Bogucki A
prof. dr hab. Andrzej Bogucki, Klinika Chorób Układu Pozapiramidowego, Uniwersytet Medyczny w Łodzi, III Szpital Miejski im. dr. Karola Jonschera, ul. Milionowa 14, 93-113 £ódŸ, Polska, e-mail:
Neurol Neurochir Pol. 2013 Sep-Oct;47(5):476-83. doi: 10.5114/ninp.2013.38227.
Apomorphine is the most potent dopamine receptor agonist and its symptomatic effectiveness is comparable to levodopa. Subcutaneous apomorphine is rapidly and completely absorbed. Plasma peak concentrations are achieved after 5-15 minutes and onset of clinical effect is within 20 minutes. Apomorphine intermittent subcutaneous injections are effective as rescue therapy for unpredictable off periods in advanced Parkinson disease (PD). More often apomorphine is administered as a subcutaneous infusion which secures the continuous dopaminergic stimulation. The benefit on 'off' periods is consistent across all studies, but dyskinesia improvement is not so obvious. Two infusion therapies (apomorphine and intraduodenal levodopa) and deep brain stimulation (DBS) are effective in advanced PD patients with untreatable motor complications. Apomorphine infusions should be considered in patients unable to undergo DBS because of cognitive impairment and neurosurgical contraindications.
阿扑吗啡是最有效的多巴胺受体激动剂，其症状改善效果与左旋多巴相当。皮下注射阿扑吗啡吸收迅速且完全。5 - 15分钟后达到血浆峰值浓度，临床效果在20分钟内显现。阿扑吗啡间歇性皮下注射作为晚期帕金森病（PD）不可预测的“关”期的抢救治疗有效。更常见的是，阿扑吗啡以皮下输注的方式给药，以确保持续的多巴胺能刺激。所有研究中，其对“关”期的益处是一致的，但对异动症的改善并不明显。两种输注疗法（阿扑吗啡和十二指肠内左旋多巴）以及脑深部电刺激（DBS）对有无法治疗的运动并发症的晚期PD患者有效。由于认知障碍和神经外科手术禁忌症而无法接受DBS的患者应考虑使用阿扑吗啡输注治疗。
