The Comparison Of Effect Of HHFNC And NPPV For The Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

ObjectivesTo compare the efficacy of the HHFNC and NPPV in patients with AECOPD,Comparing the results of arterial blood gas,heart rate,respiratory rate,mean arterial pressure,blood cell count and the change of the scale scores among the two groups before and follow HHFNC and NPPV therapies.The intubation rate?mortality and the re-hospitalization after 3-month were calculated in two groups.providing better treatment option for patients with AECOPD.MethodsA total of 80 patients aged over 40 years with AECOPD who were hospitalized in the Department of Respiratory and Critical Medicine,Affiliated Hospital of Yan'an University from January 2016 to December 2017.They were divided into HHFNC and NPPV according to different treatment methods,There are 40 cases in each group.The twogroupswereroutinelytreatedaccordingtothe AECOPDtreatment guidelines.Baseline data were collected from two groups of patients with AECOPD,and routine treatment was given according to the consensus of experts on AECOPD.The vital signs?HR,RR,MAP?,blood gas analysis?pH,PaO₂,PaCO₂,SaO₂?,and blood cells counts?HB,WBC,N%?,and scale scores?VAS scale,APACHE-II scale?were recorded before and follow treatment of 12h,72h.The intubation,mortality and re-admission after3 months were analyzed.Statistics all data and evaluate effection of both groups.Results1.The baseline data were compared between groups before treatment.Basic data is no difference between groups before treatment?P>0.05?.2.In the HHFNC group and NPPV group,the RR and HR values at 12h after treatment decreased compared with those at 0h before treatment,and decreased more significantly at 72h after treatment.Compared with no treatment,it is meaningful at 12h and 72h after treatment?P<0.05?.However,RR and HR decreased significantly at 72h compared with 12h after treatment.Compared with untreated,mean arterial pressure did not change much after 12 hours of treatment?P>0.05?,but it decreased significantly after72h before treatment?P<0.05?.There was no significant difference in RR,HR and MAP between the two groups at 0h,12h,and 72h after the start of treatment?P>0.05?.3.Compared with arterial blood gas at 0h and 12h and 72h after treatment in both groups,PH,PaO2,and SaO2 were significantly increased in both groups,and the increase was more pronounced with prolongation of treatment time,while PaCO2 was decreased,and the degree of decline was positively correlated with treatment time.?P<0.05?.At different time periods,there was no difference in blood gas indexes between the two groups at12 h after treatment vs untreated.There was no difference in PH,PaCO2,and SaO2 between the two groups at 72h after treatment,but the increase in PaO2 at 72 h after treatment was more pronounced in the NPPV group?P<0.05?,suggesting that NPPV was more effective in increasing PaO2 than HHFNC after 72h of treatment.4.The scores of dyspnea were compared between the two groups before and after treatment.The VAS scores of the two groups were significantly lower at 72 h after treatment than 0 h before treatment?P<0.05?.After treatment for 0h and 72h,The VAS scores was no difference between the two groups?P>0.05?,suggesting that the two auxiliary ventilation methods can reduce the patient's dyspnea andrelieve shortness of breath..APACHE?score was similar both groups during treatment?P>0.05?.APACHE?score in both groups was obvious difference during treatment?P<0.05?.5.HHFNC group and NPPV group blood cell values?including hemoglobin,white blood cell count,neutrophil percentage?at 0h?72h after treatment showed no statistically significant difference?P>0.05?.Blood cells were compared at 0h and 72h after treatment within each group,and WBC and N%were decreased after treatment for 72h?P<0.05?.The difference in HB was not obvious?P>0.05?.6.The hospitalization time and non-invasive assisted ventilation time were statistically significant?P<0.05?.The total number of hospital days and ventilation time were shorter in HHFNC than those in NPPV.HHFNC can reduce hospital stay and non-invasive ventilation time.7.The re-admission,intubation and mortality have no significant difference after 3months?P>0.05?.Conclusion1.Two treatment methods have a good effect on improving oxygen and increase PH,decreasing acidosis with AECOPD.2.Both groups reduced the APACHE?scores and symptoms of dyspnea of patients with AECOPD in a short period of time,suggesting that theearly use of NPPV for the appropriate AECOPD patients can significantly reduce the patients'clinical symptoms and improve their prognosis.3.The total length of hospital stay and ventilation time were no difference between the two groups.4.HHFNC therapy can be safely used in patients with AECOPD combined with mild to moderate respiratory acidosis.Efficacy is equivalent to NPPV.5.HHFNC therapy is not only a method of oxygen therapy,but also has a positive effect on improving ventilation.There is no facial discomfort caused by masks.It can be used as a safe and effective alternative therapy for AECOPD combined with mild to moderate respiratory acidosis.