| Objective:Noninvasive positive-pressure ventilation(NIPPV) is appositive-pressure ventilation with face mask or nose-face mask or other things.It is welcomed by patients and doctors for its advantages of helping ventilation without intubation through trachea,and thus greatly decreasing the intubation time and the rate of complications such as ventilator-associated pneumonia.Recently,it is found good clinic effect that applying NIPPV to people with acute exacerbating chronic obstructive pulmonary disease(AECOPD) and breath failure.This research is for the sake of observing the influence of NIPPV to air exchange,trachea intubation rate,and something like the death rate,average time and expenditure of in hpspital of people with AECOPD and breath failure and conscious disturbance, Concentrations of IL-8in sputum or in blood:Both groups compared with treatments ahead and end,and initially discuss the treatments of NIPPV can bring to people with AECOPD and conscious disturbanceMethods:63patients in hospital with conscious disturbance and breath failure because of AECOPD were in involved between december the2009to march the2012,46were men,while17were women,their ages were between48to85,and averaged67.02±13.71, and the courses of the disease continued6to32years.All of them presented cough,expectoration,dyspnea,conscious disturbance,and even coma,which accord with the diagnosis standards of breath failure of COPD, conscious disturbance patients were graded6to12(10.12±1.38) by Glasgow coma scale (GCS) criterion.The63patients were randomly allotted to NIPPV cure group (A group n=32) and stanard cure group (B broup n-31).Both groups were given conventionality treatments,involved anti-inflammatory, spasmolysis, anti-asthmatic, relieve a cough, eliminating phlegm,oxygen uptake and so on.Besides,B group were given routine medicine,while A group were added promptly by bi level positive airway pressure(BIPAP) with a veil,in order to create a NIPPV,S/T mode.More than2hours were needed for the first time to use NIPPV,and repeated from time to time during at least3days.Observe air excahange indexes,such as heart rate(HR) at hours of the0th,2nd,24th,and72nd,respiratory rate (RR),Glasgow coma scale (GCS),poressure of oxygen in arterial blood(PaO2),PH,partial pressure of carbon dioxide in artery (PaCO2), and compare trachea intubation rate,and the death rate,average days and expenditure of in hospital between the two groups. Concentrations of IL-8in sputum or in blood:Both groups compared with treatments ahead and endResults:There is no marked difference (P>0.05) of indexes of general conditions and HR、RR、GCS、PaO2、PaCO2and PH between the2groups at the Oth hour.Compared with those of the Oth hour, HR. RR、GCS、PaCO2of A group at the2nd hour fall evidently,with PH、PaO2hoist at the same time (P<0.05).Indexes are improved at the24th and72nd hours.However,according to group B,indexes at the2nd hour are not distinctly meliorated compared with that of the Oth hour (P>0.05),but meliorate distinctly after the24th hour (P<0.05=except RR (P>0.05),the reasons of which are partly because of trachea cannel to some patients already.For patients of group A,3were given trachea cannel because of intolerance or intromission after2or72hours in hospital,among whom2left hospital at last,and1died.According to group B,15got trachea cannel treatment,10of the15were spilled that moaned invasive ventilation less than24hours after got admission to hospital,and the other5were more than24hours.9.4%,the trachea cannel rate of group A,was obviously lower than that of group B,which was48.4%(P<0.05),and which showed statistical significance.1case of group A died of multiple organ failure in hospital,and5cases of group B died of ventilator-associated pneumonia,infective shock or multiple organ failure.The hospital mortality of group A of3.1%was obviously lower than that of group B of16.1%apparently,but not statistically (P>0.05).the average length of stay between the2groups are statistical significant (P <0.05),A was13±6days,and B was23±8days.Furthermore,the average hospital expense are statistical significant (P<0.05) too, A was11145±2389yuan,and B was17218±5379yuan.Patients of group A presented discomfortableness prevalently at first when getting cured,the rate of which was as high as43.6%,but they could get tolerance after psychological counseling,having the position and tightness of nose face mark or the parameters of breathing machine adjusted and so forth.It was apparent that the longer of the therapy time,the better of coordinate between patient and machine.Local skin of2patients got congestive and anabrotic after been oppressed,but got recovered after local processing and continuous desiccation.3patients got abdominal distention,but released after been directed to breathe through instead of mouth or been set a stomach tube.And4patients reduced or released their nervousness and dread after got dissemination and explanation. A group of72hours after treatment level of IL-8in sputum or in blood obviously were less than B group of72hours after the treatment(P<0.01); A Group of72hours after treatment level of IL-8sputum or in blood were all lower than before treatment, there was significant difference (P<0.01), B group of72hours after treatment IL-8level of sputum or in blood were all lower than before treatment, but no significant difference (P>0.05).Conclusion:Applying BIPAP respirator to assisted ventilation to cure AECOPD treath failure and conscious disturbance can achieve exact curative effect,it can promptly improve air exchange of AECOPD patients,control trachea cannel rate and hospital mortality,reduce the length and expense of stay,save medical resource.This research proves that patients with AECOPD breath failure and conscious disturbance get indexes changed by BIPAP treatment,or keep originats by standard treatments.Treatment for72hours after the whole body and airway inflammation level obviously improved, and standard treatment group, no significant change. |
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