Applying Clinical Experiential Training On The Efficacy Of The Long-term Home Noninvasive Ventilation In Patients With COPD

Objective:To analyze the effect of clinical experiential training on the improvement of compliance and short-term efficacy of long-term home noninvasive ventilation in patients with chronic obstructive pulmonary disease（COPD）with hypercapnia.Methods:Collect COPD patients’data which with acute exacerbation of COPD and were condition stable with hypercapnia after treatment in the emergency department of Harrison International Peace Hospital in Hebei Province during January 2017 to January 2020.Patients meeting the criteria were randomly divided into the experimental group or the control group.Patients included in the study received a type of training before the implementation of home noninvasive ventilation treatment.The experimental group applying clinical experiential training mode,and the control group applying conventional training mode.The patients’compliance and short periodic efficacy of the two groups after different training modes were compared,and the influence of training mode on the treatment of noninvasive ventilation was evaluated.Results:A total of 67 patients were included,43 males（64.2%）,24females（35.8%）,average age 67.37±8.93 years,and the average course of disease was 9.04±8.00 years.32 cases（47.8%）entered the experimental group and 35 cases（52.2%）in the control group.There was no significant difference in general indicators between the two groups,and there was comparability between the two groups.All the patients were treated with different medication schemes,29.9%were treated with LAMA,26.9%were treated with LAMA+LABA,34.3%were treated with LABA+ICS,9.0%of the patients were treated with LAMA+LABA+ICS,and there was no significant difference in the composition of drug treatment schemes between the two groups.There was no significant difference between and within groups in the setting of ventilator parameters and within groups.The number of consultation in the experimental group at the end of one month and the end of three months was significantly lower than that of the control group,and the difference was statistically significant.The ventilation time of the experimental group at the end of one month and the end of three months was significantly higher than that of the control group（8.2±1.6h vs 7.1±2.3h,P<0.05）,and（9.5±1.0h vs 8.4±2.0h,P<0.05）.The compliance of ventilator use in the test group after one month and three months was significantly higher than that in the control group（90.6%vs 65.7%,P<0.05）,（96.9%vs77.1%,P<0.05）.20.9%of the patients had dry mouth and nose,19.4%had mask discomfort,14.9%had dysphagia,14.9%had facial erythema,9.0%had nasal ulcer,7.5%had eye irritation,and 6.0%had headache.There was no significant difference in the proportion of ventilator complications between the two groups.The pulmonary function parameters FEV1%and FEV1（L）of the two groups were significantly improved after 6 months of ventilator treatment.The improvement of Pa O₂ and Pa CO₂ in the experimental group was earlier than that in the control group.The Pa O₂of the experimental group was higher than that of the control group after one month and three months treatment（P<0.05）.Pa CO₂ in the experimental group was significantly lower than that in the control group after one month treatment（49.21±6.25 mm Hg vs 53.31±8.44 mm Hg,P<0.05）.The improvement of CCQ in the experimental group was earlier than that in the control group.After three months treatment,CCQ total score（2.33±0.47 vs 2.03±0.69）,CCQ symptom score（2.43±0.64 vs2.05±0.83）and CCQ function score（2.35±0.58 vs 1.97±0.76）of the experimental group were lower than those of the control group（P<0.05）.Conclusions:1.Clinical experiential training is an effective and feasible training mode,and its training effect is significantly better than that of common training.The compliance of patients using noninvasive ventilator after clinical experiential training was significantly better than that of common training.2.It is feasible to treat stable COPD patients with hypercapnia by long-term noninvasive ventilation at home.After long-term home ventilation treatment,the lung function of the patients were significantly improved,and the quality of life was improved.Earlier benefited of home noninvasive ventilation after applying clinical experiential training compared with common training.