[Dr.Vad]

Уважаемые коллеги!

Анализируя зарубежные публикации, обнаружил интересные наблюдения: дексаметазон не является больше стандартом в лечении ишемических/геморрагических инсультов:

Br Med J. 1978 Oct 7;2(6143):994-6.
Dexamethasone in acute stroke.

Mulley G, Wilcox RG, Mitchell JR.

Over 13 months 118 patients admitted to hospital with acute stroke were allocated at random to treatment with either dexamethasone or placebo. At one year there was no significant difference in the numbers of survivors or in the quality of life between the two groups. The results suggest that there is no indication for the routine administration of dexamethasone to a heterogeneous group of patients with stroke.



Br Med J (Clin Res Ed). 1986 Jan 4;292(6512):21-3.
High dose steroid treatment in cerebral infarction.
Norris JW, Hachinski VC.
Steroid treatment is widely used in acute cerebral infarction yet its value is controversial. High dose dexamethasone (480 mg over 12 days) was given in a double blind, randomised controlled trial to 113 consecutive eligible patients with acute cerebral infarction admitted to an acute stroke unit. Those with stroke for more than 48 hours, known embolic sources, diabetes, and infection were excluded. Death and quality of survival were recorded over 21 days. The active drug group (54 patients) matched the placebo group (59 patients) for age, initial stroke score, delay in beginning treatment, and other relevant variables. The two groups did not differ significantly in death rate or quality of survivorship. The small difference in mortality between the two groups may have represented a marginal therapeutic effect, which might reach significance in a larger sample. The widespread use of steroids in response to such a marginal therapeutic gain would expose large numbers of patients with stroke to more serious hazards of steroid treatment and convert patients who would otherwise have died into neurovegetative survivors. High dose steroid treatment was ineffective in ischaemic stroke, and the data suggest that further evaluation by a larger multicentre trial is not justified.

J Assoc Physicians India. 1989 May;37(5):315-7.
Role of dexamethasone in the outcome from acute stroke.
Kumar N, Jain S, Maheshwari MC.
Forty patients of acute stroke of less than 48 hours duration above the age of 40 years were studied. All patients were evaluated as per the evaluation scoring system at the time of admission within 24 hours and 7 days after admission to hospital. 25 patients were given dexamethasone and 15 patients who were not given dexamethasone were matched for age, sex, underlying diseases and clinical condition as per the evaluation scoring. The mean evaluation score in study group showed significant improvement at 7 days (p less than 0.05) as compared to control group. There was no significant difference in mortality between the study and control group, being 36% and 33% respectively. Functional status also remained identical in the two groups at the time of discharge. There was also no significant difference in the outcome of patients of intracerebral haemorrhage vs. cerebral infarction whether treated with dexamethasone or not.

West Afr J Med. 2001 Jan-Mar;20(1):1-6.
Effectiveness of high dose dexamethasone in the treatment of acute stroke.

Ogun SA, Odusote KA.

Department of Medicine, Ogun State University Teaching Hospital, Sagamu, Ogun State, Nigeria.

A prospective double-blind placebo-controlled, randomised clinical trial was carried out to determine the effectiveness of short-course of high dose dexamethasone therapy on mortality and neurological recovery in stroke patients. During a sixteen month period of study, 230 patients with clinical diagnosis of stroke were seen. Of these, 40 were eligible for the study (27 were presumed to have had haemorrhagic stroke; and 13 were presumed to have had cerebral infarction). The commonest cause of exclusion was presentation after 24 hours of the ictus. Patients were sequentially paired and randomised into high dose dexamethasone and placebo groups in a double-blind fashion. There were twenty patients in either group. Of the 27 patients with haemorrhagic stroke, 15 were in the dexamethasone group and 12 in the placebo group. Of the 13 patients with cerebral infarction, 5 were in the dexamethasone group and 8 in the placebo group. Each patient received 100 mg of dexamethasone stat, and 16 mg every 6 hours for a period of 48 hours or equivalent volumes of placebo. Assessment of each patient was done using a neurological score. Sequential analysis by Armitage was employed, using survival at 1 month as the primary criterion of effectiveness. Survivors were followed-up for 6 months. At the end of one month, 16 patients (80%) had died in the dexamethasone group and 17 (85%) in the placebo group. The average day of death was six days in the dexamethasone group and 15 days in the placebo group, but this was not statistically significant. Of the seven survivors at one month, four were in the dexamethasone group and 3 in the placebo group. Five of them had cerebral infarction and two had haemorrhagic stroke. The two in the haemorrhagic subgroup who survived the first month died at the 2nd and 4th month respectively. At the end of six months, only the five patients with cerebral infarction were alive. Of these, 2 in the dexamethasone group were back at work while the third was chair-bound. The 2 survivors in the placebo group were chair and bed bound respectively. In conclusion, this study failed to demonstrate any benefit of a short-course of high dose steroid in improving the mortality of stroke patients and its use should be discouraged.

Похоже, это стало понятно и индийцам и африканцам.