— 生理適應 · MEDIUM · MCQ —
護理師正在照護一位出現少尿（oliguric）的急性腎衰竭（ARF）病人。哪種體液管理策略最為適當？
A nurse is caring for a client with acute renal failure (ARF) who is now oliguric. Which fluid management strategy is most appropriate?
- AEncourage increased oral fluid intake鼓勵增加口服液體攝取
- BAdminister large volumes of intravenous fluids給予大量靜脈輸液
- CAdminister diuretics to promote urine output給予利尿劑以促進尿液排出
- DRestrict fluid intake to match urine output plus insensible losses✓ 正解限制液體攝取量以匹配尿量加上不顯性失水量
— Explanation · 中文詳解 —
少尿期（oliguric phase）的急性腎衰竭病人，腎臟排泄功能嚴重受損，無法有效排除體內水分，容易導致體液過量。因此，應嚴格限制水分攝取，通常是監測每日尿量，並給予約等於尿量加上蒸發散失（insensible losses，約 400-600 mL）的總量。大量輸液或鼓勵飲水會加劇體液過量，而利尿劑的效果有限。
In the oliguric phase of acute renal failure, the kidneys cannot effectively excrete water, creating a high risk for fluid overload. Therefore, fluid intake must be strictly restricted to match urine output plus insensible losses, typically calculated as approximately 400 to 600 mL above the previous day's urine volume.
✦ 台美臨床差異
美國的腎臟科醫師會依據病人情況精確計算每日液體平衡，護理師嚴格執行；台灣的照護也遵循此原則，但病人對飲食與飲水限制的理解與配合度很重要。