The Clinical Efficacy Of Noninvasive Ventilator Combined With Acetylcysteine Inhalation In The Treatment Of COPD With Type Ⅱ Respiratory Failure

Objective:The chronic obstructive pulmonary disease（COPD）is a kind of common disease,frequently-occurring disease in respiratory system with high incidence,seriously condition,high mortality and poor prognosis,and the fourth leading cause of death in urban population and the third place in the top 10 causes of death in rural population of our country,damaging the physical and mental health of our people.The incidence of COPD is increasing year by year with the aggravation of adverse factors such as aging of population structure,growing air pollution,the harmful material dust and the growing number of smoking population.The pathogenesy of COPD is complicated,mainly with chronic inflammation of the airways and incomplete reversible airflow limitation of the respiratory tract as the main feature.Gradually,some pathologic changes,such as worsened compliance of lung,the loss of alveoli and capillaries,reduction of diffusion area in lung and abnormal pulmonary blood flow always occur in COPD patients,respiratory system,leading to the dysfunction of pulmonary ventilation and ventilation,varying degrees of hypoxemia and hypercapnia,causing the respiratory failure finally,which results in that respiratory failure is one of the most common and severe complications of COPD patients.Without timely intervention treatment,the hypoxemia and carbon dioxide retention could occur in COPD patients,which is the main cause of higher mortality for COPD patients.It is a bottleneck of clinical treatment for limited therapeutic options and poor curative effect for COPD patients with type II respiratory failure.In recent years,ventilator combined with drugs,as an treatment for COPD patients with type II respiratory failure,is gradually becoming a hot research point at home and abroad,while it is well accept that noninvasive ventilator combined with drugs is used in COPD and its curative effects have getting clinical affirmation gradually.The purpose of this study is to investigate the clinical efficacy of noninvasive ventilator combined with acetylcysteine and its application value in the treatment of COPD with type II respiratory failure,and provide the scientific theoretical foundation and experimental basis for related basic research and clinical application research,and offer pointcut of clinic prevention and treatment for COPD.Method:COPD patients with type II respiratory failure selected in the respiratory medicine department of GanZhou Municipal Hospital from January 2018 to June2019 were selected and collected as experimental subjects.According to the following standards,exclusive criteria,patients,informed consent and compliance,the integrity of treatment and follow-up visit,et al,87 cases were excluded finally,as the observation group,while the patients,blood preparation were collected before and after the treatment respectively.82 cases of COPD patients with type II respiratory failure were selected as the control group.All patients had complete clinical data and were diagnosed as COPD with type II respiratory failure by experienced respiratory physician.The patients in control group were treated with conventional therapy,such as bronchodilators,glucocorticoids,antibacterial agents,and noninvasive ventilator et al,while the patients in observation group were treated with noninvasive ventilator combined with acetylcysteine based on the conventional therapy.To analyze and compare the patients,respiratory symptoms and symptoms,such as cough,sputum production,chest distress and shortness of breath,Low breathing sound,dry wet then sound,et al between the observation group and control group for investigate the clinical efficacy of noninvasive ventilator combined with acetylcysteine and its application value in the treatment of COPD with type II respiratory failure,while the lung function index FEVl and FEVl%,the blood gas index PaO₂ and PaCO₂ and the inflammatory factors IL-4 and IL-6 between the two groups were selected and compared also.Result:1.87 cases of COPD patients with type II respiratory failure were included in the observation group,including 67 males and 20 females,with an average age of64.38±7.52 years and an median age of 68,an average BMI of 23.14±1.36 Kg/m²,an average smoking index of 396.53±27.82,an average course of 17.34±6.89 years,an average PaCO₂ of 82.46±9.13 mmHg before treatment,an average PaO₂ of56.54±11.25 mmHg before treatment,an average FEV1 of 0.93±0.11L before treatment,an average FEV1%of 51.43±6.42 before treatment,an average serum levels of IL-4 and IL-6 of 1.67±0.24 ng/L and 43.07±6.24 ng/L before treatment,respectively.82 cases of COPD patients with type II respiratory failure were included in the control group,including 64 males and 18 females,with an average age of63.18±9.45 years and an median age of 67,an average BMI of 23.57±2.08 Kg/m²,an average smoking index of 402.15±18.35,an average course of 19.17±4.25 years,an average PaCO₂ of 81.67±11.03 mmHg before treatment,an average PaO₂ of57.39±9.82 mmHg before treatment,an average FEV1 of 0.95±0.08 L before treatment,an average FEV1%of 50.87±8.96 before treatment,an average serum levels of IL-4 and IL-6 of 1.64±0.43 ng/L and 41.39±9.51 ng/L before treatment,respectively.Compared with the control group,there was no significant difference in gender,age,BMI,smoking index,smoking history,course and lung function index（FEV1 and FEV1%）,blood gas index（PaO₂ and PaCO₂）and inflammatory factors（IL-4 and IL-6）between the two groups（P>0.05）.2.The average FEV1 and FEV1%of patients in observation group after treatment were 1.47±0.16 L and 62.36±7.31,respectively.The average FEV1 and FEV1%of patients in control group after treatment were 1.26±0.11 L and56.72±6.59,respectively.The results suggested that the lung function index（FEV1 and FEV1%）in observation group was significantly higher than that in control group(P<0.0001,with statistical significance.3.The average PaCO₂ and PaO₂ of patients in observation group after treatment were 59.38±11.84 mmHg and 82.63±10.32 mmHg,respectively.The average PaCO₂and PaO₂ of patients in control group after treatment were 65.72±8.35 mmHg and76.44±12.03 mmHg,respectively.The results suggested that the average PaCO₂ in observation group was significantly lower than that in control group,while the average PaO₂ was significantly higher than control group,P<0.001,with statistical significance.4.The average serum levels of IL-6 and IL-4 of patients in observation group after treatment were 19.76±4.34 ng/L and 1.23±0.27 ng/L,respectively.The average serum levels of IL-6 and IL-4 of patients in control group after treatment were34.28±6.19 ng/L and 1.15±0.38 ng/L,respectively.The results suggested that the average serum levels of IL-6 in observation group was significantly lower than that in control group（P<0.001）,with statistical significance.But there was no difference in the average serum levels of IL-4 among the two groups（P>0.05）,did not achieve statistical significance.5.The rate of conspicuity therapeutic effect,the effective rate,inefficiency and the total effective rate of the observation group after treatment were 47.13%,36.78%,16.09%and 83.91%,respectively.The rate of conspicuity therapeutic effect,the effective rate,inefficiency and the total effective rate of the control group after treatment were 39.02%,26.83%,34.15%and 65.85%,respectively.There was no difference in the rate of conspicuity therapeutic effect and the effective rate among the two groups（P=0.736,P=0.166）,did not achieve statistical significance.But the total effective rate of the observation group after treatment was significantly higher than the control group（P=0.007）,with statistical significance.Conclusion:1.The application of noninvasive ventilator combined with acetylcysteine can significantly increase the lung function index（FEV1 and FEV1%）of COPD patients with type II respiratory failure,suggesting that the federated application can improve the patient,s lung function.2.The application of noninvasive ventilator combined with acetylcysteine can significantly increase the PaO₂ of COPD patients with type II respiratory failure,and reduce the index of PaCO_2.3.The application of noninvasive ventilator combined with acetylcysteine can significantly reduce the serum levels of IL-6 of COPD patients with type II respiratory failure,suggesting that the federated application can relieve the patient,s inflammatory reaction.4.The application of noninvasive ventilator combined with acetylcysteine can significantly relieve the patients,respiratory symptoms and symptoms,such as cough,sputum production,chest distress and shortness of breath,Low breathing sound,dry wet then sound,et al,suggesting that the federated application can improve the therapeutic effect.