物理手法作为预防干预措施来管理血管迷走性晕厥：系统评价。
Physical manoeuvers as a preventive intervention to manage vasovagal syncope: A systematic review.
机构信息
Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen, Belgium.
Cochrane Belgium, Belgian Centre for Evidence-Based Medicine (Cebam), Leuven, Belgium.
出版信息
PLoS One. 2019 Feb 28;14(2):e0212012. doi: 10.1371/journal.pone.0212012. eCollection 2019.
AIMS
To summarize the best available evidence on the effectiveness of physical counterpressure manoeuvers (PCM) for vasovagal syncope management compared to a control intervention. Control interventions included either a PCM, no intervention, or other interventions feasible in a lay setting.
METHODS
A systematic literature search (March 21st 2018) was performed in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase. PCM were subdivided into 1) PCM decreasing orthostatic load (PCMOL), 2) PCM shortening the hydrostatic column between heart and brain (PCMHC), 3) PCM using mechanical compression of the veins (PCMMC). The primary outcome was syncope, secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR). When possible, a random effects meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous outcomes, and mean differences (MD) or standardized mean differences (SMD) were calculated for continuous outcomes. Heterogeneity was assessed by means of the I2 statistic. The total body of evidence was evaluated by means of the GRADE methodology.
RESULTS
Eleven trials involving 688 people with vasovagal syncope were included. Risk of bias was high in all included studies. The total body of evidence (GRADE) was considered to be low or very low. PCM were found to improve syncope as compared to control (OR: 0.52, 95% CI [0.33;0.81], p = 0.004). Similarly, before-and-after studies without a control group showed a significant reduction in syncope following PCM (OR: 0.01, 95%CI [0.00;0.01], p<0.001). No studies investigated PCMOL. PCMHC increased SBP, DBP, MAP, SV, and CO, and decreased HR. PCMMC increased SBP, DBP, and MAP.
CONCLUSION
PCM may reduce syncope and increase SBP, DBP, and MAP. The effects on other outcomes are less clear. Additional high-quality studies are needed.
目的
总结物理对抗压力手法（PCM）治疗血管迷走性晕厥的最佳证据，与对照干预措施相比。对照干预措施包括 PCM、无干预或其他在非专业环境中可行的干预措施。
方法
系统检索 Cochrane 对照试验中心注册库、MEDLINE 和 Embase 中的文献（2018 年 3 月 21 日）。PCM 分为 1）降低直立负荷的 PCM（PCMOL），2）缩短心脏和大脑之间静压柱的 PCM（PCMHC），3）使用静脉机械压迫的 PCM（PCMMC）。主要结局为晕厥，次要结局包括收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、每搏输出量（SV）、心输出量（CO）和总外周阻力（TPR）。当可能时，进行随机效应荟萃分析。二分类结局计算比值比（OR）及其 95%置信区间（CI），连续性结局计算均值差（MD）或标准化均数差（SMD）。异质性通过 I2 统计评估。总证据体通过 GRADE 方法评估。
结果
纳入 11 项涉及 688 例血管迷走性晕厥患者的试验。所有纳入研究的偏倚风险均较高。总证据体（GRADE）被认为是低或极低。与对照组相比，PCM 可改善晕厥（OR：0.52，95%CI [0.33；0.81]，p = 0.004）。同样，没有对照组的前后对照研究显示，PCM 后晕厥显著减少（OR：0.01，95%CI [0.00；0.01]，p<0.001）。没有研究调查 PCMOL。PCMHC 增加 SBP、DBP、MAP、SV 和 CO，降低 HR。PCMMC 增加 SBP、DBP 和 MAP。
结论
PCM 可能减少晕厥，增加 SBP、DBP 和 MAP。对其他结局的影响尚不清楚。需要更多高质量的研究。
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