Противоотечная терапия глюкокортикоидами у пациентов с глиомами: за и против

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.

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