急诊阵发性室上性心动过速转复方法回顾性分析

A retrospective analysis of cardioversion for paroxysmal supraventricular tachycardia in emergency department

目的回顾性分析急诊阵发性室上性心动过速（PSVT）转复方法，以指导临床诊疗。方法回顾性分析我院急诊抢救室2015年6月至12月间收治的PSVT患者，按照手法转复成功和不成功分为两组，符合标准40例，成功组11例，不成功组29例，比较两组基本信息、生命体征、部分血生化指标、二线治疗情况等，统计方法中分类变量以百分数表示，连续变量以均数±标准差（x±s）表示，两组间参数比较采用成组t检验和卡方（妒）检验。结果手法转复成功率为27．5％，两组选取的基本信息、生命体征、肌钙蛋白I（cTnl）及脑钠肽前体检测（NT-proBNP）差异均无统计学意义，两组血清钾水平分别为（3．8±0．4）mmol／L，（3．5±0．35）mmol／L，差异有统计学意义（P〈0．05），成功组中标准法转复6例，改良法转复5例，差异有统计学意义（P〉0．05），二线治疗主要包括普罗帕酮、腺苷、电复律、维拉帕米、胺碘酮，普罗帕酮为最常用的二线药物，使用率占58．6％。结论手法转复成功率较低，适当提高血钾水平可提高手法转复成功率。

Objective To analyze retrospectively the cardioversion for paroxysmal supraventricular tachycardia （PSVT） in emergency department in order to explore rational guidance for the diagnosis and treatment for PSVT. Methods A retrospective analysis of PSVT patients in the emergency department admitted from June 2015 to December 2015 was carried out. First, all the patients were divided into two groups according to the cardioversion achieved by Valsalva＇s maneuvre or not. Forty patients were enrolled in study. There were 11 patients got cardioversion successfully achieved by the Valsalva＇s maneuvre and 29 patients failed to get cardioversion. Then, comparisons of demographics, vital sign, serum CTNI, potassium and NTproBNP level were carried out between these groups of patients using statistical analysis. The categorical variable was expressed in percentage and the continuous variable was described by mean±standard deviation and the comparisons of parameters were conducted by group t-test and chi-square test. Results The success rate of PSVT maneuvre cardioversion was 27.5%. In addition, there were no significant differences in demographics vital sign, TNI and NTproBNP between the two groups while there were significant differences in serum potassium level between the two groups [（3.8±0.4）mmol/L vs. （3.5±0.35）mmol/L P〈0.05]. There was no significant difference in successful rate of cardioversion between the standard Valsalva＇s maneuvre（n=6） the modified Valsalva＇s maneuvre（n=5）. The second-line treatment mainly included propafenone, adenosine, electroversion, verapamil and amiodarone. The propafenone was the most common second-line agent used for PSVT cardioversion accounting for 58.6%. Conclusions The success rate of Valsalva＇s maneuver cardioversion was low. Keeping properly a higher level of serum potassium could increase the success rate of cardioversion by Valsalva＇s maneuvre.