Physical Medicine and Rehabilitation Program Office, Department of Veterans Affairs, Washington, DC; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Center for Rehabilitation Sciences and Engineering, Richmond, VA.
Ann Neurol. 2014 Feb;75(2):277-86. doi: 10.1002/ana.24067. Epub 2014 Feb 20.
Mild traumatic brain injury (mTBI) and postconcussion syndrome (PCS) are common among military combatants. Hyperbaric oxygen (HBO2 ) is a proposed treatment for these conditions, but it has not been rigorously studied. The objective of this study was to determine the effects of HBO2 by 3 months post compression at 2 commonly employed dosing levels to treat PCS; whether specific subgroups may have benefited; and if no overall effect was found, whether benefit is masked by other conditions.
This randomized, double-blind, sham-controlled study was conducted at the Naval Air Station in Pensacola, Florida on 61 male Marines with a history of mTBI and PCS. Intervention consisted of 40 once daily 60-minute hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA) at 1 of 3 randomly preassigned oxygen fractions, resulting in respective blinded groups with an oxygen-breathing exposure equivalent to (1) surface air (sham), (2) 100% oxygen at 1.5ATA, or (3) 100% oxygen at 2.0ATA. The main outcome measure was the Rivermead Post-Concussion Questionnaire-16 (RPQ-16) collected before compressions and at 2 later points.
The interaction of time by intervention group was not significant for improvement on the RPQ-16. Nor was there evidence of efficacy on the RPQ-16 for any subgroup. No significant time by intervention interaction was found for any functional, cognitive, or psychomotor secondary outcome measure at an unadjusted 0.05 significance level.
Using a randomized control trial design and analysis including a sham, results showed no evidence of efficacy by 3 months post-compression to treat the symptomatic, cognitive, or behavioral sequelae of PCS after combat-related mTBI.
轻度创伤性脑损伤（mTBI）和脑震荡后综合征（PCS）在军事战斗人员中很常见。高压氧（HBO2）是治疗这些疾病的一种方法，但尚未经过严格研究。本研究的目的是确定在 2 种常用剂量下，在压迫后 3 个月内 HBO2 治疗 PCS 的效果；是否特定亚组可能受益；如果没有发现总体效果，是否被其他条件所掩盖。
这项随机、双盲、假对照研究在佛罗里达州彭萨科拉的海军航空站进行，共有 61 名有 mTBI 和 PCS 病史的男性海军陆战队员参与。干预措施包括 40 次每天 60 分钟的高压舱压缩，在 2.0 个大气压（ATA）下，在 3 个随机预先分配的氧气分数中的 1 个，导致分别有吸氧暴露等效于（1）空气（假）、（2）1.5ATA 的 100%氧气或（3）2.0ATA 的 100%氧气的盲法组。主要观察指标是在压缩前和随后的 2 个时间点收集的 Rivermead 脑震荡后问卷-16（RPQ-16）。
干预组之间的时间交互作用对 RPQ-16 的改善没有显著影响。在 RPQ-16 上，也没有任何亚组有效的证据。在未经调整的 0.05 显著性水平下，任何功能、认知或运动知觉的次要结果测量都没有发现时间与干预的显著交互作用。
使用随机对照试验设计和分析，包括假对照，结果表明，在压迫后 3 个月内，没有证据表明 HBO2 治疗与战斗相关 mTBI 后 PCS 的症状、认知或行为后遗症有效。
