Department of Emergency Medicine, Royal North Shore Hospital, Pacific Highway and Reserve Road, St Leonards, Sydney, NSW 2065, Australia.
Emerg Med J. 2010 Apr;27(4):287-91. doi: 10.1136/emj.2009.073866.
Paroxysmal supraventricular tachycardia (SVT) is a relatively common problem presented to the emergency department. Most sources advocate the use of vagal manoeuvres as first-line management, including Valsalva manoeuvre. Despite this, there is lack of standardisation as to how the technique is performed. There is currently no 'gold standard' Valsalva manoeuvre. We propose a modified Valsalva manoeuvre, based on techniques described in small-scale electrophysiological studies, but no large clinical trials.
The study was designed to assess the impact of introducing this modified Valsalva manoeuvre as the departmental standard for non-pharmacological reversion of SVT.
A retrospective audit reviewing the preceding 6-month presentations of SVT was performed, and a questionnaire assessing techniques used and anticipated success rates was completed by a representative sample of emergency department doctors. Finally, a prospective trial of the impact of the modified Valsalva manoeuvre on patients presenting in SVT to the emergency department was performed. After meeting the study criteria and giving consent, the patients were instructed to perform the modified Valsalva manoeuvre, that is, while lying supine on the bed in a Trendelenberg position, they forcefully expire into a section of suction tubing and pressure gauge for at least 15 s and at a pressure of at least 40 mm Hg.
The retrospective 6-month audit revealed only one successful reversion with Valsalva from a sample of 19 patients. Thirty-two doctors completed the questionnaire describing a variety of different Valsalva techniques highlighting a lack of consensus. 27 patients were recruited to the prospective trial, of whom 19 were correctly diagnosed as having paroxysmal SVT. Of these 19 patients, 6 reverted with the modified Valsalva manoeuvre.
Our findings support previous observations that there is lack of standardisation as to how Valsalva is performed, and an apparent reliance on adenosine. The impact of introducing this technique as our departmental standard was a raise in non-pharmacological reversion from 5.3% to 31.7% with no reported significant adverse effects.
阵发性室上性心动过速（SVT）是急诊科常见的问题。大多数资料都提倡使用迷走神经刺激作为一线治疗，包括瓦尔萨尔瓦动作。尽管如此，对于该技术的操作方法仍缺乏标准化。目前没有“金标准”的瓦尔萨尔瓦动作。我们提出了一种改良的瓦尔萨尔瓦动作，基于小规模电生理研究中描述的技术，但没有大型临床试验。
本研究旨在评估将这种改良的瓦尔萨尔瓦动作作为部门标准用于非药物逆转 SVT 的效果。
对 SVT 前 6 个月的就诊情况进行回顾性审核，并对急诊科医生进行了一项关于所使用技术和预期成功率的问卷调查。最后，对改良的瓦尔萨尔瓦动作对急诊科 SVT 患者的影响进行了前瞻性试验。患者符合研究标准并同意后，指导他们进行改良的瓦尔萨尔瓦动作，即患者取仰卧位，头高脚低位，用手捏紧一段吸痰管和压力计，用力呼气至少 15 秒，压力至少 40mmHg。
回顾性的 6 个月审核显示，19 例患者中仅有 1 例通过瓦尔萨尔瓦动作成功逆转。32 名医生完成了问卷调查，描述了各种不同的瓦尔萨尔瓦技术，突出了缺乏共识的问题。27 例患者被纳入前瞻性试验，其中 19 例被正确诊断为阵发性 SVT。在这 19 例患者中，有 6 例通过改良的瓦尔萨尔瓦动作逆转。
我们的研究结果支持先前的观察结果，即瓦尔萨尔瓦动作的操作方法缺乏标准化，并且明显依赖于腺苷。将该技术作为我们部门标准的引入，使非药物逆转率从 5.3%提高到 31.7%，且没有报告明显的不良反应。
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