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第113章 师傅你,别念了......(1 / 2)

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顾风用了短短几秒钟在脑海里梳理了一下接下来沟通的内容。

开口说道:

“首先要讲的是非药物治疗作,包括自我护理、行为治疗( 比如合理安排白天短时睡眠、规律夜间睡眠) 、团体治疗及心理治疗等。

此外,培养健康的睡眠卫生习惯,适当摄入咖啡因、避免大量碳水化合物的均衡饮食、定期适当身体锻炼等,也被推荐用于发作性睡病的治疗。

关于这些,你回去后可以聘请长期的医疗团队。我相信这些对于你来说不是问题。这些建议,在你出院后我会给你打印出来。”

李坦点了点头。

对于他来说,能用钱解决的问题太不是问题了。

“顾医生,咱们还是先说说药的事儿吧。”

顾风看着心急的李坦。

我知道你现在很急,但你先别急,我只怕你一会儿听不进去......

“那行,我先按症状一个一个的给你讲用药。

1.日间过度思睡(EDS):药物莫达非尼( modafinil) 及其活性成分阿莫达非尼( armodafinil) 可通过抑制单胺类神经递质的再摄取,增强包括中枢-皮质-边缘系统等多条多巴胺能信号传递,促进 Hcrt 能神经传递,从而对日间过度思睡(EDS)症状发挥显着改善作用,可在服用药物数天内起效。莫达非尼已于 2017 年获大夏食品和药物管理局批准为日间过度思睡(EDS)一线治疗药物。

γ-羟丁酸钠( gamma-hydroxybutyrate) 的药理机制与激活脑内γ-氨基丁酸 B 受体,抑制乙酰胆碱作用,阻断突触部位冲动传递而抑制中枢神经兴奋性有关,被海外食品和药物管理局推荐作为日间过度思睡(EDS)一线治疗药物.

皮托利桑 ( pitolisant) 为选择性组胺 3 受体拮抗剂/反向激动剂,通过促进组胺的合成与释放,增强组胺能神经

元活性,提高患者的清醒度和警觉性。在多项 III期临床研究中,皮托利桑能够显着改善 EDS,并可能减少猝倒发作和改善幻觉,2016 年获海外食品和药物管理局批准用于 NT1 和 NT2 的治疗,2019 年获海外食品和药物管理局批准用于 EDS 的治疗。

索利安芬醇( solriamfetol) 通过选择性抑制多巴胺和去甲肾上腺素的再摄取,IIb 期和 III 期临床试验证实索利安芬醇可有效改善发作性睡病患者( 包括合并有阻塞性睡眠呼吸暂停综合征) 的 EDS 症状,2019 年被海外食品和药物管理局批准为治疗发作性睡病 EDS 的一线药物。

哌甲酯( methylphenidate) 可通过阻断突触前膜对单胺类递质的再摄取,增强中枢-皮质-边缘系统多巴胺活性及网状上行激动系统兴奋传递,已被证实可改善 65%~ 85% 发作性睡病患者的EDS 症状,可作为 EDS 的二线治疗药物。大夏哌甲酯处方率较高,但得警惕其不良反应,以及药物依耐性与耐药性。

安非他明( amphetamine) 和右旋安非他明(dexamphetamine) 作用机制类似于哌甲酯,可一定程度地改善发作性睡病EDS 症状。

文拉法辛( venlafaxine) 是一种选择性 5-羟色胺( 5-hydroxytryptamine,5-HT) 、去甲肾上腺素和多巴胺的再摄取抑制剂,对 EDS 症状起到一定的缓解作用。此外,中枢拟交感化合物马吲哚、单胺氧化酶-B 抑制剂司来吉兰也曾被用于改善发作性睡病的 EDS 症状。

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