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Backgroud and ObjectivesBronchial asthma is a chronic inflammatory disease of the airways that was associated with cells (as eosinophile,mastocyte,T-cell,neutrophil,airway epithelium,ect) and celelular component (histamine ect).The airway chronic inflammation induce airway high hyperreactirity and cause symptom of recurrent attacks paroxysmal asthma,chest distress,cough,and so on; most patients were recovered without any treatment or by treatment of antiinflammatory。It is now estimated that as many as 300 million people suffer from asthma and asthma attacks and the increased by 1% per year.The burden of this disease to governments, health care systems, families, and patients is increasing worldwide,so there is a far-reaching society significance in the asthma research。Now, pathogenesis and treatment of asthmas get a great of advancement,especially, drug treatment is very important in treatment of asthma;For the past several years,chronic inflammation of airway and airway hyperreactivity is controlled by inhaled in glucocoreticoid and prolonged action B2-Receptor agonist,the times of acute episode decreases. But part of Bronchial Asthma of no-normalizing treatment t with acute respiratory failure,were usually not relieved by common drug treatment immediately;even when face organic dangerous,patient usually need mechanical ventilation treatment to ensure ventilation function.Trachea cannula and mechanical ventilation are safety and effective in treatment of life -treatening of Bronchial asthma, but rachea cannula and mechanical ventilation bring patients about painful and high expense,at the same time,many kinds of severe complications were observed,for example,barotraumas,VAP,naso sinusitis,otitis media, ect;meanwhile most of patients cannot accept.Noninvasive positive-pressure ventilation (NIPPV) possess some characteristic of no-traumatic occlusion,convenient,economy,less-complication, good Tolerate-on,good security,apparente curative;especially,there are noticeable effects in treatment of COPDand acute left heart failure, and it was approved by most of medical workers.Now part of internal and overseas scholars reports that it was safety and effectual and economy and convenient that NIPPV cure severe Bronchial asthma.But it is a highly contentious issue about NIPPV in trearment of severe asthmas, and especially there were no uniform standards about indications, observing indexes and therapeutic effect indexes of NIPPVespecially about indication,observe index,curative judgement index. In this study we investigated therapeutic effects of NIPPV on patientsThis study choose severe asthmas,make use of NIPPV tocure with severe asthmas,and establish control groups to contrast and observe,aim directly at one hour,three hours,No.4day blood gas analysis,PEF,days in hospital,investigate therapeutic value about NIPPV curing severe asthmasWe investegrated therapeutic value about NIPPV in treatment of patients with severe asthmas by blood gas analysis at 1 hour and 3hours,PEF, admission day。2. Objects and Methods:2.1ObjectsForty patients with severe bronchial asthma were randomly collected from the respiratory department of Pingxiang People's Hospital from Oct.2008 to Dec.2009.2.2 Diagnostic criteria, inclusion and exclusion criteriaInclusion criteria:(1)According with severe asthmatic diagnostic criteria; (2)From 20 to 60 years old。Diagnostic criteria:(1)severe asthma according to《Global Initiative For Asthma》diagnostic criteria of 2008, there are short of breath,non-fluent talk,interrupt words with (or no)mind change, orthopnea, widespread wheeze or breath weaken obviously with wheeze weaken, RR>30deuto/minute, HR110-160 deuto/minute, blood gas analysis with respiratory acidosis (PH 7.20-7.30) with oxygen-poor (PaO2:50.0～70.0mmHg) carbon dioxide retention (PaCO2:55.0～78.0mmHg)。(2)stemum shows over gasing or lung marking thickening or no abnormalities; (3)deplete cardiac asthma and emophysematous。2.3 Empirical MethodForty cases of severe asthma were randomly divided into two groups.One group was treated by noninvasive positive pressure ventilation (NIPPV)and drugs (experimental group) with 20 cases including male 5 cases and female 15 cases,from 20 to 52 years old,mean age 36.05±9.058.Another group were treated by drugs(control group) with 20 cases including male 7 cases and female 13 cases,from 24 to 50 years old,mean age 38.70±7.54。There are no significant differences about age,sex and laboratory P>0.05), considered statistical significance Control group were treated by oxygen therapy and common drugs, experimental groups were treat by NIPPV and oxygen therapy and common drugs.Useing American STAR330 model BiPAP ventilation via facial mask or masal mask;Useing S/T, Press suppport (PSV)+Positiveend-expiratory pressure (PEEP)。VT:300～500ml, Inspiratory pressure 14-20mmH20, expiratory pressure 3-5 mmH20, Adjusting VT>5Kg/kg from low level to high level, inspiratory/expiratory (I/E)1:2-2.5, RR:16-20times/minute, duration of ventilation 4-6hours/time,2-4time every day。According to patient's information to choose different facial mask or masal mask, Oxygen flow to reach 5L/minute。2.4 Observing Observe the comparison that was made on changes of PH,PaO2,PaCO2,SaO2,PEF in the arterial blood gas before and after the treatment in two groups.and also days in hospital.2.5 Statistical analysis Datas were analyzed by SPSS13.0 statistics software and the measurement data are expressed as means±SEM.Paired t test is used to determine the differences in distinct groups with P< 0.05 considered statistically significant.3.Results3.1 No obvious differences were observed about physiological index and blood gas analysis in experimental group compared with control group before treatment (P> 0.05)。3.2 Two group'clinical manifestation:The blood gas analysis were improved obviously after one hour and three hours treatment and these indexes were improved progressively with prolongation of time in experimental group; There were no significant differences of blood gas analysis after one hour treatment than before in control groupControl group'blood gas analysis do not improve after one hour treatmentAnd the indicators were improved slightly after three hours treatment, improve slightly after three hours treatment, and thenimprovedlater improve gradually; There are significant differences deviation between before and after treatment in two groups (P<0.05),show statistical significance。There were significant differences about increase value of blood gas analysis in experimental group compared with control group after three hours treatmentTwo groups compare to increase value of blood gas analysis after three hours treatment, experiment group show significant deviation than control group (P<0.05); Two groups compare to increase value of PEF when leave hospital,, experiment group show significant deviation than control group (P<0.05); During the observed period,In observe period of time, a male patient's condition aggravated in experimental group there is a male patient from experiment group that his illness made more serious after one hour treatment of NIPPV, shows respiratory failure to further made more serious and he was transferred to transfer ICU treated with to cure by trachea cannula and mechanical ventilation,Furthermore four patients from control group were worse that illness made more serious after 3 hours drug treatmentdrugs treatment, and their respiratory failure were all aggravated and then transferred to ICU treated shows respiratory failure to further made more serious and to transfer ICU to cure with trachea cannula and mechanical ventilation。Both sides havesignificant difference。Experiment group's days are obviously shorten than control group, show significant difference。3.3 Complication:there is A patient to show up intestinal tympanites from experiment group; there is A patient to show up indentaition with skin hypersensitiveness in face guard of parts nasalis from experiment group,but symptom decreased after accommodating pressure of face mask; there is not severe complication correlate with NIPPV from experiment groups; there are nineteen patients' condionts to improved after post-treatment with NIPPV. There is only a patien to show up dysphoria and mind change after post-treatment with NIPPV, through rechecking blood gas analysis,we find PaCO2 rising,and give the patient mechanical ventilation. There are four patients to show up respiratory failure and transfer ICU to assisted mechanical ventilation from control groups, four patients to show up different degree complication of pars laryngea pharyngis,two patients to show up invariably degree hoarse voice after post-treatment with mechanical ventilation.4.ConclusionsThe study foud that experiment group improved patient' internal environment and corrected patient's acidosis and decreased patient's respiratory muscle to working and consumed oxygen,decreased patient to trachea cannula and mechanical ventilation,may be able to improve lung compliance,deseased days in hospital and cost of hospitalization through research both sides of severe asthmaes between before and after treatment;it is feasible that make use of NIPPV in treatment of severe asthma patientsl。But there are large sample and even more observe index to monitoring patient's conditions change; If patient's illness do not improve but aggravating in progress after one hour treatment of make use of NIPPV, must alter to curing by trachea cannula and mechanical ventilation, avoid to delay treatment opportunity。... |
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