Ashraf Hira, Fatima Turab, Ashraf Ifra, Majeed Sadaf
Dr. Hira Ashraf, FCPS. Department of Emergency Medicine, Pakistan Ordinance Factory Hospital, Wah Cantt, Pakistan.
Dr. Turab Fatima, FCPS. Department of Emergency Medicine, Pakistan Ordinance Factory Hospital, Wah Cantt, Pakistan.
Pak J Med Sci. 2023 May-Jun;39(3):693-697. doi: 10.12669/pjms.39.3.6725.
The Valsalva maneuver (VM) is the most effective measure that can be carried out to treat supraventricular tachycardia (SVT). Our objective was to compare the efficacy of postural modified VM with 20 ml syringe to standard VM for the emergency treatment of SVT.
This randomized control trial study was conducted at the Accident and Emergency Department, Pakistan ordinance factories hospital, Wah Cantt from July 2019 to September 2020. In the standard Valsalva group, fifty patients were placed at an angle of 45 with continuous monitoring of vitals and electrocardiogram. Patients blew into a 20ml syringe to generate 40 mmHg pressure for 15 seconds and remained in the same position for 45 seconds before a reassessment of cardiac rhythm at one-minute and three-minute intervals. In the modified Valsalva group same procedure was repeated with the other fifty patients, but immediately at the end of the strain, they were laid flat with their legs raised to 45° for 15 seconds. Participants returned to semi-recumbent position and cardiac rhythm was reassessed after 45 seconds and then at one and three minutes.
In the standard Valsalva maneuver (SVM)20.0% of participants versus 58% of participants in the modified Valsalva maneuvers group(MVM) reverted to sinus rhythm at one min (odds ratio or 5.52, 95% CI 2.26-13.47; p<0.001) and time of stay in the emergency room was (odds ratio or 2.39, 95% CI 1.45- 3.93; p<0.0001).
Modified Valsalva by using a wide-bore syringe is more effective method than standard Valsalva in terminating SVT.
瓦尔萨尔瓦动作（VM）是治疗室上性心动过速（SVT）最有效的措施。我们的目的是比较使用20毫升注射器的姿势改良VM与标准VM对SVT进行急诊治疗的疗效。
本随机对照试验研究于2019年7月至2020年9月在巴基斯坦瓦赫坎特兵工厂医院急诊科进行。在标准瓦尔萨尔瓦组中，50名患者以45度角放置，持续监测生命体征和心电图。患者向20毫升注射器吹气以产生40 mmHg压力持续15秒，并在同一位置保持45秒，然后每隔1分钟和3分钟重新评估心律。在改良瓦尔萨尔瓦组中，对另外50名患者重复相同程序，但在用力结束后立即平躺，双腿抬高至45°持续15秒。参与者回到半卧位，45秒后重新评估心律，然后在1分钟和3分钟时再次评估。
在标准瓦尔萨尔瓦动作（SVM）组中，1分钟时20.0%的参与者恢复窦性心律，而改良瓦尔萨尔瓦动作组（MVM）为58%（优势比为5.52，95%可信区间为2.26 - 13.47；p<0.001），且在急诊室停留时间方面（优势比为2.39，95%可信区间为1.45 - 3.93；p<0.0001）。
使用宽口径注射器的改良瓦尔萨尔瓦动作在终止SVT方面比标准瓦尔萨尔瓦动作更有效。
