Preliminary Analysis Of Noninvasive Positive Pressure Ventilation With Nasopharyngeal Airway In Patient With AECOPD And Pulmonary Encephalopathy

Objective:To evaluate the clinical effect of noninvasive positive pressure ventilation（NPPV）with nasopharyngeal airway for the treatment of AECOPD with pulmonary encephalopathy.Methods:Systematic review of the cases applying mechanical ventilation addmitted to the first affiliated hospital of Dalian medical university in January 2014 to January 2016 resulting from AECOPD with pulmonary encephalopathy.It included 12 NPPV with nasopharyngeal airway and 13 invasive mechanical ventilation.Meanwhile two group applied conventional treatments including bronchodilators,corticosteroids,antibiotics and so on.We collected the patients general information,blood routine examination,electrolyte,liver function and renal function.At the same time,arterial blood gase analysis,respiratory rate and heart rate were sampled before mechanical ventilation,and after the trial.The diffirent periods of arterial blood gases analysis were signed 0h,24 h,48h,72 h and out of the hospital.The date of using mechanical ventilation and hospital stay,and the number of hospital deaths and ventilator associated pneumonia were collected,too.The above clinical data were eveluated.Result:The base information of two groups were carefully matched before mechanical ventilation（including age,gender,duration,smoking index,APACHE Ⅱ score,GCS score,PCT,BNP and ALB,0h pH,RR and HR,P>0.05）.According to GCS score,the level of disorder of consciousness was slight to moderate in two groups.The pH and PaCO₂ were improved after the treatment（24h,48 h,72h and out of the hospital）comparing with the baseline before the therapy（0h）.At the part of pH,the group of NPPV’s mean pH before therapy was 7.332±0.064,and improved at 48h（mean pH is 7.400±0.048,P=0.014<0.05）.And it was notable improvement at the time of out of the hospital（mean pH is 7.402±0.042,P=0.001<0.05）.The group of invasive mechanical ventilation’s mean pH was impoved at every time after treatment compared with the 0h pH（every mean pH are 7.285±0.117,7.481±0.128,7.445±0.075,7.441±0.075,7.410 [7.375,7.455],P=0.000<0.05）.Between the group of NPPV and invasive mechanical ventilation,the other periords were similar（P>0.05）,besides the results of 24 h were different（P<0.05）.At the part of PaCO₂,the group of NPPV’s mean PaCO₂ was marked impoved at every time after treatment（every mean PaCO₂ were 89.45±26.09 mm Hg,70.30[63.25,81.05]mm Hg,71.16±17.06 mm Hg,62.90[55.08,92.03]mm Hg,59.9 [55.08,63.95]mm Hg,P=0.000<0.05）.The group of invasive mechanical ventilation’s mean PaCO₂ was also marked impoved at every time after treatment（every mean PaCO₂ were 69.20[63.50,87.50]mm Hg,45.65±10.19 mm Hg,50.15±10.41 mm Hg,48.09±9.22 mm Hg,54.36±9.6mm Hg,P=0.000<0.05）.Between the groups,there were difference at 24 h,48h,72h（P<0.05）,and other time these had no difference（P>0.05）.However,this study had no statistical significance between or in each group at the part of Pa O2.The mean date of using NPPV was 12.08±5.85 d,and using invasive mechanical ventilation is 30.15±21.90 d,which had statistical significance between the two groups（P<0.05）.The mean date of hospital stay was 13.67±4.74 d in NPPV group,but it was 36.28±24.04 d in invasive mechanical ventilation group.There were statistical difference between the two groups（P<0.05）.Noninvasive positive pressure ventilation and invasive mechanical ventilation group the average hospitalization expenses were 34036.31±11473.22 yuan,209678.49±122985.08 yuan,and there were statistical difference between the two groups（P<0.05）.The two group had similar rate of requiring VAP and hospital motality.Conclusion:The study confirmed that NPPV with nasopharyngeal airway had effect to AECOPD patients with slight and moderate pulmonary encephalopathy,but it was not to replace the invasive mechanical ventilation.NPPV with nasopharyngeal airway aslo can reduce the date of using mechanical ventilation and hospital stay,improve the level of pH and PaCO₂ significantly,and have fewer hospitalization expenses.