van Dijk Nynke, Quartieri Fabio, Blanc Jean-Jaques, Garcia-Civera Roberto, Brignole Michele, Moya Angel, Wieling Wouter
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
J Am Coll Cardiol. 2006 Oct 17;48(8):1652-7. doi: 10.1016/j.jacc.2006.06.059. Epub 2006 Sep 26.
In this study, we assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life.
There is presently no evidence-based therapy for vasovagal syncope. Current treatment consists of explanation and life-style advice. Physical counterpressure maneuvers have been shown to raise blood pressure and to control or abort vasovagal episodes in laboratory conditions.
We performed a multicenter, prospective, randomized clinical trial, which included 223 patients age 38.6 (+/-15.4) years with recurrent vasovagal syncope and recognizable prodromal symptoms. One hundred and seventeen patients were randomized to standardized conventional therapy alone, and 106 patients received conventional therapy plus training in PCM.
The median yearly syncope burden during follow-up was significantly lower in the group trained in PCM than in the control group (p = 0.004). During a mean follow-up period of 14 months, overall 50.9% of the patients with conventional treatment and 31.6% of the patients trained in PCM experienced a syncopal recurrence (p = 0.005). Actuarial recurrence-free survival was better in the treatment group (log-rank p = 0.018), resulting in a relative risk reduction of 39% (95% confidence interval, 11% to 53%). No adverse events were reported.
Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope and recognizable prodromal symptoms, and should be advised as first-line treatment in patients presenting with vasovagal syncope with prodromal symptoms. (The PC-Trial; http://www.controlled-trials.com/isrctn/trial/45146526/0/45146526.html; ISRCTN45146526).
在本研究中，我们评估了物理对抗压力手法（PCM）在日常生活中的有效性。
目前尚无基于证据的血管迷走性晕厥治疗方法。当前的治疗包括解释和生活方式建议。在实验室条件下，物理对抗压力手法已被证明可升高血压并控制或终止血管迷走性发作。
我们进行了一项多中心、前瞻性、随机临床试验，纳入了223名年龄为38.6（±15.4）岁、有复发性血管迷走性晕厥且有可识别前驱症状的患者。117名患者被随机分配至仅接受标准化常规治疗，106名患者接受常规治疗加PCM训练。
接受PCM训练的组在随访期间每年晕厥负担的中位数显著低于对照组（p = 0.004）。在平均14个月的随访期内，接受常规治疗的患者中总体有50.9%经历了晕厥复发，接受PCM训练的患者中有31.6%经历了晕厥复发（p = 0.005）。治疗组的无复发精算生存率更好（对数秩检验p = 0.018），相对风险降低了39%（95%置信区间，11%至53%）。未报告不良事件。
物理对抗压力手法对于有血管迷走性晕厥且有可识别前驱症状的患者是一种无风险、有效且低成本的治疗方法，对于出现有前驱症状的血管迷走性晕厥患者，应建议将其作为一线治疗方法。（PC试验；http://www.controlled-trials.com/isrctn/trial/45146526/0/45146526.html；ISRCTN45146526）
