Lancet:憋气并抬高双腿:能有效终止室上速(REVERT试验)

前两天在心外科值班,发现有个患者发室上速,因此想到改良的valsalva试验,发现有效,但是实际心律转回来是不是它的作用我就不清楚了,当时只是在公众号上看到过,但是原文没有看见,因此重新去翻了一下这个老的研究。

Lancet:憋气并抬高双腿:能有效终止室上速(REVERT试验)

Summary

Background:The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. Valsalva动作是一种治疗室上速的国际推荐方法,但实际上心脏复律的概率很低(5–20%),因此必须使用其他治疗方法,包括腺苷,这通常会让患者感到不适。 我们评估了Valsalva动作的姿势修改是否可以提高其转律的有效性。

Methods:We did a randomised controlled, parallel-group trial at emergency departments in England. We randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fibrillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mmHg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, opaque, sealed, tamper-evident envelopes. Patients and treating clinicians were not masked to allocation. The primary outcome was return to sinus rhythm at 1 min after intervention, determined by the treating clinician and electrocardiogram and confirmed by an investigator masked to treatment allocation. This study is registered with Current Controlled Trials (ISRCTN67937027). 我们在英格兰的急诊室进行了一项随机对照,平行分组的试验。 我们随机分配表现为室上速(不包括房颤和房扑)的成人患者,以1:1的比例进行改良的Valsalva动作(半卧位,仰卧位复位,Valsalva应变后立即被动抬高腿),或标准半 -卧式Valsalva动作。 两组均使用40 mmHg的压力,持续15 s的标准时间。 以中心分层的随机化是集中和独立进行的,分配有连续编号,不透明,密封,防篡改信封。 患者和主治医生没有被掩盖。 主要结果是在干预后1分钟恢复窦性心律,这由治疗的临床医生和心电图确定,并由掩盖治疗分配的研究者确认。 该研究已在“当前对照试验”中注册。

Findings:We enrolled 433 participants between Jan 11, 2013, and Dec 29, 2014. Excluding second attendance by five participants, 214 participants in each group were included in the intention-to-treat analysis. 37 (17%) of 214 participants assigned to standard Valsalva manoeuvre achieved sinus rhythm compared with 93 (43%) of 214 in the modified Valsalva manoeuvre group (adjusted odds ratio 3·7 (95% CI 2·3–5·8; p<0·0001). We recorded no serious adverse events. 我们在2013年1月11日至2014年12月29日之间招募了433名参与者。除5名参与者的二次参与之外,每组214名参与者被纳入了治疗意向分析。 分配给标准Valsalva动作的214位参与者中有37位(17%)实现了窦性心律,而改良Valsalva动作组的214位参与者中有93位(43%)(调整后的优势比为3·7(95%CI 2·3–5·8; p <0·0001)。我们未发现严重不良事件。

Lancet:憋气并抬高双腿:能有效终止室上速(REVERT试验)
分配的方案
Lancet:憋气并抬高双腿:能有效终止室上速(REVERT试验)
两组基线水平
Lancet:憋气并抬高双腿:能有效终止室上速(REVERT试验)
结局

Interpretation:In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients. 对于室上速的患者,应考虑采用改良的Valsalva动作,在吹气动作最后抬高患者腿部并仰卧,这是常规的首选治疗方法,可以向患者传授。

看看是具体是怎么一个动作:

全文下载:

Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial

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