Khurana Ramesh K, Mittal Deepika
Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
J Community Hosp Intern Med Perspect. 2022 Jul 4;12(4):114-120. doi: 10.55729/2000-9666.1080. eCollection 2022.
We hypothesized that oral leak size, a hitherto unstudied technical variable, would influence hemodynamic responses and difficulty level in executing the Valsalva maneuver (VM).
Based on power analysis, 38 healthy participants were included. Oral leak size in random order was 0.35, 0.71, 1.01,1.40 mm. Level of difficulty was rated 1 to 10, with ≥7-10 being severe. VM was performed at 40 mmHg expiratory strain for 15 s. Three trials were averaged for each leak size. Data were analyzed by repeated measures ANOVA and pairwise comparisons with Tukey adjustment, a mixed effect model, and a generalized linear model.
Of the 38 participants, 4 were excluded from analysis for protocol deviation. Phase II L mean BP (MBP) was significantly higher with the largest leak versus all others (P < 0.001). TL was significantly lower with the largest leak versus all others (P = 0.0029). Difficulty performing the VM increased significantly with every increase in leak size (P < 0.001), and a significantly higher percentage of participants reported severe difficulty with leak 4 compared with leak 1 (P < 0.001), 2 (P = 0.0068), and 3 (P = 0.0068). There was no significant effect of phase II E SBP decline on phase II L MBP increase (P = 0.0752). Difficulty increased significantly with one unit increase in phase II L MBP (P = 0.0002).
Oral leak size affected VM hemodynamic parameters and level of difficulty. Oral leak size exceeding 1.01 mm significantly affected phase II L MBP. Level of difficulty rose with increasing leak size and was significantly correlated with increase in phase II L MBP.
我们假设口腔漏气量，这一此前未被研究的技术变量，会影响执行瓦尔萨尔瓦动作（VM）时的血流动力学反应和难度水平。
基于功效分析，纳入了38名健康参与者。口腔漏气量按随机顺序分别为0.35、0.71、1.01、1.40毫米。难度水平评定为1至10级，≥7 - 10级为重度。VM在40毫米汞柱呼气压力下进行15秒。每种漏气量进行三次试验并取平均值。数据采用重复测量方差分析以及经Tukey校正的两两比较、混合效应模型和广义线性模型进行分析。
38名参与者中，4名因方案偏差被排除在分析之外。与其他所有漏气量相比，最大漏气量时II期L平均血压（MBP）显著更高（P < 0.001）。最大漏气量时总时长（TL）显著低于其他所有情况（P = 0.0029）。随着漏气量每次增加，执行VM的难度显著增加（P < 0.001），与漏气量1相比，漏气量4时报告重度困难的参与者比例显著更高（P < 0.001），与漏气量2相比（P = 0.0068），与漏气量3相比（P = 0.0068）。II期E收缩压下降对II期L MBP升高无显著影响（P = 0.0752）。II期L MBP每增加一个单位，难度显著增加（P = 0.0002）。
口腔漏气量影响VM血流动力学参数和难度水平。超过1.01毫米的口腔漏气量显著影响II期L MBP。难度水平随漏气量增加而上升，且与II期L MBP升高显著相关。
