体位改良的Valsalva动作在终止阵发性室上性心动过速中的疗效观察

Observation of the effect of postural modified Valsalva manoeuvre in terminating paroxysmal supraventricular tachycardia

目的观察体位改良的Valsalval动作在终止阵发性室上性心动过速(PSVT)中的有效性与安全性。方法选取2017年1月至2018年6月徐州医科大学附属医院急诊内科及心内科门诊收治的PSVT患者98例,采用密封信封抽签法进行随机分组,即标准Valsalval动作组(48例)、体位改良Valsalval动作组(50例),分别采用标准Valsalval动作和标准Valsalval动作后立即平卧位及双下肢被动伸直抬高。比较两组一般临床资料、总转复率、1次转复窦性心律成功率及不良反应发生率。结果两组患者性别构成、年龄、既往PSVT发作史、冠心病、高血压及糖尿病发生率,发作时心率、收缩压及舒张压差异均无统计学意义(均P>0.05);改良Valsalva组总转复成功率为40.0%(20/50)、1次转复成功率为28.0%(14/50),均高于标准Valsalva组的16.7%(8/48)、12.5%(6/48),差异均有统计学意义(χ2=27.924、16.308,均P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论体位改良的Valsalval动作可有效提高PSVT转复成功率,且安全性较高。

Objective To observe the efficacy and safety of postural modified Valsalval manoeuvre in terminating paroxysmal supraventricular tachycardia(PSVT).Methods From January 2017 to June 2018,a total of 98 patients with PSVT were selected in the Affiliated Hospital of Xuzhou Medical University.They were randomly allocated to standard Valsalval manoeuvre group(48 cases)and postural modified Valsalval manoeuvre group(50 cases)according to sealed envelope method.The patients in standard Valsalval manoeuvre group carried out standard semi-recumbent Valsalva manoeuvre,while the other group received semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain.The general clinical data,total cardioversion success rate,first-time cardioversion success rate and the incidence of adverse reactions were compared between the two groups.Results There were no statistically significant differences in male proportion,age,history of PSVT or coronary heart disease,incidence of hypertension,diabetes and heart rate,systolic and diastolic blood pressure at attack between the two groups(all P>0.05).The total cardioversion success rate[40.0%(20/50)],first-time cardioversion success rate[28.0%(14/50)]in the modified group were significantly higher than those in the standard group[16.7%(8/48),12.5%(6/48)](χ2=27.924,16.308,all P<0.05).The incidence of adverse reactions was low in both two groups,and there was no statistically significant difference(P>0.05).Conclusion Postural modified Valsalval manoeuvre can effectively improve the cardioversion success rate of PSVT,and has high safety,which is worthy of clinical promotion.