— 生理適應 · MEDIUM · SATA —
下列哪些臨床發現顯示急性胰臟炎病人可能出現全身性發炎反應症候群的併發症?(選所有適合的)
Which of the following clinical findings in a client with acute pancreatitis indicate a potential complication of systemic inflammatory response? (Select all that apply.)
- ARespiratory rate 26 breaths/min✓ 正解呼吸頻率 26 次/分
- BTemperature 38.6°C (101.5°F)✓ 正解體溫 38.6°C (101.5°F)
- CHeart rate 110 beats/min✓ 正解心率 110 次/分
- DWhite blood cell count 18,000/mm³✓ 正解白血球計數 18,000/mm³
- ESerum amylase 450 U/L血清澱粉酶 450 U/L
— Explanation · 中文詳解 —
SIRS(全身性發炎反應症候群)的判斷標準包括:體溫異常(>38°C)、心跳過速(>90次/分)、呼吸過速(>20次/分)以及白血球計數異常(>12,000/mm³)。急性胰臟炎若併發 SIRS,顯示病情嚴重,可能導致多重器官衰竭。澱粉酶升高是胰臟發炎診斷指標,而非 SIRS 的定義標準。
Systemic inflammatory response syndrome (SIRS) is indicated by a temperature greater than 38°C, heart rate over 90 beats/min, respiratory rate exceeding 20 breaths/min, and a white blood cell count above 12,000/mm³. These findings reflect a systemic inflammatory process, whereas elevated serum amylase confirms pancreatitis but is not a criterion for SIRS.
✦ 台美臨床差異
台美臨床對於 SIRS 評估的認知一致,但美國護理資訊系統常自動計算 SIRS 分數並提醒醫療團隊。