Hart Brett B, Weaver Lindell K, Gupta Ashutosh, Wilson Steffanie H, Vijayarangan Amarnath, Deru Kayla, Hebert Donald
Emmes, Rockville, Maryland U.S.
Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S.
Undersea Hyperb Med. 2019;46(3):353-383.
Some clinical trials report improvement in persistent post-concussive symptoms (PCS) with hyperbaric oxygen (HBO2) following mild traumatic brain injury (mTBI), but questions remain regarding the utility of HBO2 for PCS, the effects of HBO2 on post-traumatic stress disorder (PTSD), and the influences of sham control exposures.
A systematic review and pooled analysis was conducted to summarize available evidence for HBO2 in mTBI-associated PCS ± PTSD. Data aggregated from four Department of Defense (DoD) studies with participant-level data (n=254) were grouped into pooled HBO2 and sham intervention groups. Changes from baseline to post-intervention on PCS, PTSD, and neuropsychological measures were assessed using linear mixed models to evaluate main intervention and intervention-by-baseline PTSD effects. Potential dose-response relationships to oxygen partial pressures were investigated. Intervention effects from three other published studies with summary-level participant data (n=135) were also summarized..
Pooled DoD data analyses indicated trends toward improvement favoring HBO2 for PCS (Rivermead Total Score: -2.3, 95% CI [-5.6, 1.0], p=0.18); PTSD (PTSD Checklist Total Score: -2.7, 95% CI [-5.8, 0.4], p=0.09); and significant improvement in verbal memory (CVLT-II Trial 1-5 Free Recall: 3.8; 95% CI [1.0, 6.7], p=0.01). A dose-response trend to increasing oxygen partial pressure was also found, with a greater HBO2 effect in mTBI-associated PTSD suggested. The direction of results was consistent with other published studies.
A definitive clinical trial, with an appropriate control group, should be considered to identify the optimal HBO2 dosing regimen for individuals with mTBI-associated PTSD ± PCS.
一些临床试验报告称，轻度创伤性脑损伤（mTBI）后采用高压氧（HBO₂）治疗可改善持续性脑震荡后症状（PCS），但HBO₂对PCS的效用、HBO₂对创伤后应激障碍（PTSD）的影响以及假对照暴露的影响仍存在疑问。
进行了一项系统评价和汇总分析，以总结HBO₂治疗mTBI相关PCS±PTSD的现有证据。从四项美国国防部（DoD）研究中汇总的参与者水平数据（n = 254）被分为HBO₂汇总组和假干预组。使用线性混合模型评估从基线到干预后PCS、PTSD和神经心理学指标的变化，以评估主要干预措施以及干预与基线PTSD的交互作用。研究了与氧分压的潜在剂量反应关系。还汇总了其他三项发表研究的汇总水平参与者数据（n = 135）的干预效果。
DoD汇总数据分析表明，HBO₂治疗PCS有改善趋势（Rivermead总分：-2.3，95%CI[-5.6, 1.0]，p = 0.18）；PTSD（PTSD检查表总分：-2.7，95%CI[-5.8, 0.4]，p = 0.09）；言语记忆有显著改善（CVLT-II试验1-5自由回忆：3.8；95%CI[1.0, 6.7]，p = 0.01）。还发现了氧分压升高的剂量反应趋势，提示HBO₂对mTBI相关PTSD的效果更大。结果方向与其他已发表研究一致。
应考虑进行一项有适当对照组的确定性临床试验，以确定mTBI相关PTSD±PCS患者的最佳HBO₂给药方案。
