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a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > h2{}.products_52_wrapper li p{}.mobiles_sidebar{}.foot_contact:before{}.index_sub_title a{}.other_184_right{}.HJZF_contact_inquiry{}.hj_navbar_nav > li > a > h2:before{}.nav_li.on>a h2{}.container-fluid{}.other_184_right{}.other_184_right>.index_sub_title{}#news-44_1891 > section > div > div > div > ul > li > div > div.index_text{}.other_184_right>.con{}.other_184_pagination{}.banner_27_zyzfw{}#aboutus-23_1891 > section > div > div > div > ul > li:nth-child(4){}.main_page{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(2) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(3) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(2):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(4).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(4):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(5).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(5):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(6).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(6):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(7).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(7):hover a{}.HJZF_Z__inner_product_categroy5 ul 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img{}.runlin_banner{}.runlin_banner_left{}.runlin_banner_right{}.runliin_top_email{}.runlin_email.first{}.runlin_des + .more{}.runlin_left li{}.runlin_yiji > span h3{}.submit_runlin_search{}.nav_drop{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > div.runlin_des > b{}.hjzf2_z_products_list_left a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{flex:0 0 100%}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > 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section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, 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帕金森患者必读,饮食与药物的相生相克!
  2024/04/11| 阅读次数:1554

 

今天是世界帕金森病日,帕金森病是一种常见的中老年神经系统退行性疾病,随着疾病的进展,帕金森病的运动和非运动症状会逐渐加重,一方面会损害患者本身的日常活动,另一方面,也会带来巨大的社会和医疗负担。


据统计,我国帕金森病患者达260万例,约占全球患者的一半。这种疾病起病隐匿,进展缓慢,需要尽早诊断、及时干预,对提高疗效、改善生命质量和预后极为重要。


帕金森病治疗方法和手段包括药物治疗、手术治疗、肉毒毒素治疗、运动疗法、心理干预、照料护理等。药物治疗作为首选,是整个治疗过程中的主要治疗手段。



六大类抗帕金森药物

一. 复方左旋多巴

左旋多巴是治疗帕金森病的标准疗法,是帕金森病药物治疗中最有效的对症治疗药物。


二. 多巴胺受体激动剂(DAs)

与多巴胺受体结合,兴奋多巴胺受体。非麦角类 DAs 作为早发型患者病程初期的首选药物,包括普拉克索、罗匹尼罗、吡贝地尔、罗替高汀和阿扑吗啡。


三.单胺氧化酶B型抑制剂(MAO-BI)

抑制多巴胺的重摄取及突触前受体。主要包括第一代 MAO-BI 司来吉兰及第二代 MAO-BI 雷沙吉兰。


四. 儿茶酚-O-甲基转移酶抑制剂(COMTI)

抑制 COMT,减少左旋多巴代谢。主要有恩他卡朋、托卡朋和奥吡卡朋以及恩他卡朋双多巴片。


五. 抗胆碱能药

选择性阻断纹状体的胆碱能神经通路。国内有苯海索,主要适用于有震颤的患者。


六. 金刚烷胺

促进纹状体多巴胺的合成和释放,减少神经细胞对多巴胺再摄取。对少动、强直、震颤均有改善作用,并且对改善异动症有帮助。


帕金森治疗药物众多,每一类药物都有其的优劣势,在临床选择药物时应充分考虑到以患者为中心,根据患者的个人情况,如年龄、症状表现、疾病严重程度、共患病、工作和生活环境等进行药物选择和调整。



服药期间的饮食注意事项


正确的饮食营养对于帕金森病患者的健康状况能起到非常重要的作用。目前,国内外研究者并没有制定出针对帕金森患者的特殊饮食模式,但是对于帕金森患者,针对其用药,有以下饮食注意事项。


注意高蛋白质食物

左旋多巴与食物中的蛋白质在肠道同一部位被吸收。食用蛋白质(鱼、肉、蛋、奶和豆类)可影响左旋多巴吸收。因此,不要随餐服用左旋多巴药物,我们在可以选择在进食前1小时或进食后1.5小时服药。


不同于其他疾病,大量的肉奶蛋等高蛋白的食物并不适合帕金森患者。每天可摄入大约 50 克的肉类,可选择蛋、鱼、虾、瘦肉类如猪肉、牛肉、禽肉等(1只鸡蛋所含的蛋白质相当于 25克精瘦肉类)。高蛋白质食物宜在晚餐供给,这样对左旋多巴的吸收干扰最小。


注意酪胺含量高的食物

单胺氧化酶B抑制剂(如司来吉兰)与酪胺食物同时服用时可能出现严重的不良反应——酪胺反应:药物导致酪胺代谢分解减少,吸收入血后血压急剧升高、心律下降,轻者剧烈头痛,重可危及生命。


富含酪胺的食物有:


奶酪注意任何包含奶酪的食品
肉类和鱼烟熏、陈年或发酵肉类和鱼、热狗、加工三明治肉、熏肉和火腿
酵母自制酵母面包、罐装、加工和冷冻食品
豆类豆浆、味噌、豆腐、酱油
蔬菜和水果熟透的香蕉、椰子、鳄梨等水果、菠菜和泡菜等
饮料啤酒、葡萄酒、威士忌、红酒等
添加剂嫩肉剂或罐装肉汁
其他巧克力、咖啡、花生、巴西坚果


任何吃剩的食物都会在放置过程中形成酪胺,因此建议吃刚烹饪好的新鲜食物,吃剩的饭菜放在冰箱里保存不要超过2-3天时间。


值得一提的是,第二代 MAO-BI 雷沙吉兰与第一代 MAO-BI 司来吉兰化学结构相似,但效力比司来吉兰高3~15倍,且不产生苯丙胺类代谢物。由于选择性高,在服用时不会导致 “酪胺反应”。不论单药使用,还是联合左旋多巴,都无须限制酪胺饮食。



注意富含拟胆碱的食物

用抗胆碱能药物(苯海索等)治疗的帕金森患者,应尽量避免同时进食富含拟胆碱的食物,如槟榔等,以避免减低药效。


参考文献

中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.帕金森病基层诊疗指南(2019年)[J].中华全科医师杂志,2020,19(1):5-17.

中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍学组.中国帕金森病治疗指南(第四版)[J].中华神经科杂志,2020,53(12):973-986.

重视帕金森病的蛋白质饮食管理--王璐茜,王涛《实用老年医学》2015年第12期

陈茜,陈頔,曹国颖,等.抗帕金森病药雷沙吉兰的药理作用和临床评价[J]. 临床药物治疗杂志, 2018年, 16(6).




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