The Clinic Study In Applying NIPPV To People With Acute Exacerbating Chronic Obstructive Pulmonary Disease (AECOPD) And Breath Failure And Pulmonary Encephalopthy

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 hospital of people with AECOPD and breath failure and pulmonary encephalopathy, and initially discuss the treatments of NIPPV can bring to people with AECOPD and pulmonary encephalopathy.Methods: 61 patients in hospital with pulmonary encephalopathy and breath failure because of AECOPD were in involved between January the 2002 to December the2008, 49 were men, while 12 were women, their ages were between 48 to 83, and averaged67.02±13.71, and the courses of the disease continued 6 to 30 years. All of them presented cough, expectoration, dyspnea, conscious disturbance, and even coma, which accord with the diagnosis standards of pulmonary encephalopathy because of breath failure of COPD. pulmonary encephalopathy patients were graded 6 to 12(10.12±1.38)by Glasgow coma scale (GCS) criterion. The 61 patients were randomly allotted to NIPPV cure group(A group n﹦32)and standard cure group ( B group n﹦29 ) . 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 than 2 hours were needed for the first time to use NIPPV, and repeated from time to time during at least 3 days. Observe air exchange indexes, such as heart rate(HR)at hours of the 0th , 2nd, 24th, and 72nd, respiratory rate(RR), Glasgow coma scale (GCS), pressure 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. Results: There is no marked difference (P>0.05)of indexes of general conditions and HR RR GCS PaO₂ PaCO₂ and pH between the 2 groups at the 0th hour. Compared with those of the 0th hour, HR,RR,GCS,PaCO₂ of A group at the 2nd hour fall evidently, with PH,PaO₂ hoist at the same time(P<0.05). Indexes are improved at the 24th and 72nd hours. However, according to group B, indexes at the 2nd hour are not distinctly meliorated compared with that of the 0th hour(P>0.05), but meliorate distinctly after the 24th 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, 3 were given trachea cannel because of intolerance or intromission after 2 or 72 hours in hospital, among whom 2 left hospital at last, and 1 died. According to group B, 15 got trachea cannel treatment, 10 of the 15 were spilled that moaned invasive ventilation less than 24 hours after got admission to hospital, and the other 5 were more than 24 hours. 9.4%, the trachea cannel rate of group A, was obviously lower than that of group B, which was 51.8% (P<0.05), and which showed statistical significance. 1 case of group A died of multiple organ failure in hospital, and 5 cases of group B died of ventilator-associated pneumonia, infective shock or multiple organ failure. The hospital mortality of group A of 3.1% was obviously lower than that of group B of 17% apparently, but not statistically(P>0.05). the average length of stay between the 2 groups are statistical significan(tP<0.05), A was 12±6 days , and B was 23±8 days. Furthermore, the average hospital expense are statistical significant(P<0.05)too, A was 12145±2389 Yuan, and B was 18218±5379 Yuan. Patients of group A presented discomfortableness prevalently at first when getting cured, the rate of which was as high as 43.6%, 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 of 2 patients got congestive and anabrotic after been oppressed, but got recovered after local processing and continuous desiccation. 3 patients got abdominal distention, but released after been directed to breathe through instead of mouth or been set a stomach tube. And 4 patients reduced or released their nervousness and dread after got dissemination and explanation.Conclusion: Applying BIPAP respirator to assisted ventilation to cure AECOPD breath failure and pulmonary encephalopathy 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 pulmonary encephalopathy get indexes changed by BIPAP treatment, or keep originals by standard treatments.