進入體循環。乳果糖在腸道中被細菌分解，產生乳酸，可降低腸道 pH 值，將氨轉化為不易吸收的銨離子 (NH4+)，促進其排出，從而降低血氨水平。
Clients with cirrhosis frequently develop hepatic encephalopathy, primarily because intestinal ammonia is not metabolized by the liver and enters the systemic circulation. Lactulose is broken down by intestinal bacteria into lactic acid, which lowers intestinal pH and converts ammonia (NH3) into the poorly absorbed ammonium ion (NH4+), promoting its elimination and reducing blood ammonia levels.
✦ 台美臨床差異
美國肝臟科醫師會密切監測病人血氨值；台灣則多依賴臨床症狀評估，特別是意識狀態的變化。