Clinic Study Of Noninvasive Positive Pressure Ventilation In Treatment Of Patients Due To Acute Exacerbation Of Chronic Obstructive Pulmonary Disease With Type Ⅱ Respiratory Failure

Objective:To investigate the clinic effect of the facemask noninvasive positive pressure ventilation(NIPPV) in acute exacerbation of Chronic Obstructive Pulmonary Disease with typeⅡrespiratory failure.Methods:Sixty patients of AECOPD complicating with typeⅡrespiratory failure were voluntary divided into two groups:the comparision group(30 cases) and the treatment group(30 cases).Two groups were given the anti-inflammation,evenly breathes heavily,the spasmolysis,relieves a cough,the phlegm reduction conventional treatment and so on energy support.The comparision group was added the low concentration oxygen by anasal catheter continually and respiratory stimulants therapsis.The treatment group received mask BiPAP ventilator treatment.The unconscions patients were added respiratory stimulants.Clinical symptoms, the arterial blood gas analysis,vital signs and adverse reactions were observed in two groups before and after 2hours,24hours,72hours,7days continous NIPPV.The foundamental diseases were scored by APACHEⅡ,consiousness conditions were estimated by the level of awareness score.Results:In the treatment group and the comparision group after the treatment of 72hour and 7days,heart rate,respiratory rate, arterial partial pressure of carbon dioxide obviously dropped and arterial partial pressure of oxygen,pH obviously rose.Compared with comparision group,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide,pH and respiratory rate,heart rate in the treatment group were improved rapidly after ventilation 4 hours and 24 hours(P＜0.05),APACHEⅡand the level of awareness score obviously dropped after ventilation 24 hours(P＜0.01 ),13 cases with unconsiousness turned into consciousness after ventilation 4～24 hours.The efficiency in unconscious was 76%,it was more significant than the comparision group 26.7%(P＜0.01).The treatment group total effectiveness 83.33% (25/30) and the comparision group 60%(18/30) compares the difference to have statistics significance(P＜0.05).The mortality was markedly lower in the treatment group(10%) than in the comparision group(33.3%)(P＜0.05).The mean length of hospital stay was significantly shorter in the the treatment group than in the comparision group(P＜0.05). High APACHEⅡscore,low hypoproteinemia level and patient-ventilator confrontation existed in the treatment failure patients.Conelutions:The effect of typeⅡrespiratory failure from AECOPD treated by BiPAP breathing machine is prominent.NIPPV is an effective therapy in different severe respiratory failure due to AECOPD.Early use of NIPPV can improve rapidly gas exchange and vital signs of patients.It's superior to conventional treatment of respiratory stimulants.Most patients in a state of unconsciousness with respiratory failure due to AECOPD do not need to accept tracheal intubation,and the patients in the condition of moderate unconsciousness have more benefits from NIPPV.Early use of NIPPV reduces intubation and mechanical ventilation, mortality and shortens mean hspital stay and improves effective power.Improve the patient's tolerance,compliance and improve the human-machine synchronization can enhance the efficacy of NIPPV.