Clinical Study On Family Long-term Application Of Noninvasive Positive Pressure Ventilation In The Treatment Of Chronic Obstructive Pulmonary Disease Merge With Respiratory Failure

Objective:To observe and evaluate the efficacy and safety of long-term noninvasive positive pressure ventilation?NPPV?in the treatment of chronic obstructive pulmonary disease?COPD?merge with type II respiratory failure.Method:Selecting a group of patients with chronic obstructive pulmonary disease,who received treatment at our hospital Respiratory and Critical Care Medicine from Sep.2016 to Mar.2018.After hospitalization,the patients recovered to a stable state with cough,expectoration and wheezing.After arterial blood gas analysis and pulmonary function examination,60 patients simultaneously met FEV1/predicted value<50%,PaO₂<60mmHg,PaCO₂>50mmHg,were included in the study.They were randomly divided into two groups:control group?30 cases?and treatment group?30 cases?.The control group was treated with routine comprehensive treatment such as home oxygen therapy after discharge,while the treatment group was treated with family NIPPV on the premise of routine comprehensive treatment.The status of two groups of patients were followed up at discharge time and at 6 and 12 months after discharge,blood gas analysis?PaO₂,PaCO₂?,lung function?FEV1,FVC?,SRI score,CAT score,BDI score and6-minute walking distance were recorded and the results were analyzed with statistics.To comprehensively evaluate the efficacy of long-term NIPPV in the treatment of COPD with respiratory failure.The end point of the study is 12 months follow-up and patient death.Those who refuse to continue wearing non-invasive ventilators and those who donot wear ventilators as requested during the participation process are regarded as exfoliated cases.Results:The baseline data of age,gender,blood gas analysis?PaO₂,PaCO₂?,lung function?FEV1,FVC?,various scoring tables?SRI,CAT,BDI?and 6MWD were analyzed at discharge.The data is comparable for the difference was not statistically significant?P>0.05?.During the follow-up period,there were no death cases and no serious complications.One patient in the treatment group dropped out because of poor compliance of non-invasive ventilator during the treatment period.?1?Blood gas analysis:After 6 months and 12 months of treatment,the PaO₂ of patients in the two groups increased,with statistical significance?P<0.001?;PaCO₂ of patients in the two groups decreased compared with that before treatment,and with the passage of treatment time,PaCO₂ decreased more significantly.Compared among two groups,PaO₂ and PaCO₂ in the treatment group improved more significantly than those in the control group?P<0.05?.Patients in the treatment group chose the continuous application at night?nocturnal continuous group?and application during the day or alternate use during the day and night?non-nocturnal continuous group?.To compare the PaCO₂ levels of the two kinds of patients after 6 months and 12 months of treatment,it was found that the PaCO₂ levels of the patients who used NPPV continuously during the night sleep period improved more significantly than those who did not use NPPV continuously at night?P<0.05?,PaO₂ did not improve significantly,and there was no significant difference between the two groups?P>0.05?.?2?Pulmonary function indicators:After treatment,there was no significant difference in FEV1 and FVC both in the two groups?P>0.05?,and there was no significant difference between the two groups?P>0.05?.?3?CAT score:At 6 months and 12 months after treatment,the CAT score of patients in the treatment group decreased significantly compared with that before treatment,and the decrease was more obvious after 12 months?P<0.001?.There was no significant improvement in the control group after 6 months and 12 months of treatment compared with that before treatment,with no significant difference?P>0.05?.There was no significant difference between nocturnal continuous group and non-nocturnal continuous group?P>0.05?.?4?BDI score:After 6 months and 12 months of follow-up,the BDI score of patients in the treatment group increased significantly compared with that before treatment?P<0.05?,and with the extension of time,the increase of the BDI score was more obvious.In the control group,there was no significant increase in the BDI scorecompared with that before treatment,with no significant difference?P>0.05?.There was no significant difference between nocturnal continuous group and non-nocturnal continuous group?P>0.05?.?5?SRI score:At 6 months and 12 months after treatment,the SRI score of patients in the treatment group increased significantly?P<0.001?,and with the increase of treatment time,the SRI score increased more significantly.In the control group,the SRI score did not increase significantly compared with that before treatment,with no significant difference?P>0.05?.There was no significant difference between nocturnal continuous group and non-nocturnal continuous group?P>0.05?.?6?6-minute walking distance?6MWD?:At 6 months and 12 months after treatment,the 6MWD of the patients in the treatment group was higher than that before treatment,with statistical significance?P<0.001?,and the improvement was more obvious at 12months than that before treatment.After treatment,the 6MWD of the patients in the control group did not increase significantly compared with that before treatment,with no statistical significance?P>0.05?.There was no significant difference between nocturnal continuous group and non-nocturnal continuous group?P>0.05?.Conclusions:1.Family long-term application of NPPV could improve blood gas analysis?PaO₂,PaCO₂?for patients with severe and extremely severe stable phase of COPD merge with type II respiratory failure,and PaCO₂ decreased more significantly for patients with continuous use of non-invasive ventilator at night than patients without continuous use at night.2.For patients with severe and extremely severe stable phase of COPD merge with type II respiratory failure,there was no significant improvement in lung function?FEV1and FVC?after treatment of family long-term NPPV.3.Family long-term application of NPPV can reduce the CAT score for patients with severe and extremely severe stable phase of COPD merge with type II respiratory failure,can delay the aggravation of the disease,increase the BDI score,alleviate the degree of dyspnea and increase the SRI score,which can significantly improve the health-related quality of life for patients with COPD.4.Family long-term application of NPPV can increase 6MWD for patients with severe and extremely severe stable phase of COPD merge with type II respiratory failure,and can increase the activity endurance of patients with COPD.