Noninvasive Positive Pressure Ventilation In The Treatment Of Acute Exacerbations Of Chronic Obstructive Pulmonary Disease With Hypercapnia

Objective:To invetigate the clinical effects of non-invasive positive pressure ventilation in patients with chronic obstructive pulmonary disease combined hypercapnia.Method :A retrospectively study was conducted in the respiratory medicine of Shanxi big hospital between 2013 to 2015 years.cases of AECOPD combined hypercapnia?PaCO₂?70mm Hg?were chosen.1.Inclusion Criteria?1?Be diagnosised of acute exacerbation of chronic obstructive pulmonary disease.?2??1?Designated for chronic obstructive pulmonary disease,according with the 2013 years chronic obstructive pulmonary disease branch of Chinese Medical Association?2013years Revised Edition?.?2?Designated for acute exacerbation chronic obstructive pulmonary disease,according with Chinese expert consensus of 2012 years.2.Packet conditionAccording to the pH of pre–treatment of the blood gas,the patients were divided into three groups,group?pH < 7.25?,group?7.35 > pH?7.25?and group?pH?7.35?.Results:1.basic data:A total of 57 patients with chronic obstructive pulmonary disease complicated with hypercapnia were treated with noninvasive positive pressure ventilation be selected.Among them,10 cases were in pH<7.25 group[7 cases of pulmonary encephalopathy?7/10,70%?].41 cases were in 7.35>pH?7.25 group[16 cases of pulmonary encephalopathy?16/41,39%?].6 cases were in pH?7.35 group[1 cases of pulmonary encephalopathy?1/6,16.%?].The success rate and failure rate of pH?7.35 group were 100%?6/6?and?0?.Compared with group pH?7.35,group pH < 7.25 has a higher median ages?2c =6.828,p=0.033?.The sex,arterial partial CO₂ pressure and arterial partial O₂ pressure have no statistical difference.2.Comparison of blood gas indexes: Compared with before treatment,group 7.35 > pH?7.25 and group pH?7.35 all has a obvious improve in arterial partial pH,arterial partial CO₂ pressure and arterial partial O₂ pressure?p<0.05 or p<0.01?,after treatment,pH and oxygen partial pressure were increased and reduction of carbon dioxide partial pressure.Group pH < 7.25 has a obvious improve in arterial partial pH?p=0.009?,but do not has statistical difference in arterial partial CO₂ pressure and arterial partial O₂ pressure?p=0.24 and 0.114?.But,has a statistical difference in arterial partial CO₂ pressure and arterial partial O₂ pressure in patients who were effectived treated by non-invasive positive pressure ventilation.3.Clinical outcomes of NPPV: All patients were able tolerate noninvasive positive pressure ventilation,51 cases were discharged from the hospital,6 cases do not have effect.Until the end of treatment,all groups do not have statistical difference in the success rate?p=0.087?,and the same to the pulmonary encephalopathy and do not have pulmonary encephalopathy in each groups.Among the 6 cases do not have effect,each group had 3 cases in group7.35> pH?7.25 and group pH< 7.25.and every group had 2 cases which hadpulmonary encephalopathy.One cases improved through trachea cannula and noninvasive positive pressure ventilation,3cases refused tracheal intubation,one case give up treatment after tracheal intubation combined myocardial infarction,one case ineffective treatment after trachea cannula of the failed cases.Conclusions :AECOPD Patients with chronic obstructive pulmonary disease combined respiratory failure can be treated effectively and safely with NPPV,and same to the AECOPD with lower arterial partial pH and?or?pulmonary encephalopathy patients.