Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia.
Eur J Emerg Med. 2012 Dec;19(6):346-52. doi: 10.1097/MEJ.0b013e32834ec7ad.
Use of the Valsalva manoeuvre (VM) as a first-line management tool for the reversion of supraventricular tachycardia (SVT) in both emergency medicine and prehospital emergency-care settings has presented challenges, requiring continuous examination and refinement to define both its appropriateness and effectiveness. This report details the evolution of knowledge related to SVT and the historical evolution and controversies associated with VM; it also highlights the ongoing development of an evidence-based model of practice for the management of SVT in the emergency medicine and prehospital emergency-care settings. A two-part review of the literature using electronic medical databases was conducted. Other relevant texts or articles unavailable within the electronic search were also identified. Part 1 of the search criteria identified the historical evolution of the pathophysiology of SVT, whereas part 2 identified the use of VM for the clinical management of SVT. Part 1 of the review identified a total of 38 articles with eight meeting the inclusion criteria, and part 2 of the review identified a total of 44 articles with 17 meeting the inclusion criteria. An evidence-based model of practice requires clarification. The differentiation of nodal re-entrant tachycardias may, with further research, lead to identification of the specificity of VM in reversion of SVT during the early stages of arrhythmia. There is a need for further prehospital and emergency department research to quantify an evidence-based approach to VM.
在急诊医学和院前急救环境中，使用瓦尔萨尔瓦动作（VM）作为恢复室上性心动过速（SVT）的一线管理工具存在挑战，需要不断检查和改进，以确定其适当性和有效性。本报告详细介绍了与 SVT 相关的知识演变，以及与 VM 相关的历史演变和争议；它还强调了在急诊医学和院前急救环境中，基于证据的 SVT 管理实践模式的持续发展。使用电子医学数据库对文献进行了两部分回顾。还确定了无法在电子搜索范围内获得的其他相关文本或文章。搜索标准的第 1 部分确定了 SVT 病理生理学的历史演变，而第 2 部分则确定了 VM 在 SVT 临床管理中的使用。第 1 部分的综述共确定了 38 篇文章，其中 8 篇符合纳入标准，第 2 部分的综述共确定了 44 篇文章，其中 17 篇符合纳入标准。需要明确一个基于证据的实践模式。随着进一步的研究，对结折返性心动过速的区分可能会确定 VM 在心律失常早期恢复 SVT 中的特异性。需要进一步进行院前和急诊科研究，以量化基于证据的 VM 方法。
