[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-115-1-medical-surgical-036":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":64},"內外科護理學","medical-surgical",{"id":7,"webId":8,"year":9,"session":10,"subject":4,"number":11,"stem":12,"options":13,"answer":18,"answerNote":19,"images":20,"explanation":21,"explanationDeep":22,"topics":23,"freq":10},"nurse-115-1-內外科護理學-036","nurse-115-1-medical-surgical-036",115,1,36,"有關肺栓塞造成的通氣與灌流比失衡（ventilation and perfusion mismatch）之敘述，下列何者正確？",{"A":14,"B":15,"C":16,"D":17},"肺泡與血管間的隔膜增厚，使得氧氣無法擴散進入血流中","細小氣管內有大量濃稠的痰液，阻礙肺泡的通氣","大部分的肺中有充分的血流灌注，但肺泡中未能有足夠的氣體可進行交換","肺泡中有足夠的通氣，但肺中有部分區域血流灌注受阻下降","D",null,[],"本題考點是通氣灌流比失衡的兩種型態辨識。肺栓塞是血栓阻塞肺動脈分支，受阻區域的肺泡仍有正常通氣，卻沒有血流可供氣體交換，形成死腔效應、通氣灌流比上升，故D的「肺泡通氣足夠但部分區域灌流受阻下降」正確。A所述肺泡與微血管間隔膜增厚使氧氣擴散受阻，屬擴散障礙，見於肺纖維化與肺水腫。B所述細支氣管被大量濃稠痰液阻塞而通氣受限，屬通氣不足造成的低通氣灌流比。C所述血流灌注充足但肺泡氣體不足，即分流效應，見於肺塌陷與肺炎實質化，方向與肺栓塞恰好相反，是本題最主要的干擾選項。","把通氣灌流比想成分數，通氣在上、灌流在下，就能把病生理一次分類：分母（血流）被堵住＝比值變大＝死腔效應，代表病是肺栓塞；分子（通氣）被堵住＝比值變小＝分流效應，代表病是痰液阻塞、肺塌陷、肺炎、急性呼吸窘迫症候群。臨床鑑別價值在於分流造成的低血氧對純氧治療反應差，因為氧氣送不到沒有通氣的肺泡；而死腔效應的低血氧對氧氣治療反應相對較好，因為問題在血流分布。肺栓塞另一個特徵是二氧化碳可經未受阻區域代償排出，早期常呈低碳酸血症與呼吸性鹼中毒，這與呼吸道阻塞造成的二氧化碳滯留形成對比。健康的肺整體通氣灌流比約為零點八，直立姿勢下肺頂偏高、肺底偏低，屬生理性差異。可延伸複習深部靜脈栓塞與肺栓塞的三大危險因子。",[24,26,28,30,32],{"term":25,"count":10},"通氣灌流比失衡",{"term":27,"count":10},"肺栓塞死腔效應",{"term":29,"count":10},"分流效應",{"term":31,"count":10},"擴散障礙",{"term":33,"count":10},"低碳酸血症代償",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-115-1-medical-surgical-037","提供腎絲球過濾率為17 mL\u002Fmin\u002F1.73 m 2的病人之護理指導，下列何者正確？",37,{"webId":40,"stem":41,"number":42,"year":43,"session":10},"nurse-106-1-medical-surgical-033","病人下肢出現腫脹、發紅、溫熱感且霍曼氏徵象（Homan’s Sign）呈陽性反應，下列何者為其最有可能的診斷？",33,106,{"webId":45,"stem":46,"number":47,"year":43,"session":48},"nurse-106-2-medical-surgical-047","有關發生急性溶血性輸血反應處置之敘述，下列何者錯誤？",47,2,{"webId":50,"stem":51,"number":52,"year":53,"session":10},"nurse-108-1-medical-surgical-005","病人癲癇發作，意識不清的護理措施，下列何者正確？",5,108,{"webId":55,"stem":56,"number":57,"year":58,"session":10},"nurse-109-1-medical-surgical-049","有關氣喘病人使用糖皮質類固醇吸入劑（glucocorticoid inhaled medication）之護理指導，下列何者正確？",49,109,{"webId":60,"stem":61,"number":62,"year":63,"session":48},"nurse-110-2-medical-surgical-003","腦下垂體腫瘤（pituitary tumor）病人出現雙顳側視野及視力變差，下列何者為其腫瘤壓迫部位？",3,110,"2026-08-06",1787299088953]