A Clinical Study On Treatment Of Two Different Aerosol Inhalation For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease (AECOPD) Combined With Respiratory Failure

Objective:To investigate the curative effect of combined treatment of noninvasive positive pressure ventilation with aerosol inhalation of budesonide and Center for oxygen atomization inhalation budesonide for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure.Method:This study was a randomized controlled clinical trials,60 patients with AECOPD combined with respiratory failure were randomly assigned to study group and control group (30 patients for each group). For study group, aerosol inhalation of budesonide treatment was simultaneously combined with noninvasive positive pressure ventilation; for control group, noninvasive positive pressure ventilation was temporarily stopped during the aerosol inhalation of budesonide. Before and right after treatment for 3 days,7 days session of each patient, the indexes of blood gas analysis (PaCO2 and PaO2) and breathing rates.before and after the treatment for 7 days,every patients of pulmonary function test (FEV1%) and mMRC were recorded, and the scores of CCQ questionnaire, clinical rating, APACHE Ⅱ and GCS were recorded also. All outcomes were statistically analyzed using SPSS 19 software package, and presented in the form of mean ± standard deviation (x±s) Paired T test was used for comparing the before- and after-treatment outcome on a single group, the significant interval was set as p<0.05; ANOVA of repeated measurement was used for comparing the respiration rate (R) and the indexes of blood gas analysis sampled from multiple sampling time between two groups, the significant interval was set as p<0.05. T test of independent samples was used for comparing the treatment outcomes between two groups, the significant interval was set as p<0.05;Results:1. Baseline results:the basic situation of the team and the control group on admission (age, gender, smoking history, PaO2, PaCO2, R, FEV1%, clinical score and APACHE II score) there was no statistically significant difference (P > 0.05)2. Curative effect evaluation2.1 Changes of biological indexes (PCO2 and PO2):For study group, after 7 days of treatment, the PCO2 was significantly lower than before-treatment, and the PO2 was significantly higher (p<0.05); for control group, after 7 days of treatment, the PCO2 was significantly lower than before-treatment, and the PO2 was significantly higher (p<0.05). When comparing the difference between two groups, the decreasing interval of PCO2 after treatment in study group is significantly larger than control group (F=4.55 p=0.038), and the increasing interval of PO2 after treatment in study group is significantly larger than control group (F=4.70 p=0.035), also.2.2 Changes of physiological indexes (FEV1%):For both study and control group, there is no significant changes found in FEV1% after treatment (p>0.05).2.3 Changes of symptomatic indexes (R, mMRC and CCQ):For both study group and control group, after 7 days of treatment, the respiration rate, mMRC and CCQ were all significantly lower than before-treatment (p>0.05). When comparing the difference between two groups, the remission of tachypnea in study group was more significant than that in control group (F=4.32, p=0.043); the improvement of mMRC in study group is more significant than that in control group (t=-2.55 p=0.014); and the improvement of CCQ in study group is more significant than that in control group also (t=-3.13 p=0.003).2.4 Changes of Clinical Indexes (Clinical Rating, APACHE II):For both study group and control group, after 7 days of treatment, the scores of clinical rating and APACHE II were all significantly lower than before-treatment (p>0.05). When comparing the difference between two groups, the improvement of scores of clinical rating and APACHE II in study group are all more significant than that in control group (t=-5.33 p=0.000, t=-2.70 p=0.010, respectively).Conclusion:1、In patients with AECOPD combined with respiratory failure, the treatment effects can both be observed in various extensions for aerosol inhalation of budesonide combined with noninvasive positive pressure ventilation simultaneously, or noninvasive positive pressure ventilation temporarily stopped. The improvement and remission of CO2 retention, anoxia, tachypnea, dyspnea (mMRC), quality of life (CCQ), clinical indexes (Clinical Rating, APACHE II) can also be observed in various extensions for both the two treatment options,2、 while there is no effect observed on pulmonary function (FEV1%).3、 when comparing with noninvasive positive pressure ventilation temporarily stopped, there are much more significant improvements and remissions of CO2 retention, anoxia, tachypnea, dyspnea (mMRC), quality of life (CCQ), clinical indexes (Clinical Rating, APACHE Ⅱ) observed on aerosol inhalation of budesonide combined with noninvasive positive pressure ventilation simultaneously...