neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2023-25-2-106-113neurosurgery-1378Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWПротивоотечная терапия глюкокортикоидами у пациентов с глиомами: за и противThe use of glucocorticoids in the treatment of cerebral edema for glioma tumour patients: Pro and Contrahttps://orcid.org/0000-0003-2444-8136ПриродовА. В.PrirodovA.

129090 Москва, Большая Сухаревская пл., 3; 117997 Москва, ул. Островитянова, 1

Alexander Vladislavovich Prirodov

3 Bolshaya Sukharevskaya Sq., Moscow 129090; 1 Ostrovityanova St., Moscow 117997

https://orcid.org/0000-0001-6858-6210СоловьеваП. И.SolovyevaP. I.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0003-0284-295XХрипунИ. А.KhripunI. A.

344022 Ростов-на-Дону, пер. Нахичеванский, 29

29 Nakhichevansky Lane, Rostov-on-Don 344022

https://orcid.org/0000-0003-3363-7940МикаиловМ. М.MikailovM. M.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ГБУЗ «НИИ скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»; «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationГБУЗ «НИИ скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov State Medical University, Ministry of Health of RussiaRussian Federation202310072023252106113Copyright © Природов А.В., Соловьева П.И., Хрипун И.А., Микаилов М.М., 20232023Природов А.В., Соловьева П.И., Хрипун И.А., Микаилов М.М.Prirodov A., Solovyeva P.I., Khripun I.A., Mikailov M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1378

Цель работы – повышение уровня осведомленности о существующих схемах противоотечной терапии дексаметазоном у врачей разных специальностей (нейрохирургов, неврологов, реаниматологов, эндокринологов). На основании данных научной литературы авторы дают подробное описание используемых ранее и существующих в настоящее время схем противоотечной терапии глюкокортикоидами (в частности, дексаметазоном) у пациентов с первичными и вторичными опухолями головного мозга и его оболочек. Авторы оценивают различные схемы назначения дексаметазона (от 2 до 64 мг / сут с дробным введением и однократные дозировки до 20 мг) пациентам с опухолями глиального ряда в плане эффективности терапии. Дан анализ рисков возникновения побочных эффектов и осложнений терапии. Выделены 3 группы рисков: ранние (нарушения углеводного обмена, психоэмоциональные симптомы, артериальная гипертензия, прибавка массы тела), поздние (экзогенный гиперкортицизм, нарушения липидного обмена, проксимальная миопатия, остеопороз, язвенная болезнь желудка и двенадцатиперстной кишки, иммуносупрессивные состояния) и возникающие на фоне резкой отмены препарата (надпочечниковая недостаточность). В заключение авторы отметили способы возможного предотвращения и уменьшения побочных эффектов.

Aim. To improve awareness of existing treatment regimens of cerebral edema by dexamethasone among doctors of various specialties (neurosurgeons, neurologists, intensive care specialists, endocrinologists). Based on scientific literature data the authors presented detailed descriptions of previously used and relevant now treatment regimens of cerebral edema by glucocorticoids (dexamethasone in particular). The authors estimated various dexamethasone prescribing schedules (2–64 mg doses fractionally used per day and one‑time 20 mg dose) for glioma tumor patients for understanding the effectiveness of therapy. The authors analyzed the risks of possible therapy by‑effects and complications. The risks were divided into the following groups: early (carbohydrate metabolic disorders, psychoemotional symptoms, hypertension, weight gain), later (exogenous hypercorticism, lipid metabolic disorders, proximal myopathy, osteoporosis, gastric and duodenal ulcer disease, immunosuppressive conditions) and withdrawal syndrome (adrenal insufficiency). In conclusion, the authors noted the ways to possibly prevent and reduce the side effects.

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The authors declare that there are no conflicts of interest present.