Analysis Of The Efficacy And Prognosis Of Noninvasive Positive Pressure Ventilation In The Treatment Of AECOPD With Type â…¡ Respiratory Failure

ObjectiveThis study explored the efficacy and safety of noninvasive positive pressure ventilation（NPPV）in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）patients with typeâ…¡respiratory failure,the use of glucocorticoids,and the impact of comorbidities on the prognosis.To provide a reference for optimizing the treatment plan,forming a closed loop of treatment,evaluation and rectification.MethodThe clinical data of 100 patients with AECOPD complicated with typeâ…¡respiratory failure treated in the Department of Respiratory and Critical Care Medicine of Shaanxi Provincial People’s Hospital from 2018 to 2019.12 were analyzed retrospectively.The control group（n=50）received conventional treatment,and the NPPV group（n=50）received NPPV on the basis of conventional treatment.The improvement of arterial blood gas after 72 hours of treatment,prognosis,glucocorticoid dosage,length of hospital stay and hospitalization cost were compared between the two groups.To analyze the influence of complications on the prognosis of AECOPD,etc.Results1.Baseline data of the two groups showed no statistical difference（P>0.05）and were comparable;2.NPPV group:After 72h of treatment,RR and HR decreased,PaO₂increased,Pa CO₂decreased,and p H value increased,（P<0.001）;3.Control group:After 72h of treatment,RR and HR decreased,PaO₂increased,Pa CO₂decreased,（P<0.001）;p H value increased,（P=0.015）;4.NPPV and control group:After 72h of treatment,the RR and HR of the NPPV group were lower than the control group,19.0（16.0,20.0）VS.21.0（20.0,22.0）times/min（P<0.001）,80.0（76.0,84.0）VS.84.0（78.0,90.8）times/min（P=0.011）;The NPPV group is higher than the control group in PaO₂,88.0（83.8,99.3）VS.74.5（64.6,88.3）mm Hg（P<0.001）;The NPPV group is lower than the control group in Pa CO₂,51.6（49.7,62.0）VS.62.2（56.3,73.7）mm Hg（P<0.001）;the difference in p H was no statistical difference,7.39（7.36,7.42）VS.7.36（7.34,7.40）mm Hg（P=0.053）;5.Clinical outcome:There was no statistical difference in effective rate（χ²=2.367,P=0.124）,tracheal intubation rate（χ²=0.000,P=1.000）,fatality rate（χ²=1.223,P=0.269）,and length of hospital stay9.5（8.0,12.0）VS.10.0（8.8,14.0）days,（Z=-1.715,P=0.086）;the hospitalization cost of the NPPV group was higher than the control group,16733.0（13929.3,24389.0）VS.13755.5（10376.6,18943.5）Yuan,（Z=-2.885,P=0.004）;6.Adverse reactions of NPPV:4.0%（2/50）skin damage on the bridge of the nose,6.0%（3/50）flatulence,10.0%（5/50）sputum dysfunction,8.0%（4/50）air leakage,no serious adverse reactions occurred.7.Glucocorticoid:65.0%（65/100）intravenous infusion of methylprednisolone,the dose of NPPV group is lower than the control group,40.0（0.120.0）VS.120.0（0,160.0）mg,（Z=-2.197,P=0.028）;8.Comorbidities:25.0%（25/100）complicated with type 2 diabetes,higher than the national prevalence rate of 10.4%in 2013,（χ²=22.875,P<0.001）;pneumonia 56.0%（56/100）;There is a correlation between type 2 diabetes and pneumonia（χ²=5.411,P=0.020）;pulmonary heart disease,pulmonary hypertension 13.0%（13/100）;pulmonary bullae 40.0%（40/100）;Atrial fibrillation 23.0%（23/100）;coronary atherosclerotic heart disease 45.0%（45/100）;hypertension 47.0%（47/100）;stroke sequelae 15.0%（15/100）;Conclusions1.For patients with AECOPD complicated with type II respiratory failure,NPPV can effectively increase blood oxygen partial pressure and reduce carbon dioxide retention,which is more effective than conventional treatment;2.The effective rate,tracheal intubation rate,fatality rate,and length of hospital stay of NPPV are not better than the control group,and the hospitalization costs are higher.This result may be caused by insufficient samples;3.NPPV has few adverse reactions,relatively mild,and can be improved after symptomatic treatment;4.The dosage,course of treatment and route of administration of glucocorticoid are unreasonable,but the adverse reactions of glucocorticoid are ignored;5.The dose of methylprednisolone in the NPPV group is lower than that in the control group,and whether NPPV can reduce the use of hormone remains to be further studied;6.The prevalence of type 2 diabetes in AECOPD patients is higher than general population;7.There is a correlation between type 2 diabetes and pneumonia in AECOPD patients;8.COPD patients often have a variety of comorbidities,strengthening the early diagnosis and treatment of comorbidities such as type 2 diabetes mellitus,pulmonary infection,pulmonary heart disease,pulmonary hypertension and atrial fibrillation can improve the prognosis of patients.