调查海拔高度>4 000 m筑养路职工的焦虑发病现状，分析重复经颅磁刺激(repeat transcranial magnetic stimulation, rTMS)和药物干预对焦虑的疗效。

选取2015年4月至2016年7月青海省果洛公路段、玉树公路段、海东公路段高海拔地区在职筑养路职工920例作为研究对象。采用汉密尔顿焦虑量表(HAMA)对每名研究对象进行焦虑筛查，分别统计不同海拔高度(2 000～3 000 m, 3 001～4 000 m和>4 000 m)筑养路职工的焦虑情况。对285例作业于海拔高度>4 000 m的筑养路职工中存在轻、中、重度焦虑症状患者进行前瞻性随机对照研究，并随机分为rTMS组和药物干预组(每组25例),药物干预组采用盐酸丁螺环酮片10 mg 3次/d口服。比较两组治疗前后HAMA评分变化情况。

海拔高度>4 000 m作业环境下的筑养路职工焦虑发病率均高于较低海拔的筑养路职工，HAMA评分≥14分占20.40%(58/285),且HAMA评分≥29的严重焦虑发病率均高于作业海拔高度较低者，[HAMA评分≥29分的占10.88%(31/285)vs 3.49%(11/315), 10.88%(31/285)vs 5.31%(17/320), P均<0.05]。(rTMS)和药物干预组焦虑症状显著改善。

海拔高度对高原筑养路工人焦虑的发病率有重要影响作用，当海拔>4 000 m时，工人的焦虑发生率明显高于海拔<4 000 m的工人的发病率。rTMS和药物干预治疗均能显著改善焦虑患者的病情。rTMS的疗效要显著优于单纯药物治疗的疗效，对重度焦虑尤为明显。

To investigate the present situation of anxiety of the road workers in the plateau area, and analyze the effect of repetitive transcranial magnetic stimulation (repeat transcranial magnetic stimulation rTMS) combined with drug intervention on anxiety.

920 road workers in the high-altitude area of Qinghai province from April 2015 to July 2016 were studied by using the Hamilton anxiety scale (HAMA) for screening anxiety and the levels of anxiety in road workers were recorded according to different altitude (2 000 to 3 000 m, 3 001 to 4 000 m, above 4 000 m). 285 cases of road workers in above 4 000 meters altitude with light, medium and severe anxiety were enrolled in a prospective randomized controlled study, and were randomly divided into rTMS group and drug intervention group (25 cases in each group). The drug intervention group was treated with oral buspirone hydrochloride 10 mg three times perday. The changes of HAMA scores before and after treatment in two groups were compared.

The incidence of anxiety in workers of above 4 000 meters altitude was higher than that of workers in lower altitude area. The percent of HAMA scores of ≥14 points in high altitude group is 20.40% (58/285), and the incidence of severe anxiety with HAMA scores of ≥ 29 in this group is 10.88%(31/285)and is higher than that of two groups in lower altitude[10.88% (31/285) vs 3.49% (11/315), 10.88% (31/285) vs 5.31% (17/320), P<0.05]. The anxiety symptom in rTMS and drug intervention groups was improved significantly.

The altitude has an important effect on the incidence of anxiety in road workers. Inthe areas with altitude of >4 000 meters, the incidence of anxiety of the workers is significantly higher than that of the workers at the altitude of <4 000 meters. rTMS and drug intervention can significantly improve the patients’ condition.The curative effect of rTMS is significantly better than that of pure drug therapy, especially for severe anxiety.