运动障碍性疾病思考题

课后思考题

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2017临床医学(中国政府奖学金)BHANDARI, MANJU -
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帕金森病临床症状:

运动症状:①静止性震颤②肌强直③运动迟缓:随意运动减少,动作缓慢、笨拙。④姿势步态障碍:上肢摆臂幅度减小或消失,下肢拖曳。

非运动症状:①感觉障碍:嗅觉减退或睡眠障碍,尤其是快速眼动期睡眠行为异常,中晚期常有肢体麻木、疼痛。有些患者可伴有不安腿综合征。②自主神经功能障碍,如便秘、多汗、溢脂性皮炎等,后期也可以出现性功能减退、排尿障碍或体位性性低血压。③精神和认知障碍:近半数患者伴有抑郁,并常伴有焦虑。
Clinical symptoms of Parkinson's disease:

Exercise symptoms: (1) static tremor (2) muscle strength (3) movement is slow: less casual movement, slow movement, clumsy. (4) Posture gait disorder: the upper limb swing arm amplitude decreases or disappears, the lower limb drags.

Non-motor symptoms: (1) sensory impairment: loss of sense of smell or sleep disorders, especially during rapid eye movement sleep behavior abnormalities, in the middle and late stages often have limb numbness, pain. Some patients may be accompanied by restless leg syndrome. (2) Autonomic neurological dysfunction, such as constipation, sweating, seborrheic dermatitis, etc., can also appear later in the sexual function loss, urination disorders or low blood pressure. (3) Mental and cognitive impairments: Nearly half of patients are suffering from depression and often anxiety.

治疗原则:

①综合治疗②用药原则:以达到有效改善症状,提高工作能力和生活质量为目标。提倡早期诊断、早期治疗,不仅可以更好的改善症状,而且尽可能达到延缓疾病的发展。坚持“计量滴定”以避免产生药物急性副作用。
Principles of treatment:

(1) Comprehensive treatment (2) The principle of medication: to achieve effective improvement of symptoms, improve working ability and quality of life as the goal. Promoting early diagnosis and early treatment can not only improve symptoms, but also delay the development of disease as much as possible. Adhere to "measurement titration" to avoid acute side effects of the drug.

常用药物:

①抗胆碱能药:如苯海索②金刚烷胺③复方左旋多巴④DR激动剂⑤MAO-B抑制剂:如司来吉兰⑥COMT抑制剂:恩他卡朋

Common medications:

(1) Anticholinergic drugs: e.g. phenylphenicol (2) statinamine (3) compound left-handed doba (4) DR agonist (5) MAO-B inhibitors: e.g. Slagylan (6) COMT inhibitors: Entacarpone