帕金森相關(guān)英文詞匯

帕金森有關(guān)英文詞匯小結(jié)Chapter56Parkinson’sDisease帕金森1.Parkinson’sdisease(PD)帕金森2.Highlycharacteristicneuropathologicfindings有高度特異性的神經(jīng)病理學(xué)特性3.Clinicalpresentation臨床體現(xiàn)4.Motordeficits運(yùn)動(dòng)障礙5.Mentaldeterioration精神狀態(tài)惡化6.hallmarkfeatures特性7.substantianigraparscompacta黑質(zhì)致密部(Substantia=物質(zhì)；nigra=黑；parscompacta=密部,SNc)8.Lossofneurons神經(jīng)元缺失9.PresenceofLewybodies出現(xiàn)路易小體（神經(jīng)細(xì)胞內(nèi)蛋白非正常聚集，H&E染色嗜酸性，特性高密度圓心，周邊伴放射性纖維（約10nm））圖片來(lái)源wikipedia10.apositivecorrelationbetweenthedegreeofnigrostriataldopaminelossandseverityofmotorsymptoms黑質(zhì)紋狀體多巴胺減少與運(yùn)動(dòng)癥狀的嚴(yán)重程度呈正有關(guān)11.PDisrelativelyasymptomaticuntilprofounddepletion(70–80%)ofsubstantianigraparscompactaneuronshasoccurred初始無(wú)癥狀，直至黑質(zhì)紋狀體神經(jīng)元大量減少（超出70-80%）才會(huì)出現(xiàn)癥狀12.dopamine-1anddopamine-2receptors多巴胺-1和多巴胺-2受體13.Reducedactivation激活減少14.greaterinhibitionofthethalamus丘腦克制增加圖片來(lái)源：15.Clinicalimprovementmaybemoretiedtorestoringactivityatthedopamine-2receptorthanatthedopamine-1receptor.與多巴胺-1受體相比，臨床治療療效與多巴胺-2受體活性恢復(fù)有關(guān)16.Lossofpresynapticnigrostriataldopamineneuronsresultsininhibitionofthalamicactivityandreducedactivationofthemotorcortex.突觸前黑質(zhì)紋狀體多巴胺神經(jīng)元的缺失造成丘腦活性克制，從而造成運(yùn)動(dòng)皮層激活減少17.PDdevelopsinsidiouslyandprogressesslowlyPD發(fā)病緩慢，不易察覺(jué)18.Initialsymptomsmaybesensory首發(fā)癥狀以感覺(jué)神經(jīng)系統(tǒng)為主19.Classicprimaryfeatures典型癥狀20.Restingtremor靜止性震顫（主動(dòng)肌與拮抗肌交替收縮引發(fā)的節(jié)律性震顫，即病人在安靜狀態(tài)或全身肌肉放松時(shí)出現(xiàn)，體現(xiàn)更明顯）21.Solepresentingcomplaint患者唯一的主訴/癥狀22.bradykinesia運(yùn)動(dòng)緩慢（brady-緩；kinesia-運(yùn)動(dòng)）23.Posturalinstabilitythatmayleadtofalls姿態(tài)不穩(wěn)，常造成摔倒（無(wú)法保持平衡）24.However,onlytwothirdsofPDpatientshavetremorondiagnosis,andsomeneverdevelopthissign但是，僅有2/3的帕金森患者診療時(shí)出現(xiàn)震顫，有些患者可能始終未出現(xiàn)這個(gè)癥狀25.Tremorispresentmostcommonlyinthehands,oftenbeginsunilaterally,andsometimeshasacharacteristic“pill-rolling”quality震顫普通發(fā)生在手，首發(fā)于單側(cè)，含有“搓丸樣”特點(diǎn)（拇指與盤曲的食指）26.Restingtremorisusuallyabolishedbyvolitionalmovementandisabsentduringsleep靜止性震顫普通因自主運(yùn)動(dòng)而終止，并且睡眠狀況下并不出現(xiàn)27.Muscularrigidity肌肉僵直28.Increasedmuscularresistancetopassiverangeofmotion肌肉對(duì)關(guān)節(jié)被動(dòng)活動(dòng)度抵抗增加（注：①Rangeofmotion(ROM)referstotheextentajointcanbemoved.活動(dòng)度：關(guān)節(jié)活動(dòng)范疇；②Activerangeofmotioniswhenpatientsmovetheirlimbsbythemselveswithoutassistance.自主活動(dòng)范疇；③Passiverangeofmotioniswhenapatient’slimbmovementorexerciseisdoneforthem.被動(dòng)活動(dòng)范疇）29.Cogwheel木齒輪30.Upperandlowerextremities上下肢31.Facialmuscles面部肌肉32.Intellectualdeteriorationisnotinevitable智力惡化并不是必然的33.SomepatientsdeteriorateinamannerindistinguishablefromAlzheimer’sdisease某些患者智力惡化的模式與阿爾茲海默癥類似34.Limbmusclerigidity四肢肌肉僵直35.Restingtremor(at3–6Hzandabolishedbymovement)靜止性震顫（3-6赫茲，自主運(yùn)動(dòng)時(shí)可終止震顫）（注：國(guó)際單位制中頻率的單位，它是每秒中的周期性變動(dòng)重復(fù)次數(shù)的計(jì)量）37.Prominentasymmetry呈現(xiàn)明顯的不對(duì)稱性38.Asymmetriconset癥狀起始呈不對(duì)稱性39.Apositiveresponsetodopaminergicmedication多巴胺藥品治療有效40.Decreasedmanualdexterity手操作靈活度下降41.Difficultyarisingfromaseatedposition從坐位到站位困難42.Diminishedarmswingduringambulation行走時(shí)手臂不再擺動(dòng)43.Dysarthria(slurredspeech)構(gòu)音障礙（口齒不清）44.Dysphagia(difficultywithswallowing)吞咽困難45.Festinatinggait(tendencytopassfromawalkingtoarunningpace)慌張步態(tài)（采用小跑而非步行的方式行走）（注：慌張步態(tài)：起步后小步快速往前，腳掌不離地，擦地而行，且身體向前傾，有一種要撲倒在地的趨勢(shì)）46.Flexedposture(axial,upper/lowerextremities)彎曲姿態(tài)（軸向，上下肢）47.“freezing”atinitiationofmovement動(dòng)作起始緩慢48.Hypomimia(reducedfacialanimation)表情缺少49.Hypophonia(reducedvoicevolume)發(fā)聲削弱50.Micrographia(diminutionofhandwrittenletters/symbols)寫字過(guò)小51.Autonomicandsensorysymptoms自主神經(jīng)和感覺(jué)癥狀52.Bladderandanalsphincterdisturbances膀胱及肛門括約肌功效障礙53.Constipation便秘54.Diaphoresis發(fā)汗55.Olfactorydisturbance嗅覺(jué)障礙56.Orthostaticbloodpressurechanges體位性血壓變化57.Paresthesia感覺(jué)異常58.Paroxysmalvascularflushing陣發(fā)性潮紅59.Seborrhea皮脂溢60.Sexualdysfunction性功效障礙61.sialorrhea(drooling)流涎（流口水）62.Apathy淡漠63.Bradyphrenia(slownessofthoughtprocesses)思想遲鈍64.Confusionalstate精神混亂狀態(tài)，意識(shí)含糊狀態(tài)65.Dementia癡呆66.Hallucinosis/psychosis(typicallydruginduced)幻覺(jué)/妄想性精神?。ㄆ胀ㄓ伤幤芬l(fā)）67.Sleepdisorders(excessivedaytimesleepiness,insomnia,obstructivesleepapnea,andrapideyemovementsleepbehaviordisorder)睡眠障礙（日間睡眠過(guò)分，失眠，阻塞性睡眠呼吸暫停、快速眼動(dòng)睡眠行為障礙）（注：快速動(dòng)眼（REM）睡眠行為障礙（RBD）一種發(fā)生在REM睡眠中出現(xiàn)的多個(gè)不自主運(yùn)動(dòng)或行為異常，多為激烈粗暴動(dòng)作，如拳打腳踢、翻滾喊叫、打人、性攻擊等，半數(shù)患者還會(huì)出現(xiàn)顏面、口周及肢體的不自主運(yùn)動(dòng)，并伴有生動(dòng)、驚人的夢(mèng)境，常會(huì)引發(fā)自傷或傷及同睡者）68.NolaboratorytestsareavailabletodiagnosePD.沒(méi)有實(shí)驗(yàn)室檢查能夠作為PD診療的根據(jù)69.Neuroimagingmaybeusefulforexcludingotherdiagnoses神經(jīng)（腦部）成像可輔助排除其它診療70.Medicationhistoryshouldbeobtainedtoruleoutdrug-inducedparkinsonism應(yīng)盡量獲取用藥史以排除藥品誘導(dǎo)的帕金森神經(jīng)機(jī)能障礙71.Medicationinducedparkinsonism(e.g.,inducedbyantipsychotics,phenothiazineantiemetics,ormetoclopramide)藥品誘導(dǎo)的帕金森神經(jīng)機(jī)能障礙（如抗精神病藥，吩噻嗪類止吐藥或甲氧氯普胺）（注：吩噻嗪類止吐藥例如氯丙嗪、異丙嗪、奮乃靜）72.Neurologicconditions神經(jīng)系統(tǒng)疾病73.Essentialtremor特發(fā)性震顫（注：重要為手、頭部及身體其它部位的姿位性和運(yùn)動(dòng)性震顫）74.Corticobasalganglionicdegeneration皮質(zhì)基底神經(jīng)節(jié)變性75.Multiplesystematrophy多系統(tǒng)萎縮（注：臨床體現(xiàn)為不同程度的自主神經(jīng)功效障礙、對(duì)左旋多巴類藥品反映不良的帕金森綜合征、小腦性共濟(jì)失調(diào)和錐體束征等癥狀）76.Progressivesupranuclearpalsy進(jìn)行性核上麻痹77.Thegoalsoftreatmentaretominimizesymptoms,disability,andsideeffectswhilemaintainingqualityoflife.治療目的是減少癥狀、機(jī)體無(wú)力，藥品不良反映，確保生活治療78.Educationofpatientsandcaregiversiscritical,andexerciseandpropernutritionareessential.患者及照護(hù)者教育很重要，并且鍛煉及適宜的營(yíng)養(yǎng)也很重要。79.AnalgorithmformanagementofearlyandlatePD早期及晚期PD的治療流程80.Psychosocialsupport社會(huì)心理支持81.Rasagiline雷沙吉蘭（注：第二代單胺氧化酶克制劑，能阻滯神經(jīng)遞質(zhì)多巴胺的分解，與司來(lái)吉蘭（第一代單胺氧化酶克制劑，涉及思吉寧、咪哆吡、金思平等）相比克制作用強(qiáng)5-10倍，對(duì)長(zhǎng)久應(yīng)用多巴制劑藥效出現(xiàn)衰退的患者也有改善的作用。另外，雷沙吉蘭的代謝產(chǎn)物是一種無(wú)活性的非苯丙胺物質(zhì)，副作用?。?2.Anticholinergic抗膽堿能劑83.Amantadine金剛烷胺84.carbidopa/levodopa甲基多巴/左旋多巴85.Managementofmotorfluctuations控制癥狀波動(dòng)（又稱藥效波動(dòng)，即當(dāng)藥效存在時(shí)病人的運(yùn)動(dòng)正常，一旦藥效消失，病人就會(huì)出現(xiàn)較差的運(yùn)動(dòng)狀態(tài)(例如：顫動(dòng)、僵硬，或是活動(dòng)緩慢)）86.Increasedosingfrequencyoflevodopa增加左旋多巴用藥頻率87.AddMAO-BinhibitororCOMTinhibitor加用單胺氧化酶克制劑或兒茶酚-O-甲基轉(zhuǎn)移酶(COMT)克制劑88.Addadopamineagonist加用多巴胺激動(dòng)劑89.Managementofpeak-dosedyskinesia劑峰異動(dòng)癥管理（注：在左旋多巴血藥濃度達(dá)高峰時(shí)出現(xiàn)運(yùn)動(dòng)障礙,體現(xiàn)為頭面部、四肢或軀干的不自主舞蹈樣或肌張力障礙樣動(dòng)作。）90.Reducedopaminergicdrugdose減少多巴胺能藥品劑量91.Addamantadine應(yīng)用金剛烷胺92.Symptomaticcontrol癥狀控制93.Ageisnotthesoledeterminantfordrugchoice年紀(jì)不是藥品選擇考慮的唯一因素。94.bradykinesia行動(dòng)過(guò)緩95.rigidity僵直96.antiparkinsonianmedications抗帕金森藥品97.Monotherapyusuallybeginswithamonoamineoxidase-B(MAO-B)inhibitor,orifthepatientisphysiologicallyyoung,adopamineagonist.普通單藥起始，如一種單胺氧化酶克制劑。如若患者生理功效尚佳，可考慮多巴胺激動(dòng)劑。98.Forpatientswhoareolder,cognitivelyimpaired,orhavingmoderatelyseverefunctionalimpairment,l-dopa(e.g.,carbidopa/levodopa)ispreferred年紀(jì)較大，認(rèn)知功效損害，有中重度功效損害，建議使用左旋多巴（卡比多巴/左旋多巴）。99.Withthedevelopmentofmotorfluctuations,additionofacatechol-Omethyltransferase(COMT)inhibitorshouldbeconsideredtoextendl-dopadurationofactivity.隨著癥狀波動(dòng)的發(fā)現(xiàn)，可考慮加入兒茶酚-O-甲基轉(zhuǎn)移酶克制劑，以增加左旋多巴的活性。100.Alternatively,additionofanMAO-Binhibitorordopamineagonistshouldbeconsidered或可考慮加用單胺氧化酶克制劑及多巴胺激動(dòng)劑。101.Formanagementofl-dopa-inducedpeak-dosedyskinesias,theadditionofamantadineshouldbeconsidered對(duì)于左旋多巴造成的峰劑異動(dòng)癥，可考慮使用金剛烷胺102.AnticholinergicMedications抗膽堿能藥品103.Anticholinergicdrugscanbeeffectivefortremorandsometimesdystonicfeaturesinsomepatientsbutrarelyshowsubstantialbenefitforbradykinesiaorotherdisabilities.膽堿能藥品對(duì)于某些病人的顫動(dòng)、肌張力障礙為特性的運(yùn)動(dòng)可能有效，但是對(duì)于運(yùn)動(dòng)緩慢及其它運(yùn)動(dòng)障礙無(wú)明顯獲益。104.Theycanbeusedasmonotherapyorinconjunctionwithotherantiparkinsoniandrugs.抗膽堿能藥品能夠單用或與其它抗帕金森類藥品合用。105.Theydifferlittlefromeachotherintherapeuticpotentialoradverseeffects.抗膽堿能類藥品之間在治療潛能和不良反映方面差別不大。106.Anticholinergicsideeffectsincludedrymouth,blurredvision,constipation,andurinaryretention.抗膽堿能的不良反映涉及口感、視覺(jué)含糊、便秘以及尿儲(chǔ)留。107.Moreseriousreactionsincludeforgetfulness,confusion,sedation,depression,andanxiety.較為嚴(yán)重的不良反映涉及健忘、意識(shí)含糊、鎮(zhèn)靜、抑郁以及焦慮。108.Patientswithpreexistingcognitivedeficitsandtheelderlyareatgreaterriskforcentralanticholinergicsideeffects.既已存在認(rèn)知障礙的患者以及老年患者發(fā)生中樞抗膽堿能不良反映的幾率更大。109.Amantadineoftenprovidesmodestbenefitfortremor,rigidity,andbradykinesia.Itmayalsodecreasedyskinesiaatrelativelyhighdoses(400mg/day)金剛烷胺對(duì)于顫動(dòng)、僵直以及行動(dòng)過(guò)緩療效較好，在相對(duì)較高的劑量下（400mg/日）可進(jìn)一步緩和行動(dòng)過(guò)緩。110.Adverseeffectsincludesedation,vividdreams,drymouth,depression,hallucinations,anxiety,dizziness,psychosis,andconfusion.（金剛烷胺）不良反映涉及鎮(zhèn)靜、逼真夢(mèng)境、口干、抑郁、幻覺(jué)、焦慮、困倦、精神錯(cuò)亂以及意識(shí)含糊等。111.Livedoreticularis(adiffusemottlingoftheskinintheupperorlowerextremities)isacommonbutreversiblesideeffect網(wǎng)狀青斑（上肢或下肢皮膚出現(xiàn)的彌漫性的色斑）是金剛烷胺的常見(jiàn)不良反映，可逆轉(zhuǎn)。112.Dosesshouldbereducedinpatientswithrenaldysfunction(100mg/daywithcreatinineclearancesof30–50mL/min,100mgeveryotherdayforcreatinineclearancesof15–29mL/min,and200mgevery7daysforcreatinineclearanceslessthan15mL/min,andthoseonhemodialysis.腎功效不全需調(diào)節(jié)（金剛烷胺）劑量肌酐去除率推薦劑量30-50mL/min100mg/dqd15-29mL/min100mgqod<15mL/min200mg,qw血液透析113.l-dopa,themosteffectivedrugavailable,istheimmediateprecursorofdopamine.左旋多巴是現(xiàn)在可獲得的最有效的抗帕金森類藥品，它是多巴胺直接前體。114.Itcrossestheblood–brainbarrier,whereasdopamine,carbidopa,andbenserazidedonot.左旋多巴可跨越血腦屏障，這一能力使多巴胺、卡比多巴、多巴絲肼（美多芭）都不含有的。115.Ultimately,allPDpatientswillrequirel–dopa最后，全部帕金森患者都會(huì)需要使用左旋多巴。116.Thedecisionwhethertostartl-dopaassoonasthediagnosisismadeoronlywhensymptomscompromisesocial,occupational,orpsychologicalwell-beinghasgeneratedcontroversy對(duì)于何時(shí)啟動(dòng)左旋多巴治療現(xiàn)在尚存爭(zhēng)議，有人認(rèn)為診療后即應(yīng)開(kāi)始使用，有人認(rèn)為只有當(dāng)癥狀影響社會(huì)、工作以及精神狀態(tài)才應(yīng)啟動(dòng)。117.IntheCNSandelsewhere,l-dopaisconvertedbyl-aminoaciddecarboxylase(l-AAD)todopamine.Intheperiphery,l-AADcanbeblockedbyadministeringcarbidopaorbenserazide.在中樞及其它部位，左旋多巴由L-氨基酸脫羧酶轉(zhuǎn)變?yōu)槎喟桶?。在外周，L-氨基酸脫羧酶活性可被應(yīng)用的卡比多巴和多巴絲肼所阻斷。118.CarbidopathereforeincreasestheCNSpenetrationofexogenouslyadministeredl-dopaanddecreasesadverseeffects(e.g.,nausea,vomiting,cardiacarrhythmias,posturalhypotension,andvividdreams)fromperipherall-dopametabolismtodopamine.因此，卡比多巴可提高外源性攝入的左旋多巴進(jìn)入中樞神經(jīng)系統(tǒng)的含量，并且可減少由于左旋多巴代謝為多巴胺造成的不良反映（如惡心、嘔吐、心律失常、體位性低血壓、逼真夢(mèng)境）119.BenserazideisunavailableintheUnitedStates.多巴絲肼在美國(guó)無(wú)藥。120.Startingl-dopaat300mg/day(individeddoses)incombinationwithcarbidopaoftenachievesadequatereliefofdisability.Theusualmaximaldoseofl-dopais800to1,000mg/day.左旋多巴起始劑量為300mg/日，分次服用，普通與卡比多巴合用，對(duì)運(yùn)動(dòng)障礙可達(dá)成較為抱負(fù)的緩和。左旋多巴慣用最大劑量為800-1000mg/日。121.About75mgofcarbidopaisrequiredtoeffectivelyblockperipherall-AAD,butsomepatientsmayneedmore.卡比多巴75mg可有效克制外周L-氨基酸脫羧酶活性，但某些患者對(duì)此的需求量可能增加。122.Carbidopa/l-dopaismostwidelyusedina25/100mgtablet,but25/250mgand10/100mgdosageformsarealsoavailable.卡比多巴/左旋多巴普通是復(fù)合制劑（卡比多巴25mg/左旋多巴100mg），另外尚有25/250mg以及10/100mg規(guī)格的藥品。123.Controlled-releasepreparationsofcarbidopa/l-dopaareavailablein50/200mgand25/100mgstrengths.卡比多巴/左旋多巴控釋制劑有50/200mg和25/100mg兩種規(guī)格的藥品。123.Forpatientswithdifficultyswallowing,anorallydisintegratingtabletisavailable.對(duì)于吞咽困難的患者，可使用口崩片。124.Ifperipheraladverseeffectsareprominent,25mgcarbidopa(Lodosyn)tabletsareavailable.如患者外周不良反映明顯，可額外使用25mg卡比多巴片（商品名：Lodosyn心寧美）125.Thereismarkedintra-andintersubjectvariabilityintimetopeakplasmaconcentrationsafterorall-dopa.口服左旋多巴后，患者藥品血漿達(dá)峰時(shí)間存在明顯的個(gè)體差別（intrasubjectvariability指同一患者每次服藥達(dá)峰時(shí)間可能不同；intersubjectvariability指不同患者服藥達(dá)峰時(shí)間可能不同）126.Mealsdelaygastricemptying,butantacidspromotegastricemptying.進(jìn)食可減慢胃排空，制酸劑可增進(jìn)胃排空。（antacids，普通被翻譯為制酸劑，與H2受體阻滯劑和PPI等抑酸劑不同，普通是含有鋁或（及）鎂的堿性化合物為主，運(yùn)用其中和胃酸的能力）127.l-dopaisabsorbedprimarilyintheproximalduodenumbyasaturablelargeneutralaminoacidtransportsystem.左旋多巴重要在十二指腸近端，通過(guò)中性氨基酸飽和轉(zhuǎn)運(yùn)系統(tǒng)，大量吸取。128.Largeneutralaminoacids(includinghigh-proteinmeals)caninterferewithbioavailability因此大量中性氨基酸攝入（如攝入高蛋白食物）可影響藥品的生物運(yùn)用度。129.l-dopaisnotboundtoplasmaproteins,andtheeliminationhalf-lifeis～1hour.Theadditionofcarbidopaorbenserazidecanextendthehalf-lifeto1.5hours,andtheadditionofaCOMTinhibitor(e.g.,entacapone)canextenditto～2to2.5hours.左旋多巴不予血漿蛋白結(jié)合，消除半衰期約為1小時(shí)。和卡比多巴或多巴絲肼合用可延長(zhǎng)半衰期至1.5小時(shí)，和COMT克制劑（如恩他卡朋）聯(lián)用，半衰期可延長(zhǎng)至2-2.5小時(shí)。130.Long-terml-dopa-associatedmotorcomplicationscanbedisabling.長(zhǎng)久左旋多巴有關(guān)運(yùn)動(dòng)并發(fā)癥可造成患者運(yùn)動(dòng)障礙。131.Themostcommonoftheseareend-of-dose“wearingoff”and“peak-dosedyskinesias.”最常見(jiàn)的運(yùn)動(dòng)并發(fā)癥涉及“劑末藥效消失”和“劑峰異動(dòng)癥”132.Theriskofdevelopingmotorfluctuationsordyskinesiasisfelttobe～10%peryearofl-dopatherapy.However,motorcomplicationscanoccurasearlyas5to6monthsafterstartingl-dopa,especiallywhenexcessivedosesareusedinitially.使用左旋多巴患者出現(xiàn)癥狀波動(dòng)或行動(dòng)緩慢的風(fēng)險(xiǎn)大概為10%/年。但是，運(yùn)動(dòng)并發(fā)癥最早可在啟動(dòng)左旋多巴治療后5-6個(gè)月即出現(xiàn)，特別是最初使用劑量超量的狀況下。133.“End-of-dosewearingoff”iscommonandrelatedtotheincreasinglossofneuronalstoragecapabilityfordopamineandtheshorthalf-lifeofl-dopa.劑末藥效消失很常見(jiàn)，普通與多巴胺神經(jīng)元儲(chǔ)藏能力下降以及左旋多巴半衰期較短有關(guān)。134.Bedtimeadministrationofadopamineagonistorasustainedreleaseformulationproduct(e.g.,carbidopa/l-dopaCR,ropiniroleXL,orpramipexoleER)canhelpreducenocturnaloffepisodesandimprovefunctioninguponawakening.入睡前應(yīng)用多巴胺激動(dòng)劑或使用緩釋制劑（e.g卡比多巴/左旋多巴控釋劑型，羅平尼羅緩釋劑，普拉克索緩釋劑）可協(xié)助緩和夜間發(fā)作，并協(xié)助睡醒后功效恢復(fù)。135.“Delayed-on”or“no-on”canresultfromdelayedgastricemptyingordecreasedabsorptionintheduodenum.“藥效發(fā)揮延遲”或“用藥無(wú)效”可能是用于胃排空延遲，或十二指腸吸取削弱的成果。136.Crushingthetabletofcarbidopa/l-dopaandtakingwithaglassofwaterorusingtheorallydisintegratingtabletformulationonanemptystomachcanhelp.將卡比多巴/左旋多巴片碾碎（非緩控釋制劑）和一杯水同服或使用口崩片劑型，并空腹使用可能會(huì)改善這一癥狀。137.Subcutaneousapomorphinemayalsobeusedasrescuetherapy.皮下注射阿樸嗎啡（多巴胺激動(dòng)劑）可作為解救治療。138.“Freezing,”asudden,episodicinhibitionoflowerextremitymotorfunction,maybeworsenedbyanxietyandmayincreasetheriskoffalls.“凍僵”，一種忽然的、陣發(fā)性的下肢運(yùn)動(dòng)功效克制，抑郁可加重，并可能增加跌倒的風(fēng)險(xiǎn)。139.Dyskinesiasareinvoluntarychoreiformmovements,usuallyinvolvingtheneck,trunk,andextremities.Theyareusuallyassociatedwithpeakstriataldopaminelevels.運(yùn)動(dòng)障礙是不自主的舞蹈病樣動(dòng)作，涉及脖子、軀干和肢體末端。這些癥狀可能和紋狀體多巴胺水平達(dá)峰值有關(guān)。140.Lesscommonly,dyskinesiasalsocandevelopduringtheriseandfallofl-dopaeffects(thedyskinesias-improvement-dyskinesiasordiphasicpatternofresponse).比較少見(jiàn)的，運(yùn)動(dòng)障礙可能在左旋多巴藥效升高或削弱過(guò)程中發(fā)展（出現(xiàn)運(yùn)動(dòng)障礙-緩和-運(yùn)動(dòng)障礙或者藥品反映的雙相反映模式）141.“Off-perioddystonia,”sustainedmusclecontractionsthatoccurmorecommonlyindistallowerextremities(e.g.,feetortoes),occuroftenintheearlymorninghours.Theymaybetreatedwithbedtimeadministrationofsustained-releaseproducts,useofbaclofen,orselectivedenervationwithbotulinumtoxin。非周期性肌張力障礙，體現(xiàn)為肌肉持續(xù)收縮，重要發(fā)生于遠(yuǎn)端下肢末端（如腳或腳趾），常發(fā)生于清晨。可通過(guò)睡前應(yīng)用緩釋劑型，巴氯芬或肉毒素進(jìn)行選擇性去神經(jīng)支配治療。（注：巴氯芬：能克制興奮性氨基酸神經(jīng)遞質(zhì)的釋放，減少脊髓單突觸和多突觸反射的興奮性，減少P物質(zhì)的釋放和鈣內(nèi)流，從而緩和肌強(qiáng)直和痛性痙攣）142.Attherapeuticdoses,selegilineandrasagiline,selectiveinhibitorsofMAO-B,areunlikelytoinducea“cheesereaction”(hypertension,headache)unlessexcessiveamountsofdietarytyramine(≥400mg)areingested.在治療劑量?jī)?nèi)，單胺氧化酶選擇性克制劑司來(lái)吉蘭和雷沙吉蘭不太可能造成“乳酪反映”（高血壓、頭痛），除非大量攝入膳食酪氨（>400mg）143.However,concomitantMAO-Binhibitorswithmeperidineandotherselectedanalgesicsiscontraindicatedbecauseofasmallriskofserotoninsyndrome.但是，單胺氧化酶克制劑與哌替啶等某些鎮(zhèn)痛藥藥品是嚴(yán)禁同時(shí)使用的，重要由于聯(lián)用可能小幅增加五羥色胺綜合征的發(fā)生風(fēng)險(xiǎn)。（五羥色胺綜合征是指神經(jīng)系統(tǒng)五羥色胺功效亢進(jìn)所引發(fā)的一組癥狀和體征,體現(xiàn)為認(rèn)知功效/行為變化、神經(jīng)肌肉異常、植物神經(jīng)功效不穩(wěn)定三聯(lián)征,涉及激越、焦慮、輕躁狂、意識(shí)含糊、昏睡、大汗、腹瀉、瞳孔擴(kuò)大、發(fā)熱、惡心、嘔吐、心動(dòng)過(guò)速、共濟(jì)失調(diào)、反射亢進(jìn)、肌肉強(qiáng)直、肌陣攣、震顫、寒戰(zhàn)、靜坐不能、牙關(guān)緊閉等）144.Selegilineandrasagilinemaybeneuroprotective司來(lái)吉蘭和雷沙吉蘭可能有神經(jīng)保護(hù)作用145.Selegiline(deprenyl;Eldepryl)isanirreversibleMAO-Binhibitorthatblocksdopaminebreakdownandcanmodestlyextendthedurationofactionofl-dopa(upto1hour).Itoftenpermitsreductionofthel-dopadosebyasmuchasonehalf司來(lái)吉蘭（商品名deprenyl）是一種不可逆的單胺氧化酶克制劑，可妨礙多巴胺的解說(shuō)，并能夠中度延長(zhǎng)左旋多巴的藥效（最長(zhǎng)至1小時(shí)）。聯(lián)用，可使左旋多巴用量減少二分之一。146.Selegilinealsoincreasesthepeakeffectsofl-dopaandcanworsenpreexistingdyskinesiasorpsychiatricsymptoms,suchasdelusionsandhallucinations.Otheradverseeffectsincludeinsomniaandjitteriness.司來(lái)吉蘭還可延長(zhǎng)左旋多巴的峰濃度效應(yīng)，可能使既已存在的運(yùn)動(dòng)障礙及精神癥狀惡化，如錯(cuò)覺(jué)、幻覺(jué)等其它不良反映涉及失眠和神通過(guò)敏。147.Theoraldisintegratingtabletmayprovideimprovedresponseandfewersideeffectscomparedwiththeconventionalformulation.與普通劑型相比，口崩片可能起到增效減毒的作用。148.Metabolitesofselegilinearel-methamphetamineandl-amphetamine司來(lái)吉蘭的代謝產(chǎn)物涉及左旋-脫氧麻黃堿，左旋-安非他明149.Studiesevaluatingitsneuroprotectivepropertiessuggestthatselegilinecandelaytheneedforl-dopaby～9monthsandhassymptomaticeffects,butthereisnofirmevidencethatitcanslowneurodegeneration有研究評(píng)價(jià)司來(lái)吉蘭的神經(jīng)保護(hù)作用，研究成果顯示司來(lái)吉蘭可使左旋多巴啟動(dòng)時(shí)間延緩約9個(gè)月，并且有癥狀改善，但是并無(wú)確切證據(jù)證明該藥品可減慢神經(jīng)退行性病變。150.Rasagiline,anotherMAO-Binhibitor,hassimilareffectsasselegilineinenhancingl-dopaeffectsandmodestbeneficialeffectasmonotherapy.Earlyinitiationisassociatedwithbetterlong-termoutcomes雷沙吉蘭是另一種單胺氧化酶克制劑，在增強(qiáng)左旋多巴作用方面，與司來(lái)吉蘭相似，且作為單藥方案，含有中檔獲益。早期啟動(dòng)可能含有更加好的長(zhǎng)久成果。160.Whenanadjunctiveagentisrequiredformanagingmotorfluctuations,rasagilinemayprovide1hourofextra“on”timeduringtheday.當(dāng)需要額外藥品控制癥狀波動(dòng)，雷沙吉蘭在治療能夠使藥品起效時(shí)間延長(zhǎng)1小時(shí)。161.Itisconsideredafirst-lineagent(asisentacapone)formanagingmotorfluctuations和恩他卡朋同樣，雷沙吉蘭是癥狀波動(dòng)藥品控制的一線藥品。162.Tolcapone(Tasmar)andentacapone(Comtan)areusedonlyinconjunctionwithcarbidopa/l-dopatopreventtheperipheralconversionofl-dopatodopamine(increasingtheareaunderthecurveofl-dopaby～35%).托卡朋（商品名Tasmar）和恩他卡朋（商品名）僅與卡比多巴/左旋多巴聯(lián)用，用以制止外周左旋多巴轉(zhuǎn)變?yōu)槎喟桶罚墒棺笮喟颓€下面積增加約35%）163.Thus,“on”timeisincreasedby～1to2hours.Theseagentssignificantlydecrease“off”timeanddecreasel-dopadosagerequirements.因此，聯(lián)用可造成藥品起效時(shí)間增加約1-2小時(shí)。這些藥品能夠明顯減少藥品無(wú)效時(shí)間，并減少左旋多巴藥品需求量。164.ConcomitantuseofnonselectiveMAOinhibitorsshouldbeavoidedtopreventinhibitionofthepathwaysfornormalcatecholaminemetabolism不推薦聯(lián)合應(yīng)用非選擇性單胺氧化酶克制劑，以避免克制了正常兒茶酚胺的代謝。165.COMTinhibitionismoreeffectivethancontrolled-releasecarbidopa/l-dopainprovidingconsistentextensionofeffect.兒茶酚胺-O-甲基轉(zhuǎn)移酶克制劑比左旋多巴/多巴胺控釋制劑在提供持續(xù)藥效方面更為有效。166.Thestartingandrecommendeddoseoftolcaponeis100mgthreetimesdailyasanadjuncttocarbidopa/l-dopa.托卡朋作為卡比多巴/左旋多巴輔助，起始推薦劑量為100mgtid。167.Itsuseislimitedbythepotentialforfatallivertoxicity.Strictmonitoringofliverfunctionisrequired,andtolcaponeshouldbediscontinuedifliverfunctiontestsareabovetheupperlimitofnormaloranysignsorsymptomssuggestiveofhepaticfailureexist.由于存在潛在致死性肝毒性，因此限制了（他卡朋）的使用。治療期間應(yīng)嚴(yán)格監(jiān)測(cè)患者肝功狀況，如果肝功指標(biāo)高于正常值上限或出現(xiàn)任何癥狀提示肝功效衰竭，應(yīng)停藥。168.Itshouldbereservedforpatientswithfluctuationsthathavenotrespondedtoothertherapies（他卡朋）僅限于存在癥狀波動(dòng)，且對(duì)其它治療無(wú)效的患者使用。169.Becauseentacaponehasashorterhalf-life,200mgisgivenwitheachdoseofcarbidopa/l-dopauptoeighttimesaday.恩他卡朋半衰期較短，因此在每次使用卡比多巴/左旋多巴時(shí)應(yīng)予以200mg,最多可使用8次/日。170.Dopaminergicadverseeffectsmayoccurandaremanagedeasilybyreducingthecarbidopa/l-dopadose.使用上述藥品可能出現(xiàn)多巴胺能不良反映，能夠通過(guò)減少卡比多巴/左旋多巴劑量而控制癥狀。171.Brownishorangeurinediscolorationmayoccur(aswithtolcapone),butthereisnoevidenceofhepatotoxicityfromentacapone.（使用恩他卡朋）可能出現(xiàn)尿液變深棕黃色（與托卡朋類似），但是恩他卡朋現(xiàn)在尚無(wú)證據(jù)證明其肝毒性。172.Theergotderivativebromocriptine(Parlodel)andthenonergotspramipexole(Mirapex)andropinirole(Requip)arebeneficialadjunctsinpatientswithdeterioratingresponsetol-dopa,thoseexperiencingfluctuationinresponsetol-dopa,andthosewithlimitedclinicalresponsetol-dopaduetoinabilitytotoleratehigherdoses.Theydecreasethefrequencyof“off”periodsandprovideanl-dopa-sparingeffect對(duì)于對(duì)左旋多巴反映逐步變差，或使用左旋多巴出現(xiàn)癥狀波動(dòng)，或由于無(wú)法耐受更高左旋多巴劑量而僅獲得有限臨床反映的患者，麥角堿衍生物溴隱亭（商品名Parlodel）及非麥角堿衍生物普拉克索（商品名Mirapex）及羅匹尼羅（商品名Requip）可作為左旋多巴有益的補(bǔ)充。這些藥品能夠減少藥品無(wú)效時(shí)間，并產(chǎn)生減少左旋多巴用藥劑量的作用。173.Thedoseofdopamineagonistsisbestdeterminedbyslowtitrationtoenhancetoleranceandtofindtheleastdosethatprovidesoptimalbenefit多巴胺受體激動(dòng)劑劑量最佳通過(guò)緩慢滴定來(lái)擬定，方便提高耐受性并找到能夠提供最佳療效的最小劑量。174.ThenonergotsaresaferandareeffectiveasmonotherapyinmildtomoderatePDaswellasadjunctstol-dopainpatientswithmotorfluctuations非麥角堿類藥品安全性更加，對(duì)于中重度帕金森患者，單藥治療有效。對(duì)于存在癥狀波動(dòng)的患者，可作為左旋多巴的輔助治療藥品175.Bromocriptineisnotcommonlyusedbecauseofanincreasedriskofpulmonaryfibrosisandreducedefficacycomparedwiththeotheragonists由于造成肺纖維化的風(fēng)險(xiǎn)較高，且療效相對(duì)較低，溴隱亭在這一領(lǐng)域較少使用。176.Thereislessriskofdevelopingmotorcomplicationsfrommonotherapywithdopamineagoniststhanfroml-dopa.Becauseyoungerpatientsaremorelikelytodevelopmotorfluctuations,dopamineagonistsarepreferredinthispopulation.與使用左旋多巴相比，應(yīng)用多巴胺激動(dòng)劑出現(xiàn)運(yùn)動(dòng)并發(fā)癥的風(fēng)險(xiǎn)相對(duì)較低。由于年輕患者更容易出現(xiàn)運(yùn)動(dòng)癥狀波動(dòng)，因此多巴胺受體激動(dòng)劑在這一群體更為推薦。177.Olderpatientsaremorelikelytoexperiencepsychosisandorthostatichypotensionfromdopamineagonists;therefore,carbidopa/l-dopamaybethebestinitialmedicationinelderlypatients,particularlyifcognitiveproblemsordementiaispresent年紀(jì)較大的患者應(yīng)用多巴胺受體激動(dòng)劑出現(xiàn)精神癥狀或體位性低血壓的可能性更高，因此卡比多巴/左旋多巴較適宜作為老年人群的起始用藥，特別是存在認(rèn)知功效障礙或癡呆的患者。178.Commonsideeffectsofdopamineagonistsarenausea,confusion,hallucinations,lightheadedness,lower-extremityedema,posturalhypotension,sedation,andvividdreams.多巴胺受體激動(dòng)劑常見(jiàn)的不良反映涉及惡心、意識(shí)錯(cuò)亂、幻覺(jué)、頭暈、下肢肢端水