Паллиативная помощь пациентам с первичными и метастатическими опухолями головного мозга

Пациенты со злокачественными опухолями головного мозга и метастазами в головной мозг (ЗОГМ) страдают от тяжёлых симптомов на протяжении всего течения заболевания, что требует особого внимания и организации помощи для поддержания качества их жизни. В статье проведён обзор литературы с акцентом на практических аспектах облегчения наиболее распространённых и инвалидизирующих симптомов. Обсуждаются четыре основных темы: симптоматическое лечение; потребности лиц, осуществляющих уход; паллиативная помощь (ПП) во время противоопухолевого лечения и оказание помощи в конце жизни. Приводятся новые данные о профилактике нейрокогнитивного дефицита путём совершенствования методов лучевой терапии, выбора противосудорожных препаратов у пациентов с судорожным синдромом. Описаны основные возможности терапии или их отсутствие по борьбе со слабостью, прогрессированием нейрокогнитивного дефицита, головной и другими видами боли. Отмечаются особенности применения опиоидных анальгетиков у пациентов данной группы. Разработка и внедрение программ перспективного планирования медицинских мероприятий может помочь обеспечить целенаправленную помощь в  соответствии с  потребностями пациентов и лиц, осуществляющих уход, что может сократить объём госпитализации и избежать ненужной агрессивной медицинской помощи на завершающем этапе жизни. Необходима интеграция ПП в систему оказания медицинской помощи пациентам со ЗОГМ. Предлагается создание специализированной службы ПП для данной группы пациентов и целенаправленное обучение специалистов. Необходима разработка практических рекомендаций по оказанию поддерживающей / паллиативной помощи больным с ЗОГМ, в том числе на завершающем этапе жизни.

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