Hosking S W, Robinson P, Johnson A G
University Surgical Unit, Royal Hallamshire Hospital, Sheffield.
Gut. 1987 Sep;28(9):1151-6. doi: 10.1136/gut.28.9.1151.
To assess whether Valsalva's manoeuvre might cause variceal bleeding, 22 patients with oesophageal varices were studied. In 12 patients who received no previous treatment to their varices the median pressure gradient across the varix wall at rest was 19 (6-36) mmHg, and in 10 patients whose varices were thrombosed at their distal end the median pressure gradient in the proximal patent varix was 8 (1-6) mmHg. In untreated patients groups, the pressure gradient rose by 6-12 mmHg during Valsalva's manoeuvre in four patients, fell by 4-11 mmHg in five patients and was virtually unchanged in the remainder. These changes seem unlikely to cause variceal bleeding. Patients who repeated Valsalva's manoeuvre showed similar changes on each occasion. Six patients in the untreated group also received hyoscinbutylbromide 20 mg iv. No change was seen in the pressure gradient in five patients, suggesting that it is of little value in preventing variceal bleeding.
为评估瓦尔萨尔瓦动作是否可能导致静脉曲张出血，对22例食管静脉曲张患者进行了研究。在12例此前未接受过静脉曲张治疗的患者中，静息时穿过静脉曲张壁的平均压力梯度为19（6 - 36）mmHg，在10例静脉曲张远端已形成血栓的患者中，近端通畅的静脉曲张的平均压力梯度为8（1 - 6）mmHg。在未治疗的患者组中，在瓦尔萨尔瓦动作期间，4例患者的压力梯度升高了6 - 12 mmHg，5例患者下降了4 - 11 mmHg，其余患者基本未变。这些变化似乎不太可能导致静脉曲张出血。重复进行瓦尔萨尔瓦动作的患者每次均表现出类似变化。未治疗组中的6例患者还静脉注射了20 mg丁溴东莨菪碱。5例患者的压力梯度未见变化，提示其在预防静脉曲张出血方面价值不大。
