修订版瓦氏动作对终止阵发性室上性心动过速的影响及临床意义

The effect and clinical significance of the Modified Valsalva Maneuver on the termination of paroxysmal supraventricular tachycardia

目的探讨修订版瓦氏动作对终止阵发性室上性心动过速(PSVT)的影响及其临床意义。方法采用前瞻性研究方法,在2018年7月至2019年5月对喀什地区第二人民医院、莎车县人民医院、泽普县人民医院、疏附县人民医院急诊科收治的PSVT患者进行简单随机化分组。对照组采用标准瓦氏动作、观察组采用修订版瓦氏动作以终止PSVT。比较两组1次复律成功率、累计复律成功率、药物干预率、平均操作次数、复律时间、瓦氏动作期间收缩压(SBP)变化、心率(HR)变化和不良反应。结果纳入研究共96例PSVT患者,每组48例。观察组1次复律成功率(33.33%vs 4.17%,P<0.01)、累计复律成功率(45.83%vs 10.42%,P<0.01)高于对照组,药物干预率低于对照组(54.17%vs 89.58%,P<0.01);观察组平均操作次数少于对照组(P<0.01)、复律时间短于对照组(P<0.01);观察组释放期10 s、释放期20 s的SBP、HR低于对照组(P<0.05,P<0.01);观察组不良反应发生率与对照组相比无统计学差异(4.17%vs 8.33%,P>0.05)。结论修订版瓦氏动作可提高PSVT复律成功率,减少操作次数,加快心律转复,减少收缩压波动,安全可靠。

Objective To investigate the effect of the Modified Valsalva Maneuver(MVM)on termination of paroxysmal supraventricular tachycardia(PSVT)and its clinical significance.Methods A prospective study of 96 patients with PSVT admitted to the emergency department of the Second People′s Hospital of Kashgar,the People′s Hospital of Shache County,the People′s Hospital of Zepu County and the People′s Hospital of Shufu County from July 2018 to May 2019 was conducted.The control group used the standard Valsalva action,and the observation group used the MVM to terminate PSVT.The success rate of one-time cardioversion or cumulative cardio version,the rate of drug intervention,the average number of operations,the time to cardioversion,and SBP changes,heart rate(HR)changes and adverse reactions were compared between two groups.Results There were 96 PSVT patients in the study,48 in each group.The success rate of one-time cardioversion(33.33%vs 4.17%,P<0.01)and cumulative cardioversion(45.83%vs 10.42%,P<0.01)in the observation group were higher than those in the control group;and the drug intervention rate(54.17%vs 89.58%,P<0.01),the average number of operations in the observation group were lower than those in the control group,and the conversion time was shorter than that in the control group(all P<0.01).The SBP、HR of the observation group in the release period of 10 s and 20 s were lower than those of the control group(P<0.05,P<0.01);the incidence of adverse reactions in the observation group was not significantly different from the control group(4.17%vs 8.33%,P>0.05).Conclusion The MVM improves the success rate of PSVT cardioversion,reduces the number of operations,speeds up conversion of PSVT,reduces systolic pressure fluctuations,and is safe and reliable.