Skipper Leonard D, Churchill Susan, Wilson Steffanie H, Deru Kayla, Labutta Robert J, Hart Brett B
Hyperbaric Oxygen Project Office, US Army Medical Materiel Development Activity (USAMMDA), Fort Detrick, Maryland U.S.
Neurotrauma and Psychological Health USAMMDA, Fort Detrick, Maryland U.S.
Undersea Hyperb Med. 2016 Aug-Sept;43(5):601-613.
We report results of an observational cohort study investigating long-term follow-up in participants from two completed United States military trials of hyperbaric oxygen (HBO₂) for persistent post-concussive symptoms (PCS), as well as challenges in recruitment and retention in active-duty military personnel. After informed consent, participants completed an electronic survey assessing PCS, post-traumatic stress disorder (PTSD), anxiety, depression and quality of life. Of 132 HBO₂ study participants, 40 (30%) completed the survey (42 could not be contacted; 50 were lost to follow-up or declined). All were male, age 28.1 ±6.6 years (mean ±1SD). Time to follow-up was 39.2 ±6.1 months. At follow-up, participants reported continued symptoms of PTSD, depression, anxiety and reduced quality of life. Among DARPA/VCU study participants, total PCS scores worsened in the 1.5 atmospheres absolute (ATA) equivalent HBO₂ group (mean change 7.4 ±15.8) and improved in the sham (-8.0 ±7.7) and 2.0 atmospheres absolute equivalent HBO₂ groups (-3.3 ±7.4). Individual changes varied widely, range -23 to +28 points. In participants from the HOPPS study, total PCS scores worsened in all groups: local care (10.5 ±8.7), sham (7.9 ±11.9) and 1.5 ATA HBO₂ (1.0 ±19.4). In this limited, cross-sectional sample, PCS and PTSD symptoms did not appear to improve over time by descriptive analyses. Low participation rates and potential response bias limit our ability to perform statistical hypothesis testing and to draw conclusions from these data. Future studies should prospectively plan longitudinal follow-up and regular engagement with participants to minimize attrition.
我们报告了一项观察性队列研究的结果，该研究调查了美国两项已完成的针对持续性脑震荡后症状（PCS）的高压氧（HBO₂）军事试验参与者的长期随访情况，以及现役军人招募和留住参与者方面的挑战。在获得知情同意后，参与者完成了一项电子调查，评估PCS、创伤后应激障碍（PTSD）、焦虑、抑郁和生活质量。在132名HBO₂研究参与者中，40名（30%）完成了调查（42名无法联系到；50名失访或拒绝参与）。所有参与者均为男性，年龄28.1±6.6岁（均值±标准差）。随访时间为39.2±6.1个月。在随访时，参与者报告PTSD、抑郁、焦虑症状持续存在，生活质量下降。在国防高级研究计划局/弗吉尼亚联邦大学（DARPA/VCU）的研究参与者中，绝对压力1.5个大气压（ATA）等效HBO₂组的总PCS评分恶化（平均变化7.4±15.8），而假手术组（-8.0±7.7）和绝对压力2.0个大气压等效HBO₂组（-3.3±7.4）有所改善。个体变化差异很大，范围为-23至+28分。在高压力氧治疗后预后研究（HOPPS）的参与者中，所有组的总PCS评分均恶化：局部护理组（10.5±8.7）、假手术组（7.9±11.9）和1.5 ATA HBO₂组（1.0±19.4）。在这个有限的横断面样本中，通过描述性分析，PCS和PTSD症状似乎并未随时间改善。低参与率和潜在的反应偏倚限制了我们进行统计假设检验以及从这些数据得出结论的能力。未来的研究应前瞻性地规划纵向随访并定期与参与者接触，以尽量减少损耗。
