van den Brink R B A, de Lange F J
AMC, afd. Cardiologie, Amsterdam.
Ned Tijdschr Geneeskd. 2017;161:D1312.
Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. There are safer interventions without neurologic complications, such as the modified Valsalva manoeuvre (efficacy 43%) and intravenous administration of adenosine (efficacy 75%). Monitor observation of the heart rhythm is required, both for vagal manoeuvres and for adenosine administration, because of the possibility of ventricular tachycardia or ventricular fibrillation induction (incidence 0.08%). Carotid sinus massage remains an important diagnostic method in patients with unexplained syncope in whom, based on the clinical history, carotid sinus hypersensitivity is suspected. It should be avoided in patients with previous TIA or stroke within the past 3 months, or those with carotid bruits, except if carotid Doppler studies have excluded significant stenosis (≥ 70%).
在急诊科，颈动脉窦按摩用于诊断和终止室上性心动过速（SVT）仍是一种广泛应用的迷走神经手法。然而，其疗效有限（约20%的SVT可被终止），且在0.2% - 1%的患者中，颈动脉窦按摩可能会并发（潜在致命的）神经系统并发症。还有一些更安全且无神经系统并发症的干预措施，如改良Valsalva动作（疗效43%）和静脉注射腺苷（疗效75%）。由于存在诱发室性心动过速或心室颤动的可能性（发生率0.08%），无论是进行迷走神经手法还是给予腺苷，都需要监测心律。对于有不明原因晕厥且根据临床病史怀疑有颈动脉窦过敏的患者，颈动脉窦按摩仍是一种重要的诊断方法。在过去3个月内有过短暂性脑缺血发作（TIA）或中风的患者，或有颈动脉杂音的患者中，应避免进行颈动脉窦按摩，除非颈动脉多普勒检查排除了严重狭窄（≥70%）。
