— 藥理與非經腸給藥 · MEDIUM · MCQ —
病人因深部靜脈栓塞接受持續肝素（Heparin）滴注。護理師發現其 aPTT 為 120 秒（對照值 35 秒）。護理師應優先採取哪項行動？
A client is receiving a continuous heparin infusion for deep vein thrombosis. The nurse notes the client's aPTT is 120 seconds (control 35 seconds). Which action should the nurse prioritize?
- ARecheck the aPTT in 1 hour1小時後重新檢測 aPTT
- BPrepare protamine sulfate準備硫酸普魯卡因胺
- CIncrease the infusion rate增加輸注速率
- DStop the heparin infusion✓ 正解停止肝素輸注
— Explanation · 中文詳解 —
Heparin 的治療範圍 aPTT 通常為對照值的 1.5 至 2.5 倍（約 52-87 秒）。120 秒已嚴重超標，出血風險極高。首要步驟是立即停藥以防止出血。Protamine sulfate 是拮抗劑，通常在停藥後病人仍有活動性出血時才使用。
The therapeutic range for aPTT on heparin is typically 1.5 to 2.5 times the control value, approximately 52 to 87 seconds. An aPTT of 120 seconds indicates a critical overdose with a high risk of hemorrhage, making it the nurse's priority to immediately stop the infusion to prevent bleeding complications.
✦ 台美臨床差異
美國護理師多依照醫院的 Heparin Protocol 自行調整流速或停藥；台灣則多需先照會醫師取得醫囑後執行。