Meinig G, Reulen H J, Simon R S, Schürmann K
Adv Neurol. 1980;28:471-89.
Three independent methods were used to quantify the therapeutic effect on peritumoral brain edema with respect to different forms of treatment (dexamethasone, furosemide, and their combination with different dosages and different periods of treatment). 1. The neurological deficit evaluated by frequency distribution analysis showed an improvement in nearly all cases. In a few cases the initial improvement was followed by a secondary deterioration. The various symptoms showed significant differences in regression with regard to the extent of the reduced deficit as well as the time dependence. 2. With a certain delay (compared to item 1), diminution of brain edema was detected by CT follow-up. The effect of dexamethasone and the combination with furosemide differed depending on the nature of the brain tumor. 3. Compared to the untreated patients, the water content was reduced by nearly 3% following dexamethasone treatment 4 x 4 mg for 4 to 6 days. Following dexamethasone/furosemide therapy for 4 to 6 days, it was reduced by about 4.5%. The result of long-term therapy with dexamethasone alone was similar. The sodium content changed parallel to the water content. Dexamethasone and dexamethasone/furosemide was most effective in patients with glioblastoma, where the water content decreased by nearly 6%. The data presented suggest that preoperative antiedema treatment with dexamethasone is necessary for several days or a few weeks in some cases. The period of treatment can be reduced significantly by dexamethasone/furosemide or extremely high doses of dexamethasone. On the other hand, the results of follow-up scoring of the neurological situation show that the optimal time of pretreatment must be limited with respect to the individual case. The therapeutic results presented allow inferences to be made concerning pathophysiology of the resolution of brain edema.
采用三种独立方法来量化不同治疗形式（地塞米松、呋塞米及其不同剂量和不同治疗周期的联合用药）对瘤周脑水肿的治疗效果。1. 通过频率分布分析评估的神经功能缺损在几乎所有病例中均有改善。少数病例最初有所改善，但随后出现继发性恶化。各种症状在缺损减少程度以及时间依赖性方面的恢复存在显著差异。2. 与第1项相比有一定延迟，通过CT随访检测到脑水肿减轻。地塞米松以及与呋塞米联合用药的效果因脑肿瘤的性质而异。3. 与未治疗的患者相比，地塞米松4×4mg治疗4至6天后，水分含量降低了近3%。地塞米松/呋塞米治疗4至6天后，水分含量降低了约4.5%。单独使用地塞米松进行长期治疗的结果相似。钠含量与水分含量平行变化。地塞米松和地塞米松/呋塞米对胶质母细胞瘤患者最有效，其水分含量降低了近6%。所呈现的数据表明，在某些情况下，术前用地塞米松进行抗水肿治疗数天或数周是必要的。地塞米松/呋塞米或极高剂量的地塞米松可显著缩短治疗周期。另一方面，神经状况随访评分结果表明，预处理的最佳时间必须根据个体情况加以限制。所呈现的治疗结果有助于对脑水肿消退的病理生理学进行推断。
