帕友有个用药“蜜月期”

风刀霜剑

　　3年前李大爷被诊断为帕金森病，经过药物治疗后，走路迈腿缓慢、静止性震颤等症状有所改善。但最近几个月，他发现自己在两次服药间隔期常常会出现身体不受控制舞动。患帕金森病5年、一直坚持服药的张阿姨，近一年来也出现了一些运动异常，有几次行走时突然停下来，就像是被“点了穴”动弹不得。
　　北京协和医院神经科副主任医师王含大夫告诉《生命时报》记者：“帕友出现的这些运动异常，实际上都是帕金森病运动并发症的表现。其发生不仅与长期应用左旋多巴制剂有关，还与用药的总量、发病年龄、病程密切相关。用药总量越大、用药时间越长、发病年龄越轻、病程越长，越易出现运动并发症。”
　　王含大夫解释说，由于帕金森病的发病机理是患者脑内多巴胺含量少于常人，因此，药物治疗主要采取间断性补充多巴胺。大部分帕金森病患者在服药头3~5年内会获得比较满意和持续的疗效，但这个“蜜月期”一过，绝大多数患者都会出现异动症和运动波动等并发症，表现为头面部、四肢或躯干的不自主舞蹈样、投掷样的运动，还可出现“冻结步态”，即行走时身体突然停下来，就像被“冻结”了一样，如果患者身处危险环境中，后果将不堪设想。
　　由于发病年龄和病程均是不可控的因素，因此通过长程管理的治疗方案可延缓帕友出现运动并发症。按照细水长流的用药原则，左旋多巴宜从小剂量开始，逐渐缓慢加量，症状的控制能满足日常生活需要即可，不求全效;患者不要随意增减药量，如果效果不理想要及时就医，找专科医生调药。另外，用药选择上，早期可以用一些对运动波动影响小的药物，比如非麦角类多巴胺受体激动剂，可以预防或推迟运动并发症的发生。
　　最后，王含大夫特别提醒，帕友服用左旋多巴时要规律，并且一定要空腹(饭前一个小时或饭后一个半小时服用)。这是因为食物中的蛋白质会和左旋多巴胺竞争性结合受体，导致药效降低，人为地造成运动并发症提前发生。另外，帕友日常生活中应坚持中等强度的运动，有助推迟运动并发症的发生。
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