高压氧改善颅脑创伤导致的焦虑和抑郁状态的疗效分析

Effect of hyperbaric oxygen on the improvement of anxiety and depression after traumatic brain injury

目的探讨高压氧（hyperbaric oxygen，HBO）治疗对颅脑创伤（traumatic brain injury，TBI）导致患者焦虑和抑郁状态的疗效及最佳治疗时程。方法收集2011年1月至2015年3月我科门诊或住院诊治的TBI后焦虑或抑郁状态患者105例，诊断为单纯焦虑的有56例，单纯抑郁有38例，焦虑同时伴有抑郁的有11例。按照患者行HBO治疗情况分为HBO组与非HBO组，HBO组为在我科连续行HBO治疗超过4周的患者59例，而非HBO组为我科诊治却未行HBO治疗或HBO治疗时程不足1周的患者46例。在67例焦虑患者（含56例单纯焦虑及11例焦虑同时伴有抑郁的患者）中，有38例行HBO治疗，而29例未行HBO治疗；49例抑郁患者（含38例单纯抑郁及11例焦虑同时伴有抑郁的患者）中，有28例行HBO治疗，而21例未行HBO治疗。对于焦虑患者，评估2组患者治疗后1、2、3、4周的焦虑自评量表（self-rating anxiety scale，SAS）和汉密尔顿焦虑量表（Hamilton anxiety scale，HAMA）评分改善情况；对于抑郁患者，则评估2组患者治疗后l、2、3、4周的抑郁自评量表（self-ratingdepressionscale，SDS）和汉密尔顿抑郁量表（Hamihon depression scale，HAMD）改善情况。结果对于所有患者，HBO治疗组的SAS评分和SDS评分（分别为44．9±11．2、36．8±14．0）在治疗后4周均显著低于同时间点非HBO治疗组（分别为51．7±13．9、42．8±14．9），差异有统计学意义（P〈0．05）。对于焦虑患者，治疗后1周和2周HBO组SAS评分和HAMA评分较非HBO组差异无统计学意义（P〉0．05），但在治疗后3周和4周HBO组患者的SAS评分和HAMA评分较治疗前和治疗后1周、2周显著下降，且显著低于同时间点非HBO组，差异有统计学意义（P〈0．05）。对于抑郁患者，治疗后1周、2周和3周HBO组的SDS评分和HAMD评分较非HBO组差异无统计学意义（P〉0．05），但在治疗后4周HBO组患者的SDS评分和HAMD评分较前3周显著下降，且显著低于同时间点非HBO组，差异有统计学意义（P〈0．05）。结论HBO治疗对TBI后焦虑和抑郁状态有显著改善作用，但对于焦虑患者治疗时程需持续3周及以上，而对抑郁患者需持续4周及以上。

Objective To explore the effect of hyperbaric oxygen （HBO） on the anxiety and depression after traumatic brain injury （TBI） and optimal treatment course. Methods One hundred and five TBI patients with depression or anxiety, who either sought medical care in the outpatient or hospitalized were recruited for the study. Of all the cases, 56 were diagnosed to have anxiety, 38 have depression, and another 11 cases were diagnosed to have both anxiety and depression. The patients were divided into the HBO group and the non- HBO group, depending upon whether or not they received HBO therapy. The patients in the HBO group were those treated with HBO in our department for at least 4 weeks, while the patients in the non-HBO group were those who received medical treatment, but without HBO therapy or those who received HBO therapy for less than 1 week. Of the 105 patients, 59 received HBO therapy and 46 did not have HBO therapy. In the 67 patients with anxiety, 38 received HBO therapy, while 29 did not have HBO therapy. On the other hand, in the 49 patients with depression, 28 received HBO therapy, while 21 did not have HBO therapy. In the ease of patients with anxiety, the scores of self-rating anxiety scale （SAS） and Hamilton anxiety scale （HAMA）, 1, 2, 3 and 4 weeks after treatment were assessed and compared between the 2 groups. And in the case of patients with depression, the scores of self-rating depression scale （SDS） and Hamilton depression scale （HAMD） , 1, 2, 3 and 4 weeks after treatment were also assessed and compared between the 2 groups. Results For all the patients, the SAS and SDS scores of the HBO group （44.9 ± 11.2,36.8 ± 14.0）4 weeks after therapy were significantly lower than those of the non-HBO group（ 51.7 ±13.9,42.8 ± 14.9 ） at the same time point （ P 〈 0.05）. For the patients with anxiety, no significant differences could be noted in the scores of SAS and HAMA, 1 and 2 weeks after HBO therapy, as compared with those of the non-HBO group （P 〉 0.05）. However, the scores of SAS and HAMA, 3 and 4 weeks after HBO therapy were significantly decreased, as compared with those of either before therapy or 1 and 2 weeks after HBO therapy. Furthermore, the scores of the HBO group were significantly lower than those of the non-HBO group, with statistical significance（P 〉 0.05）. For the patients with depression, no significant differences could be noted in the SAS and HAMA scores in the patients of the HBO group following 1 and 2 weeks after HBO therapy, when compared with those of the non-HBO group（P 〉 0. 05）. However, the scores of SAS and HAMA 4 weeks after HBO therapy were significantly decreased, as compared with those 3 weeks after HBO therapy, and was significantly lower than those of the non-HBO group at the same time point, and statistical significance could be seen when comparison were made between the two（P 〉 0.05）. Conclusions HBO therapy could obviously alleviate the symptoms of the patients with anxiety and depression. However, an over 3-week treatment course was required for the patients with anxiety, and an over 4-week treatment course was mandatory for those patients with depression.