| BackgroundChronic obstructive pulmonary disease(COPD)is a common type of respiratory disease.Epidemiological studies showed that COPD ranks the fourth fatal diseases in the world with high morbidity and mortality.According to a survey of 7 regions in China,the prevalence of COPD above age of 40 is up to 8.2 percent among 20,245 adults investigated.The study found that COPD is highly susceptible to respiratory failure and even pulmonary encep Halopathy,which has a serious adverse impact on the patient's health.In the past,the non-drug treatment of COPD with serious respiratory failure was mainly invasive ventilation.Although this type of treatment alleviated the condition of hypoxemia and airway obstruction to some extent,complications such as ventilator-associated pneumonia(VAP)and barometric injury and so on,which were difficult for some patients to tolerate.Since the 20 th century,noninvasive positive pressure ventilation(NIPPV)technology has made great progress,especially the introduction of bi-level positive airway pressure(Bi PAP).At present,NIPPV has become the first-line non-drug therapy for the treatment of COPD with respiratory failure.ObjectiveTo investigate the clinical efficacy and safety of noninvasive positive pressure ventilation in the treatment of elderly AECOPD patients with type ? respiratory failure.Methods97 elderly AECOPD patients complicated with type ? respiratory failure admitted to our Hospital from Sep 2015 to Aug 2017 were screened and 86 patients were finally enrolled in the curative effect analysis,with 43 cases in the study group and the control group respectively.The control group was treated with routine treatment including oxygen therapy,bronchodilator,antibiotics,expectorant,correct water and electrolyte imbalance.In addition to the above-mentioned routine treatment,the study group was given Bi PAP.After treatment,the arterial blood gases parameters(p H,Pa CO2,Pa O2),pulmonary ventilation function parameters(FEV1,FVC,FEV1/FVC,FEV1% and PEFR),vital signs(RR,HR,BP)in two groups were studied.At the same time,the difference of the average time of hospitalization,the tracheal intubation rate and the in-hospital mortality of the two groups were compared.In addition,the SF-36 scale was used to evaluate the quality of life between the two groups of patients before and after treatment.Results1.Arterial blood gas index: Before treatment,there was no significant difference in p H(7.28±0.03 vs.7.27±0.02),Pa CO2(78.13±4.25 mm Hg vs.79.98±4.41 mm Hg)and Pa O2(54.33±5.22 mm Hg vs.54.59±5.37 mm Hg)between the control group and the study group(P>0.05).After effective treatment,the p H value of the both groups were obviously better than that before treatmen with p H value of the study group even better than the control group(7.39±0.04 vs.7.30 ± 0.04,P = 0.028).The level of Pa CO2 in the two groups decreased significantly compared with that before treatment,and Pa CO2 in the study group decreased more significantly than the control group(61.26±4.26 mm Hg vs.69.22±3.99 mm Hg),and the level of Pa CO2 in both groups increased significantly after effective treatment compared with that before treatment,and the study group increased more significantly than the control group(72.10±5.33 mm Hg vs.58.34±4.72 mm Hg),with all P <0.05.2.Pulmonary ventilation function index: There were no significant difference in the value of FEV1(0.89±0.16 L vs.0.88±0.13L),FVC(1.58±0.22 L vs.1.57±0.13L),FEV1/FVC(%)(60.3±3.8 vs.58.4±4.2),FEV1/ predicted value(%)(62.3±4.7 vs.61.7±5.1)and PEF/ predicted value(%)(60.7 ±5.2 vs.61.4±3.9)between control group and study groupbefore treatment(P > 0.05).After effective treatment,the above-mentioned indexes in both groups all increased than those before the treatment.The FEV1(1.18±0.25 L vs.0.98±0.22L),FVC(1.84±0.25 L vs.1.70±0.19 L),FEV1/FVC(%)(67.5±3.7 vs.61.7±5.1),FEV1/ predicted value(%)(71.4±5.5 vs.63.9±3.8),PEF/predicted value(%)(70.1±3.5 vs.62.5±3.7)in study group were significantly higher than those in the control group respectively(all P <0.05).3.Signs of vital signs: Before treatment,there were no significant difference in the RR(27.23±4.94 bpm vs.27.18±5.03 bpm)?HR(114.82±12.09 bpm vs.115.17±11.98bpm)?SBP(138.29±11.13 mm Hg vs.139.47±10.92 mm Hg)and DBP(78.08±6.53 mm Hg vs.77.96±6.32 mm Hg)between the control group and the study group(P >0.05).After effective treatment,the RR and HR in both groups decreased,and the decrease of RR(16.73±3.74 bpm vs.20.34±3.78 bpm)and HR(83.21±10.90 bpm vs.94.52±11.57 bpm)in the study group was more obvious than those in the control group(all P <0.05).4.Average length of hospital stay,tracheal intubation rate and mortality rate: The average length of hospital stay in the study group was significantly shorter than that in the control group(10.8±2.34 d vs.13.9±2.13d),in addition,the tracheal intubation rate and hospitalization mortality in the study group were significantly lower than those in the control group(9.3% vs.30.2%,P=0.000;2.3% vs.9.3%,(all P <0.05).).5.Quality of life evaluation: The SF-36 scale showed that the p Hysiological function(82.87±11.63 vs.81.89±12.01),general health(80.65±5.01 vs.79.55±9.01),somatic pain(87.93±3.14 vs.68.89±4.01),social function(81.01±10.01 vs.79.45±5.29)and mental health(81.65±7.13 vs.81.24±6.7)of the study group after effective treatment were significantly better than those of the control group(all P <0.05).ConclusionNIPPV is effective and safe in the treatment of elderly AECOPD patients complicated with type ? respiratory failure.It can significantly improve arterial blood gas index,pulmonary ventilation function,reduce average hospitalization time,tracheal intubation rate,fatality rate and improve the quality of life. |
PDF Full Text Request