The Research Of Non-invasive Positive Pressure Ventilation In The Treatment Of Patients Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Combined With Acute Left Heart Failure

Objective: To investigate the therapeutic effect of Non-invasive Positive Pressure Ventilation and its related influencing factors on patients of acute exacerbation of chronic obstructive pulmonary diseases(AECOPD) combined with acute left heart failure by observe the ventilatory response and hemodynamic changes.Methods: From January 2014 to January 2015, 75 patients with AECOPD combined with acute left heart failure in intensive care unit of our hospital were randomly divided into 2 groups: 35 cases which were applied conventional medical treatment as control group, 40 cases which were applied with positive pressure ventilation therapy on the basis of routine therapy as observation group, By observing the comparison of blood gas,blood pressure, heart rate, breathing rate, oxygenation index, dyspnea score, assisted respiration score and Glasgow score of two groups before and after treatment,And by establishing the regression model to analyze the related factors may affect the treatment effect, include Heart Rate(HR), Respiratory Rate(RR), Mean Arterial Pressure(MAP), Pa O2, Pa O2/Fi O2, the predictive value of FEV1%, GCS score, CPIP score, albumin levels and body mass index,we aim to discuss the independent factors affecting the the therapeutic effect.Results:1 In the 40 cases with the treatment of Non-invasive Positive Pressure Ventilation, 31 patients were treated successfully and the success rate achieved 77.5%. In the 35 cases with conventional medical treatment, 22 patients were treated successfully and the success rate was 62.9%. The difference of success rate was statistically significant(P<0.05).2 The hemodynamic comparison before and after treatment:there was no statistically significant difference in MAP and HR of cases of two groups(P>0.05); At 1 h after treatment, MAP and HR of two groups were significantly lower than that of before treatment,the difference was statistically significant(P<0.05); the difference was no statistically significant of two groups after treatment(P>0.05).3 The comparison of Respiratory Rate and blood gas analysis related indicators: there was no statistically significant difference in RR, Pa O2 and Pa O2/Fi O2 of two groups before treatment(P>0.05),which were improved significantly at 1h after treatment,and the difference was statistically significant( P<0.05); Pa O2 and Pa O2/Fi O2 of observation group were significantly higher than that of control group, and the difference was statistically significant(P<0.05).4 The comparison of dyspnea relief time: the time of remission in dyspnea of the observation group was significantly shorter than that of the control group, and the difference was statistically significant(P<0.05).5 The comparison of related index score: The GCS score of observation group was obviously higher than that of the control group, and the difference was statistically significant(P<0.05);scale for accessory muscle use of the observation group was obviously lower than that of control group, and the difference was statistically significant(P<0.05);There was no statistically significant difference in CPIS score of two groups(P>0.05).6 Logistic Analysis on therapy indexes that may affect the success rate of Non-invasive Positive Pressure Ventilation: the concentration of albumin, GCS score before treatment, predicted value of FEVl%, BMI, PH value after the 1h treatment and GCS score of 1h after treatment are the related factors that affect the therapeutic effect of non-invasive positive pressure ventilation in the treatment of patients of AECOPD combined with acute left heart failure. PH value and GCS score of 1h after treatment are the critical factors that affect the result of non-invasive positive pressure ventilation in the treatment of patients of AECOPD combined with acute left heart failure. Conclusion:1 Non-invasive Positive Pressure Ventilation can effectively alleviate the state of respiratory failure and decrease mortality, and improve the success rate of patients of AECOPD combined with acute left heart failure.2 PH value and GCS score at 1h after therapy were the independent factors that affect the success of non-invasive positive pressure ventilation in the treatment of AECOPD combined with acute left heart failure, so closely monitoring these two factors shall be conducted in the the process of treatment.