Hyperbaric oxygen therapy as a potential treatment for post-traumatic stress disorder associated with traumatic brain injury.
Hyperbaric oxygen therapy as a potential treatment for post-traumatic stress disorder associated with traumatic brain injury.
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DOI：
10.2147/ndt.s110126
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发表时间：
2016
影响因子：
3.2
通讯作者：
Borlongan CV
中科院分区：
文献类型：
--
作者：
Eve DJ;Steele MR;Sanberg PR;Borlongan CV
创伤性脑损伤（TBI）描述了作为损伤的结果的对大脑的物理损伤的存在，并且根据损伤的严重性，经常具有心理和神经症状。最近美军在伊拉克和阿富汗的军事存在增加，与此同时，简易爆炸装置的使用增加，导致许多返回的士兵遭受一定程度的创伤性脑损伤。观察到双相反应，其首先是直接损伤相关的，其次是由于缺氧、氧化应激增加和炎症。一部分返回的士兵还患有创伤后应激障碍，在某些情况下，这可能是创伤性脑损伤的后果。有效的治疗方法仍在确定中，一个可能的治疗候选者是高压氧治疗（HBOT）。已经进行了一些临床试验，这些试验表明TBI和/或PTSD的生存率和疾病严重程度方面的益处，而其他几项研究与可能控制不良的假手术相比没有看到任何改善。在动物模型中，HBOT已显示出减少细胞凋亡、上调生长因子、促进抗氧化剂水平和抑制炎性细胞因子，因此，HBOT可能在治疗TBI和PTSD的至少第二阶段中是有利的。有一些证据表明，在脑损伤的动物模型中，HBOT暴露具有假定的预防或预处理益处，并且治疗的最佳时间范围尚未确定。HBOT具有潜在的副作用，如急性脑毒性和更多的活性氧，因此，优化暴露时间，以最大限度地提高回报和减少HBOT的有害影响是必要的。本文综述了目前对HBOT的认识，并提出了未来的发展方向，包括预防性使用和慢性治疗。
Traumatic brain injury (TBI) describes the presence of physical damage to the brain as a consequence of an insult and frequently possesses psychological and neurological symptoms depending on the severity of the injury. The recent increased military presence of US troops in Iraq and Afghanistan has coincided with greater use of improvised exploding devices, resulting in many returning soldiers suffering from some degree of TBI. A biphasic response is observed which is first directly injury-related, and second due to hypoxia, increased oxidative stress, and inflammation. A proportion of the returning soldiers also suffer from post-traumatic stress disorder (PTSD), and in some cases, this may be a consequence of TBI. Effective treatments are still being identified, and a possible therapeutic candidate is hyperbaric oxygen therapy (HBOT). Some clinical trials have been performed which suggest benefits with regard to survival and disease severity of TBI and/or PTSD, while several other studies do not see any improvement compared to a possibly poorly controlled sham. HBOT has been shown to reduce apoptosis, upregulate growth factors, promote antioxidant levels, and inhibit inflammatory cytokines in animal models, and hence, it is likely that HBOT could be advantageous in treating at least the secondary phase of TBI and PTSD. There is some evidence of a putative prophylactic or preconditioning benefit of HBOT exposure in animal models of brain injury, and the optimal time frame for treatment is yet to be determined. HBOT has potential side effects such as acute cerebral toxicity and more reactive oxygen species with long-term use, and therefore, optimizing exposure duration to maximize the reward and decrease the detrimental effects of HBOT is necessary. This review provides a summary of the current understanding of HBOT as well as suggests future directions including prophylactic use and chronic treatment.