Benarroch E E, Opfer-Gehrking T L, Low P A
Autonomic Reflex Laboratory, Mayo Foundation, Rochester, MN 55905.
Muscle Nerve. 1991 Dec;14(12):1165-72. doi: 10.1002/mus.880141204.
We analyzed the Valsalva maneuver (VM) using a photoplethysmographic technique in 24 normal subjects. We studied the effects of test duration (range 5 to 20 seconds) and magnitude of expiratory pressure (EP, range 20 to 50 mmHg) on maximal (% delta) and time integrated (int) changes in heart rate (HR), and mean (MAP) and pulse (PP) pressures during phases II and IV. At all EPs, there was correlation (P less than 0.01) between % delta MAP in both late phase II and phase IV and duration of the VM. The Valsalva ratio (VR) correlated with test duration only at high EPs. All responses, except the fall in MAP in early phase II and bradycardia in phase IV, correlated with EPs. The VR correlate not only with HR responses in phases II and IV but also with MAP and PP overshoot in phase IV. Correlations between maximal AP and HR changes in either phase II and IV were poor. Our study indicates that the photoplethysmographic technique allows a more rational interpretation of the VM in the clinical setting. The VR cannot be adequately interpreted without comcomitant monitoring of arterial pressure during the VM.
我们使用光电容积描记技术对24名正常受试者的瓦尔萨尔瓦动作（VM）进行了分析。我们研究了测试持续时间（5至20秒）和呼气压力（EP，20至50 mmHg）幅度对第二和第四阶段心率（HR）、平均动脉压（MAP）和脉压（PP）的最大（%变化）和时间积分（积分）变化的影响。在所有EP水平下，第二阶段晚期和第四阶段的%MAP变化与VM持续时间之间均存在相关性（P<0.01）。仅在高EP水平下，瓦尔萨尔瓦比值（VR）与测试持续时间相关。除第二阶段早期MAP下降和第四阶段心动过缓外，所有反应均与EP相关。VR不仅与第二和第四阶段的HR反应相关，还与第四阶段的MAP和PP过冲相关。第二阶段和第四阶段最大动脉压变化与HR变化之间的相关性较差。我们的研究表明，光电容积描记技术有助于在临床环境中对VM进行更合理的解释。在VM期间，如果不同时监测动脉压，就无法充分解释VR。
