一位 18 歲男性因機車車禍導致創傷性腦損傷（TBI），目前正在加護病房恢復中。護理師密切監測其神經學狀態。過去一小時內，他的血壓由 130/80 mmHg 上升至 190/60 mmHg，心跳下降至 45 下/分，呼吸變得不規則並出現呼吸暫停。這些徵象最可能代表下列哪一項神經學急症？
An 18-year-old male is recovering in the intensive care unit after a traumatic brain injury (TBI) from a motorcycle collision. The nurse is monitoring his neurologic status. Over the past hour, his blood pressure has risen from 130/80 mmHg to 190/60 mmHg, his heart rate has dropped to 45 beats per minute, and his respirations have become irregular with periods of apnea. Which neurologic emergency do these findings most likely represent?
- ACushing's triad indicating impending brainstem herniation from increased intracranial pressure (ICP)庫欣氏三病徵，表示顱內壓 (ICP) 升高導致的腦幹疝出臨危狀態正確答案
- BBeck's triad indicating cardiac tamponade貝克氏三病徵，表示心包填塞
- CVirchow's triad indicating pulmonary embolismVirchow 氏三病徵，表示肺栓塞
- DNeurogenic shock from spinal cord injury脊髓損傷引起的神經性休克
- A庫欣氏三病徵，表示顱內壓 (ICP) 升高導致的腦幹疝出臨危狀態
本題核心為辨識顱內壓升高（Increased ICP）末期徵象——庫欣氏三病徵（Cushing's Triad）。當顱內壓持續升高、即將造成腦幹疝脫時，病人會出現三項典型生理反應：(1) 收縮壓上升而舒張壓相對不變，形成「變寬的脈搏壓（widened pulse pressure）」，反映身體試圖維持腦部灌流壓；(2) 因副交感（迷走神經）反射性興奮造成「心搏過慢（bradycardia）」；(3) 因腦幹呼吸中樞受壓而出現「不規則呼吸或呼吸暫停（irregular respirations / Cheyne-Stokes pattern）」。臨床上同時出現「高血壓 + 心搏過慢 + 不規則呼吸」即為 Cushing's Triad，是即將發生腦疝的危急徵象，須立即通知醫師並準備降低 ICP 的處置（如抬高床頭、過度換氣、滲透性利尿劑）。 正確答案 A 對齊此典型描述。選項 B 的 Beck's triad 是心包填塞徵象（低血壓、頸靜脈怒張、心音模糊），與本題血壓上升相反。選項 C 的 Virchow's triad 是血栓形成的三個危險因子（血流阻滯、血管內皮損傷、高凝血狀態），屬於病因分類而非急性生命徵象。選項 D 的神經性休克通常呈現低血壓加上心搏過慢，與本題的高血壓表現不符。 臨床推理：護理師需熟悉 Cushing's Triad 並能及早辨識，因其代表病人已進入危急狀態，及早通報才能爭取降腦壓的治療時機。
- A · 正確答案庫欣氏三病徵，表示顱內壓 (ICP) 升高導致的腦幹疝出臨危狀態
收縮壓上升合併脈壓變寬、心搏過慢與不規則呼吸是 Cushing's Triad 的典型表現，代表顱內壓升高及即將發生的腦幹疝脫，是需要立即處置的神經學急症。
- B貝克氏三病徵，表示心包填塞
Beck's triad 為心包填塞的徵象，包含心音模糊、頸靜脈怒張與低血壓，與本題的高血壓表現不符。
- CVirchow 氏三病徵，表示肺栓塞
Virchow's triad 描述血栓形成的三個危險因子（血流阻滯、血管內皮損傷、高凝血狀態），屬於病因分類，與本題的急性生命徵象變化無關。
- D脊髓損傷引起的神經性休克
脊髓損傷造成的神經性休克通常因交感神經張力喪失而出現低血壓與心搏過慢，與本題的血壓上升表現不符。
「Cushing's Triad (庫欣氏三病徵) = 腦壓過高ICP」絕對是全球護理與專科進階急救 (ACLS/ETTC) 第一堂課必記知識，用來嚴格區分病患到底是腦壓高，還是敗血症發燒的基準公式。
English explanation
Option A is correct because the combination of rising systolic pressure with relatively unchanged diastolic pressure, bradycardia, and irregular respirations or apnea is Cushing's triad. Persistent increased intracranial pressure that threatens brainstem herniation widens the pulse pressure as the body attempts to preserve cerebral perfusion, triggers reflex vagal slowing of the heart, and compresses brainstem respiratory centers, producing irregular or Cheyne-Stokes respirations. This is an emergency requiring immediate physician notification and preparation for measures to lower intracranial pressure, such as elevating the head of the bed, hyperventilation, and osmotic diuretics. Option B is incorrect because Beck's triad describes cardiac tamponade with hypotension, jugular venous distention, and muffled heart sounds. Option C is incorrect because Virchow's triad describes blood stasis, endothelial injury, and hypercoagulability as causes of thrombosis rather than acute vital-sign changes. Option D is incorrect because neurogenic shock usually causes hypotension with bradycardia, not hypertension.
最近修訂：2026-10-06