一位病人因高血壓急症住進加護病房，血壓 220/130 mmHg，合併嚴重頭痛、意識混亂與視乳突水腫，符合高血壓腦病變，並開始持續靜脈輸注 nicardipine。輸注開始 1 小時後，哪一個血壓讀值代表達到預期的治療反應？
A client is admitted to the intensive care unit with a hypertensive emergency. The blood pressure is 220/130 mmHg, and the client has a severe headache, confusion, and papilledema consistent with hypertensive encephalopathy. A continuous intravenous infusion of nicardipine is started. One hour later, which blood pressure indicates the expected therapeutic response?
- A120/80 mmHg
- B175/100 mmHg正確答案
- C216/128 mmHg
- D140/90 mmHg
- B175/100 mmHg
正確答案是 B。高血壓急症指血壓高於 180/120 mmHg 並合併急性標的器官損傷，本例的高血壓腦病變即屬此類；處置為收治加護病房、連續監測血壓並使用可滴定的靜脈藥物。AHA 與 ACC 高血壓指引指出，沒有特殊情況的高血壓急症，第一小時收縮壓降幅不得超過 25%；若病人穩定，接下來 2 至 6 小時降至 160/100 mmHg 以下，再於 24 至 48 小時內謹慎降到正常。降得太快會讓長期高血壓已右移的腦血流自動調節失效，造成腦、心肌與腎臟缺血。220/130 mmHg 的平均動脈壓約 160 mmHg；175/100 mmHg 代表收縮壓下降約 20%、平均動脈壓下降約 22%，落在目標範圍內。A 下降約 45%、D 收縮壓下降約 36%，都降得太多；C 幾乎沒有下降，需通報並依醫囑調整輸注速率。護理重點包括每 5 至 15 分鐘測血壓或以動脈導管連續監測、神經學評估與尿量監測，並注意低血壓與反射性心搏過速。來源：2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults；2025 AHA/ACC High Blood Pressure Guideline。
- A120/80 mmHg
錯誤。由 220/130 降到 120/80 mmHg 約下降 45%，遠超第一小時 25% 的上限，會造成腦、心肌與腎臟灌流不足。
- B · 正確答案175/100 mmHg
正確。收縮壓下降約 20%，平均動脈壓由約 160 降到約 125 mmHg（約 22%），符合第一小時降幅不超過 25% 的目標。
- C216/128 mmHg
錯誤。216/128 mmHg 幾乎沒有下降，代表治療尚未達到效果，護理師應通報並依醫囑調高輸注速率。
- D140/90 mmHg
錯誤。收縮壓下降約 36%、平均動脈壓下降約 33%，超過第一小時 25% 的上限，降壓過快有缺血風險。
美國高血壓急症幾乎一律收治加護病房，以 nicardipine、clevidipine 或 labetalol 靜脈滴注滴定血壓；台灣同樣以靜脈 nicardipine 或 labetalol 為主，但部分單位仍可見舌下短效降壓藥的習慣，這類作法降壓幅度不可控，兩地指引都不建議。
English explanation
Option B is correct. A hypertensive emergency is a blood pressure above 180/120 mmHg with acute target organ damage, and this client's hypertensive encephalopathy qualifies. Care includes admission to intensive care, continuous blood pressure monitoring, and a titratable intravenous agent such as nicardipine, clevidipine, or labetalol. The AHA and ACC hypertension guidelines direct that, without a compelling condition, the systolic pressure be reduced by no more than 25% during the first hour; if the client is stable, the pressure is then lowered to below 160/100 mmHg over the next 2 to 6 hours and cautiously to normal over 24 to 48 hours. Lowering the pressure faster overwhelms cerebral autoregulation, which is shifted upward in chronic hypertension, and causes cerebral, myocardial, and renal ischemia. The mean arterial pressure of 220/130 mmHg is about 160 mmHg, and 175/100 mmHg represents roughly a 20% fall in systolic pressure and a 22% fall in mean arterial pressure, which is within the target. Option A is incorrect because it is about a 45% reduction, and Option D is incorrect because it lowers the systolic pressure about 36%, both beyond the first-hour limit. Option C is incorrect because the pressure has barely changed and the provider should be notified so the infusion can be titrated. Source: 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults; 2025 AHA/ACC High Blood Pressure Guideline.