Clinical Analysis Of Non-invasive Ventilation For 65 Patients Of Respiratory Failure

Objective:Through analysing to the patients of AECOPD,CAP and interstitial lung disease with respiratory failure that treated by non-invasive ventilation, that summarie the experience and guide clinical treatment.Methods:We choose 137 patients in China-Japan Friendship Hospital with respiratory failure from March 1, 2008 to January 31, 2010,including 49 cases of AECOPD,40 cases of community acquired pneumonia, 48 cases of interstitial lung disease, these patients were splited into two groups by randomized method,one is observation group(group A),the other is contrast group(group B)。In the patients of AECOPD ,there is 26 patients in A group,17 were men,while 9 were women;there is 23 patients in B group,15 were men,while 8 were women。In the patients of community acquired pneumonia,there is 16 patients in A group,9 were men,while 7 were women;there is 24 patients in B group,11 were men,while 13 were women。In the patients of nterstitial lung disease,there is 24 patients in A group,10 were men,while 14 were women;there is 24 patients in B group,9 were men,while 15 were women。The patients of two group tested by statistical methods to age,course,HR,RR,PH,PaO2,PaCO2 etc.,there is no obvious difference between group B and group A.Both of two groups were given treatment of controlling infection,inhaled oxygen, dilute sputum, remove bronchospasm,and if it is necessary use the drug of sapplication glucocorticoid,correcting electrolytes disturbance,and supporting .in the same time the patients of group A were given noninvasive breathing machines。We use American Respironics BiPAP? Synchrony ventilator to treat。Ventilator modes using bipolar airway pressure mode(BiPAP).Inspiratory positive airway pressure(IPAP)was seted between 3-5cmH2O,Expiratory positive airway pressure (EPAP)was seted between 15-22cmH2O.IPAP及EPAP were seted from low,than increasing gradually, to feel comfortable advisable.The ventilation frequency 15 to 20 bates.before treatment by ventilator tell the patients that the importance and necessity, guiding Patients with breathing coordination.adverse reactions may arise when, if they need cough, sputum, eating,vomiting,the patients could demolition breathing machines by themselves.All patients were connected by nasal mask. According to the patient tolerance time the ventilation time were seted from 4 to 15 hours a day .The patients were observed before and after treatment, clinical manifestation, disease outcomes of patients, hospitalized time and adverse reaction.Results:Group AECOPD:After treatment the heartbeats of patients of group A reducing from 113.6±13.5times/mins to 81.5±5.7 times/mins .the respiration rates reduced from 27.6±4.8times/mins to 17.3±4.1 times/mins.PaCO2 reducing from 70.7±22.9mmHg to 54.7±8.0mmHg .contrasting with group B reducing obvious(P<0.05).The PH of group A rising from 7.29±0.05 to 7.42±0.07.PaO2 rising from 49.1±13.4mmHg to 78.0±10.0mmHg.contrasting with group B reducing obvious.The observation group than controls more obvious improvement.The Average days in hospital of group A is 13.35±6.84。that of group B is 20.70±13.70.The total cost of hospitalization is less than group B. (groupA 9820.6 Yuan,groupB 10488.36 Yuan).Group Community-acquired pneumonia:After treatment the heartbeats of patients of group A reducing from 124.4±13.4times/mins to 88.1±11.3 times/ mins .the respiration rates reduced from 28.7±4.3 times/mins to 16.9±5.2 times/mins。contrasting with group B reducing obvious(P<0.05)。The PaO2 rising from 53.56±5.28mmHg to 82.0士7.2mmHg.contrasting with group B reducing obvious.The observation group than controls more obvious impro- vement.The Average days in hospital of group A is 10.00±4.51。that of group B is 12.22±4.55.The total cost of hospitalization is less than group B.(groupA 6220.84 Yuan,groupB 6281.08 Yuan).Group Interstitial lung disease:After treatment the heartbeats of patients of group A reducing from 14.3±8.0times/mins to 101.5±10.5 times/mins。the respiration rates reduced from 27.6±3.6times/mins to 22.3±3.6 times/mins。The PH of group A rising from 7.48±0.05 to 7.42士0.05.contrasting with group B reducing obvious(P < 0.05).The PaO2 rising from 49.8±15.4mmHg to 70.8±9.7 mmHg.contrasting with group B reducing obvious.The observation group than controls more obvious improvement.The Average days in hospital of group A is 19.42±9.39.that of group B is 26.13±8.62.The total cost of hospitalization is less than group B.(groupA 11365.19 Yuan,groupB 11557.11 Yuan).There is 24 patients of Group A of AECOPD is effectable(Efficient is 92%).2 patients switch to invasive ventilation。Finally one patient dying。There is 13 patients of Group A of Community-acquired pneumonia is effectable(Efficient is 81%).3 patients switch to invasive ventilation and Symptoms improved.There is 16 patients of Group A of Community-acquired pneumonia is effectable (Efficient is 67%).6 patients switch to invasive ventilation,2 patients Gave up treatment.Observation group adverse events occurred in the main leak.There were 32 cases (49%),due to leakage Liangjun small, no significant effect on the ventilation effect, has not been disposed of. 3 cases of facial skin crushed (5%), abdominal distention v. 7 patients (11%), facial swelling in 5 patients (8%), 7 patients complained of fear, or mask a smell (11%) above by the local skin treatment, psychological counseling after the symptoms were relieved or disappeared.Conclusion:This study used non-invasive BiPAP ventilator mode, this mode provides a higher ventilator inspiratory pressure to overcome airway resistance and increase the effective alveolar ventilation, expiratory positive pressure to provide low breathing, can neutralize intrinsic PEEP to prevent alveolar collapse, thus facilitating the diffusion of carbon dioxide and oxygen to improve PaO2, decreased PaCO2, the selected test group and control group patients before the sex, age, time of onset, clinical manifestations, arterial no significant difference in blood gas values, are comparable in the observation group compared to hospital admission and respiratory rate, heart rate, PH value, PaO2 and PaCO2 such increase was more obvious (P <0.05). Through the study of patients with our department can confirm that, in the strict control of its indications and contraindications of the premise, noninvasive positive pressure ventilation can be applied to patients with clinical symptoms improve, decrease heart rate and respiratory rate, hypoxemia, and hypercapnia effectively corrected, reduce patient suffering, reducing hospitalization time, save medical resources.(1) and the control group, AECOPD, pneumonia, interstitial lung disease, 3 groups statistical results showed that the application of conventional therapy is effective and noninvasive positive pressure ventilation, can significantly improve the patient's breathing rate, heart rate and arterial blood gas analysis The results suggest superior to conventional treatment group. Statistical significance (P <0.05). Noninvasive positive pressure ventilation for a variety of causes in the type I and II due to respiratory failure.(2) three kinds of diseases in COPD has the highest efficiency, lowest interstitial lung disease. Different diseases in the descending order of efficiency: COPD> pneumonia> IPF.(3) application of non-invasive ventilation in the treatment AECOPD, pneumonia, interstitial lung disease may shorten hospital stay, health care resources.(3) application of non-invasive ventilation in the treatment AECOPD, pneumonia, interstitial lung disease may shorten hospital stay, health care resources.(4) Application should be strictly non-invasive ventilator to grasp indications and contraindications, treatment fails in a timely manner to invasive ventilation.