改良Valsalva动作对阵发性室上性心动过速的转复效果及相关因素分析  

Efficacy and influencing factors of modified Valsalva maneuver for the cardioversion of paroxysmal supraventricular tachycardia

作　　者：董红锰 梅雪[1] 高珍珍 祁璇 Dong Hong-meng;Mei Xuey Gao;Zhen-zhen;Qi Xuan(Emergency Department,Chaoyang Hospital,Capital Medical University,Clinical Research Center of Emergency Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊科首都医科大学附属北京朝阳医院急诊医学临床研究中心心肺脑复苏北京市重点实验室,北京100020 [2]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中国急救医学》2021年第8期661-664,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的研究改良Valsalva动作对阵发性室上性心动过速(PSVT)的转复效果,并对影响转复效果的相关因素进行分析。方法分析首都医科大学附属北京朝阳医院急诊科自2019年3月至2020年12月收治的阵发性室上性心动过速患者68例,按照改良Valsalva动作转复结果分为成功组(n=32)和失败组(n=36),比较两组患者性别,年龄,发病时间,入抢救室时心率、收缩压、舒张压,室上性心动过速既往史,射频消融手术史,心肌肌钙蛋白I(c Tn I)及血钾水平等。结果改良Valsalva动作转复成功率为47.1%,两组年龄,性别,发病时间,入抢救室时心率、收缩压、舒张压,室上性心动过速既往史,射频消融手术史,c Tn I及血钾水平等差异均无统计学意义(P>0.05);二线治疗主要包括药物复律及电复律,其中普罗帕酮为我科最常用药物,在失败组中使用率为94.4%,首次静脉推注普罗帕酮的转复成功率为85.3%,未见明显不良反应。结论改良Valsalva动作对PSVT转复有良好的效果,年龄、性别、生命体征、发病时间、室上性心动过速既往史、射频消融手术史、c Tn I及血钾水平等不是影响改良Valsalva动作转复效果的因素。普罗帕酮作为二线药物安全、有效。Objective To analyze the efficacy and influencing factors of modified Valsalva maneuver for the cardioversion of paroxysmal supraventricular tachycardia( PSVT) in our emergency department. Methods Patients with PSVT admitted to Emergency Department,Chaoyang Hospital,Capital Medical University between March 2019 and December 2020 were enrolled. The modified Valsalva maneuver was used,the patients were divided into two groups according to the cardioversion achieved by modified Valsalva maneuver or not. Sixty-eight patients were enrolled in the study,32 patients got cardioversion successfully achieved by the modified Valsalva maneuver and 36 patients failed. Comparisons of gender, age, onset time, vital signs, past medical history of PSVT,radiofrequency ablation due to PSVT,serum c Tn I,potassium level were carried out between two groups.Results The success rate of modified Valsalva maneuver cardioversion was 47. 1%,no significant differences were found in gender, age, onset time, vital signs, past medical history of PSVT,radiofrequency ablation due to PSVT,serum c Tn I,potassium level( P > 0.05);Second-line treatment mainly included antiarrhythmics and electrical cardioversion, of which propafenone was the most commonly used drug in our department,with a utilization rate of 94. 4%. The conversion rate of intravenous bolus of propafenone was 85.3%,with no obvious adverse reactions. Conclusions This study suggests that the modified Valsalva maneuver is an effective therapy for PSVT patients. Common characteristics may not be the factors that affect modified Valsalva maneuver conversions,such as gender,age,time of onset,past history of PSVT,history of radiofrequency ablation,c Tn I and potassium level. As a second-line treatment,propafenone is safe and effective.

关 键 词：阵发性室上性心动过速(PSVT) 手法转复 改良Valsalva动作 普罗帕酮 

分 类 号：R541.71[医药卫生—心血管疾病]