Hagell P, Odin P
Section of Restorative Neurology, Department of Clinical Neuroscience, Division of Neurology, Wallenberg Neuroscience Center/BMC A11, University Hospital, SE-221 84, Lund, Sweden.
J Neurosci Nurs. 2001 Feb;33(1):21-34, 37-8. doi: 10.1097/01376517-200102000-00004.
Apomorphine is a potent, nonselective, direct-acting dopamine-receptor agonist. Given subcutaneously, it has a rapid onset of antiparkinsonian action qualitatively comparable to that of levodopa. Despite its long history, it was not until peripheral dopaminergic side effects could be controlled by oral domperidone that the clinical usefulness of apomorphine in Parkinson's disease began to be investigated thoroughly in the mid-1980s. Although several routes have been tried, subcutaneous administration, either as intermittent injections or continuous infusion, is so far the best and most applied in the treatment of advanced, fluctuating Parkinson's disease. Clinical trials have shown stable efficacy with markedly reduced time spent in "off" phases as well as, for infusion therapy, reduced levodopa requirements. In the most successful cases, motor fluctuations disappear and the need for oral medication is eliminated. Adverse events are usually mild and dominated by cutaneous reactions. Neuropsychiatric side effects occur, but the influence of apomorphine on these remains controversial. Controlled long-term clinical trials are highly warranted to reveal the full potentials of this treatment. Careful patient selection and follow-up, where the specialized movement disorder nurse has a crucial role, are paramount for a successful long-term outcome. Apomorphine warrants a wider application in the treatment of advanced Parkinson's disease and should be tried before more invasive interventions are considered.
阿扑吗啡是一种强效、非选择性、直接作用的多巴胺受体激动剂。皮下给药时，其抗帕金森病作用起效迅速，在性质上与左旋多巴相当。尽管其应用历史悠久，但直到口服多潘立酮能够控制外周多巴胺能副作用后，阿扑吗啡在帕金森病中的临床应用价值才在20世纪80年代中期开始得到深入研究。尽管尝试了多种给药途径，但皮下给药，无论是间歇性注射还是持续输注，目前都是治疗晚期、症状波动型帕金森病的最佳且应用最广泛的方法。临床试验表明，其疗效稳定，“关”期时间明显缩短，对于输注治疗而言，左旋多巴的需求量也有所减少。在最成功的病例中，运动波动消失，不再需要口服药物治疗。不良事件通常较轻，主要为皮肤反应。虽然会出现神经精神方面的副作用，但阿扑吗啡对这些副作用的影响仍存在争议。非常有必要进行长期对照临床试验以充分发掘这种治疗方法的潜力。谨慎选择患者并进行随访，其中专业的运动障碍护士起着关键作用，这对于取得成功的长期治疗效果至关重要。阿扑吗啡在晚期帕金森病治疗中值得更广泛应用，在考虑采用更具侵入性的干预措施之前应先尝试使用。
