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。

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。

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：