A Randomized Controlled Clinical Study Of NPPV Combined With Nebulization In The Treatment Of AECOPD Recovery Phase

OBJECTIVETo evaluate the efficacy of non-invasive positive pressure ventilation combined with atomized inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary disease.METHODSWe collected the patients to research,who were diagnosed as acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and type ? respiratory failure(PaCO2>50 mmHg,PaO2<60 mmHg)in Qilu Hospital of Shandong University and Zaozhuang Mining Group Zaozhuang hospital from January 2015 to October 2016.Eventually participating in this study was selected for 78 patients,who were divided into two groups(n=39 in each group)with different treatment measures:Patients in the control group received inhaled glucocorticoid,,long-acting ?2 agonists and long-acting M receptor blockers after discharge.Treatment group of patients not noly after discharge for 10 dayss to accept glucocorticoid,but also to add home non-invasive mechanical ventilation treatment at the same time.And then changed to the same treatment with the control group,the NPPV is going on.To 'observe and compare the patients of the arterial blood gas parameters,lung function parameters,CAT and mMRC scores at 6 months after discharge,as well as the number of hospitalizations,total number of days of hospitalization,the number of occurrences of AECOPD and the time of discharge to the first AECOPD within one year.RESULTS(1)Arterial blood gas analysis 6 months after discharge showed that treatment groups of patients with PaCO2 and PaO2 was significantly better than the control group in patients with AECOPD,and the difference was statistically significant(P<0.05).(2)After 6 months of pulmonary function tests showed that treatment groups of patients with FEV1%expected and IC was significantly better than the control group,and the difference was statistically significant(P<0.05).(3)Six months after discharge,CAT results showed that,treatment group is significantly better than the control group,and the difference was statistically significant(P<0.05).(4)6 months after discharge of mMRC and score evaluation showed that the treatment groups of mMRC was lower than the control group,and the difference was statistically significant(P<0.05).(5)Assessment within 1 years after discharge showed that the survival rate of the treatment group was no different from that of the control group in 1 year(P>0.05).The number of re hospitalization,total hospital stay,the number of AECOPD occurrences and the interval between discharge and first AECOPD(P<0.05)were significantly better in the treatment groups than those in the control group.CONCLUSIONFor moderate COPD patients,NPPV with inhaled corticosteroids combined with short acting ?2 agonists as the initial treatment,after the change of inhaled corticosteroids and long-acting ?2 agonists and long-acting M receptor blocker long-term treatment than the direct effect of long-term treatment can significantly reduce the patient's level of carbon dioxide retention,improve hypoxemia and pulmonary function,life endurance and so on.From a long-term point of view,the former treatment can not only reduce the number of hospitalized again,but also the total hospitalization days.To extend the interval time of discharge to AECOPD for the first time,and comprehensively improve the patient's quality of life.Only in this way can the treatment of patients with chronic obstructive pulmonary disease aggravate recovery period provide clinical guidance.