Prognostic Analysis Of Noninvasive Ventilation Treatment Of AECOPD Complicated With Severe Hypercapnia

Objective: Nonivasive Positive Pressure Ventilation(NPPV)is considered as the first-line treatment for Acute Exacerbation Chronic Obstructive Pulmonary Disease(AECOPD)complicated with hypercapnia.However,it is still uncertain whether AECOPD complicated with severe hypercapnia(Pa CO2≥80mm Hg)with or without mental disorders can be treated with noninvasive mechanical ventilation.Therefore,this study of noninvasive positive pressure ventilation for the treatment of AECOPD patients with severe hypercapnia(Pa CO2≥80mm Hg)patients through retrospective study of the clinical data,to analyze the related factors leading to the failure of NPPV,and analyzes the characteristics in different period of time to obtain the successful treatment of NPPV patients in each group.Methods: On January 2015 to January 2017 collected in the Department of respiration ward of 161 cases of AECOPD with severe hypercapnia in patients with clinical data were retrospectively analyzed.First,these patients’ clinical data and laboratory data were compared between the successful NPPV-treated groups and the unsuccessful NPPV-treated groups.And using the single factor Logistic regression analysis to show the effect of relative prediction factors associated with NPPV therapy,and then in the analysis of relevant indicators screened by single factor Logistic regression in multivariate analysis using the selected independent risk factor for predicting the therapeutic effect of NPPV Logistic regression.For the successful treatment of NPPV patients according to the time of better Pa CO2 values than before treatment decreased more than 15%,dyspnea symptoms,disorders of consciousness in patients with delirium were divided into three groups: early improvement group(4-6h after NPPV),medium improvement group(after> 6h and≤48h after NPPV),late improvement group(after NPPV> 2d and≤7d).And to compare the differences of clinical data and laboratory examination among groups,and to find out the characteristics of each group.Results:(1)NPPV treatment success patients number: the number of failed = 145:16.There were significant differences between the two groups in the number of patients who received regular home oxygen therapy and(or)family noninvasive ventilation,the proportion of patients who had electrolyte disturbances within 24 hours,the initial APACHE II score,the initial p H value,the initial GCS score,and the D-two polymer at admission.(2)The probability of acute physiology and chronic health scoring system Ⅱ(APACHE Ⅱ)and the combined electrolyte imbalance in the NPPV treatment group were lower than that in the failure group,the initial GCS score,the D-dimer,the PH value were higher than Failure group,stable period to be family oxygen therapy or(and)family noninvasive ventilator number more than failure group.(3)Carried logistics regression,and finally into the regression equation is the initial GCS score(P = 0.033,OR = 1.420,95% CI(1.029-1.959)).(4)There are three characteristics of the early benefit Group: the mean arterial pressure(P = 0.015),the improvement 4-6h PH value(P=0.001),whether respiratory failure(P = 0.005)occurred in the past 1 year;and the median and late benefit Group are different with these.And patients with advanced benefit were treated with NPPV for 6-48 h of GCS score(P = 0.030)and the risk of noninvasive ventilatory adverse events(P = 0.001)was different from that of early and mid-term benefit groups.Conclusion:(1)The low initial GCS score was associated with noninvasive mechanical ventilation in patients with AECOPD complicated with severe hypercapnia.(2)Patients with higher mean arterial pressure,who have a higher risk of respiratory failure in one year and who have improved PH values within 4-6 hours can benefit from early NPPV therapy.Patients with noninvasive adverse reactions can no longer improve early or.mid-term,with patients with a higher GCS score at 6-48 hours benefiting from late stages.