Analysis of the Effect of Non-Invasive Positive Pressure Ventilation in Emergency Treatment of Severe Bronchial Asthma with Respiratory Failure

Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.

Observation on the Effect of Non-Invasive Ventilator Combined with Conventional Therapy in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective:To explore the clinical effect of a non-invasive ventilator combined with conventional therapy in the treatment of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:68 patients with COPD combined with respiratory failure treated in our hospital from September 2021 to October 2023 were selected as the research subjects.Using the random number table method,they were divided into a control group and an experimental group of 34 cases each.The control group received conventional symptomatic treatment,and the experimental group received non-invasive ventilator treatment based on the control group.The clinical effects,blood gas indicators(partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))),lung function(forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),6 min walking distance),complications,and inflammatory factor levels(c-reactive protein(CRP),interleukin-6(IL-6),neutrophil-to-lymphocyte ratio(NLR))of the two groups of patients were observed.Results:(1)The clinical efficacy of the patients in the experimental group(33/97.06%)was more significant as compared with the control group(25/73.53%)(P<0.05);(2)After treatment,the clinical efficacy of the two groups of patients in terms of FEV1,FEV1/FVC,6-minute walking distance,PaO_(2)and SaO_(2)all increased in the experimental group as compared to that of the control group(P<0.05);(3)After treatment,the PaCO_(2),CRP,IL-6,and NLR of the two groups of patients decreased,and the decrease in the experimental group was higher than that of the control group(P<0.05);(4)The patients’complication rate in the experimental group(2/5.88%)was lower as compared to that of the control group(9/26.46%)(P<0.05).Conclusion:Non-invasive ventilators combined with conventional therapy achieved good clinical results in treating patients with COPD and respiratory failure.

Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective:To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects,and randomly divided into the control group and the experimental group,each with 35 cases.The control group received only conventional treatment,and the experimental group received non-invasive positive pressure ventilation,and the treatment effects and changes in the levels of IL-18,hs-CRP,and CES2 inflammatory factors were observed and evaluated in the two groups.Results:There was no significant difference between the general data of the two groups(P>0.05);after treatment,the total effective rate of clinical efficacy of the observation group(91.43%)was significantly higher than that of the control group(71.43%),and the difference showed a significant correlation(P<0.05);after treatment,the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group,and the difference showed a highly significant correlation(P<0.001).Conclusion:The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect,effectively controls the level of inflammatory factors,and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure,showing a good clinical application prospect.

Application of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU

Objective:To observe the application effect of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU.Methods:A total of 80 patients with acute heart failure merged with respiratory failure who were admitted in ICU from January, 2015 to January, 2016 were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the two groups were given routine treatments after admission. On this basis, the patients in the observation group were given non-invasive ventilator. The patients in the control group were given continuous low flow oxygen inhalation. PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before and after treatment between the two groups were compared. The serum NT-pro BNP and cTnI levels before treatment, 24 h and 48 h after treatment in the two groups were compared.Results:The comparison of PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before treatment between the two groups was not statistically significant. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the two groups were significantly elevated, while PaCO2 was significantly reduced when compared with before treatment. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the observation group were significantly higher than those in the control group, while PaCO2 was significantly lower than that in the control group. The comparison of NT-pro BNP and cTnI levels before treatment between the two groups was not statistically significant. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the two groups were significantly elevated when compared with before treatment. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the observation group were significantly lower than those in the control group.Conclusions:Non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure can effectively improve the ventilation function, reduce NT-pro BNP and cTnI levels, and is of great significance in enhancing the rescued effect.

Effect of Shenqi Fuzheng Injection and naloxone and BiPAP ventilator on serum inflammatory factors, immune function and blood gas analysis indexes in patients with AECOPD with type Ⅱ respiratory failure

Objective: To investigate the effect of Shenqi Fuzheng Injection combined with naloxone and BiPAP ventilator on serum inflammatory factors, immune function and blood gas analysis indexes in treatment of AECOPD with type Ⅱ respiratory failure. Methods: A total of 82 patients with AECOPD and type Ⅱ respiratory failure were divided into control group (n=40) and observation group (n=42) according to random data table, patients in the control group received naloxone and BiPAP ventilator therapy, and observation group patients were treated with Shenqi Fuzheng Injection on the basis of control group. The levels of serum inflammatory factors, immune function and blood gas analysis indexes were compared between the two groups before and after treatment. Results: There were no significant difference in levels of CRP, TNF-α, IL-6, CD3+, CD4+, CD8+, CD4+/CD8+, PaO2, PaCO2, SaO2 and pH before and after treatment in the two groups. After treatment, the levels of CRP, TNF-α, IL-6, CD8+and PaCO2 in two groups were significantly lower than those in same group before treatment, moreover observation group was significantly lower than control group;and levels of CRP, TNF-α, IL-6, CD8+ and PaCO2 in the observation group was significantly lower than those of the control group, the difference was statistically significant;When compared with the group before treatment, CD3+, CD4+, CD4+/CD8+, PaO2, SaO2 and pH levels of both groups after treatment were significantly increased, and the level of each index of observation group after treatment were significantly higher than the control group, the difference was statistically significant. Conclusion: The clinical effect of Shenqi Fuzheng Injection Combined with naloxone and BiPAP ventilator in treatment of AECOPD with type II respiratory failure is significant, can effectively reduce the body's inflammatory reaction, improve immune function, regulate blood gas analysis index, with a certain clinical value.

Non-invasive ventilation for acute hypoxemic respiratory failure,including COVID-19

Optimal initial non-invasive management of acute hypoxemic respiratory failure(AHRF),of both coronavirus disease 2019(COVID-19)and non-COVID-19 etiologies,has been the subject of significant discussion.Avoidance of endotracheal intubation reduces related complications,but maintenance of spontaneous breathing with intense respiratory effort may increase risks of patients’self-inflicted lung injury,leading to delayed intubation and worse clinical outcomes.High-flow nasal oxygen is currently recommended as the optimal strategy for AHRF management for its simplicity and beneficial physiological effects.Non-invasive ventilation(NIV),delivered as either pressure support or continuous positive airway pressure via interfaces like face masks and helmets,can improve oxygenation and may be associated with reduced endotracheal intubation rates.However,treatment failure is common and associated with poor outcomes.Expertise and knowledge of the specific features of each interface are necessary to fully exploit their potential benefits and minimize risks.Strict clinical and physiological monitoring is necessary during any treatment to avoid delays in endotracheal intubation and protective ventilation.In this narrative review,we analyze the physiological benefits and risks of spontaneous breathing in AHRF,and the characteristics of tools for delivering NIV.The goal herein is to provide a contemporary,evidence-based overview of this highly relevant topic.

HFNC与NIPPV对AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效观察

目的探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)与无创正压通气(non-invasive positive pressure ventilation,NIPPV)对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2021年1月至2023年1月福建医科大学附属泉州第一医院重症医学科AECOPD患者146例,根据治疗方法不同分为NIPPV组(n=47)、HFNC组(n=49)和常规治疗组(n=50)。NIPPV组采用NIPPV治疗,HFNC组采用HFNC治疗,常规治疗组采用常规氧疗和抗感染治疗。比较3组循环指标、血气指标、呼吸支持时间、气道护理次数及舒适(general comfort questionnaire,GCQ)评分。结果146例患者中男76例、女70例,年龄56~77岁,平均(66.2±5.3)岁。与治疗前相比,治疗2 h和治疗24 h时,3组呼吸频率(respiratory rate,RR)和HR较低;治疗6 h和治疗24 h时,HFNC组RR、HR均低于NIPPV组和常规治疗组,差异有统计学意义(P<0.05)。与治疗前相比,治疗7 d后3组PaO_(2)均升高、PaCO_(2)均降低;治疗7 d后,与NIPPV组和常规组相比,HFNC组PaO_(2)较高、PaCO_(2)较低,差异有统计学意义(P<0.05)。3组呼吸支持时间和气道护理次数的差异有统计学意义(P<0.05),其中NIPPV组呼吸支持时间较短,HFNC组气道护理次数较少。结论HFNC可以改善AECOPD合并Ⅱ型呼衰患者的部分循环指标和血气指标,患者舒适度更好,但呼吸支持时间较长。

Hygrometry behavior during high-flow nasal oxygen therapy and non-invasive mechanical ventilation:A narrative review of bench to clinical studies

Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.

专科护理小组用于无创呼吸机辅助通气治疗AECOPD并呼吸衰竭中对遵医行为、并发症的影响

目的研究专科护理小组用于无创呼吸机辅助通气治疗慢性阻塞性肺疾病急性加重期(Acute Exacerbation of Chronic Obstructive Pulmonary Disease,AECOPD)并呼吸衰竭的效果,及对遵医行为、并发症的影响。方法随机选取2023年4—8月广东省罗定市中医院收治的50例AECOPD并呼吸衰竭患者为研究对象,按照护理方法的不同分为对照组(n=25,常规护理)和研究组(n=25,专科护理小组)。统计并比较两组的并发症发生情况及护理前后的遵医行为、生活质量、护理满意度。结果与对照组相比,研究组的并发症发生率(0)更低,护理满意度(100%)更高,差异有统计学意义(χ^(2)=4.735、5.980,P=0.030、0.015)。且经过护理后,两组遵医行为、慢性呼吸系统疾病问卷评分均升高,且研究组各评分均高于对照组,差异有统计学意义(P均<0.05)。结论专科护理小组可提高患者的遵医行为,降低并发症发生率,利于生活质量及护理满意度的提升。

Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

NT-proBNP联合浅快呼吸指数对AECOPD伴呼吸衰竭机械通气患者撤机效果的预测价值

目的探究N-端脑钠肽前体(N-telomere natriuretic peptide precursor,NT-proBNP)联合浅快呼吸指数(Rapid shallow breathing index,RSBI)对慢性阻塞性肺疾病急性加重期(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴呼吸衰竭(RF)机械通气患者撤机失败的预测价值。方法收集2017年1月-2021年12月首都医科大学附属北京潞河医院呼吸与危重症医学科收治的81例AECOPD伴RF机械通气患者的临床资料,根据患者撤机情况情况分撤机成功和撤机失败组。所有AECOPD伴RF机械通气患者均检测NT-proBNP水平,进行RSBI评估。比较两组AECOPD伴RF机械通气患者的临床资料、NT-proBNP及RSBI水平,采用Logistic回归分析影响AECOPD伴RF机械通气撤机失败的因素,根据ROC曲线分析NT-proBNP水平联合RSBI对AECOPD伴RF机械通气患者撤机失败的预测价值。结果81例AECOPD伴RF机械通气患者中24例患者撤机失败,57例患者撤机成功,撤机失败率为29.63%。两组患者性别、年龄、COPD病程、合并症(高血压、糖尿病、高血脂症及冠心病)、吸烟史、体温、心率、平均动脉压、白细胞计数、氧分压及氧浓度比较,差异无统计学意义(P>0.05)。与撤机成功组比较,撤机失败组机械通气时间、NT-proBNP及RSBI水平均增大,差异有统计学意义(P<0.05)。Logistic回归分析显示NT-proBNP水平、RSBI是AECOPD伴RF机械通气撤机失败的独立危险因素(P<0.05);ROC分析显示,NT-proBNP水平评估AECOPD伴RF机械通气撤机失败的AUC值为0.784,95%CI为0.679~0.868,RSBI的AUC值为0.773,95%CI为0.667~0.859,二者联合预测的AUC值为0.918,95%CI为0.835~0.967。结论NT-proBNP水平和RSBI用于预测AECOPD伴RF机械通气患者撤机失败具有一定的参考价值,二者联合对于AECOPD伴RF机械通气患者撤机失败的预测价值更高。

纤维支气管镜肺泡灌洗联合无创呼吸机治疗AECOPD合并呼吸衰竭患者的临床疗效评价

目的评价纤维支气管镜肺泡灌洗联合无创呼吸机治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of chronicobstructivepulmonarydisease,AECOPD)合并呼吸衰竭疗效。方法选取2019年3月—2021年12月中部战区总医院收治AECOPD合并呼吸衰竭103例。根据治疗方案不同分为对照组(无创呼吸机,49例)和治疗组(纤维支气管镜肺泡灌洗+无创呼吸机,54例)。比较2组临床疗效、血氧分压(alveolar air oxygenpartial pressure,PaO_(2))、动脉血二氧化碳分压(partial pressure carbondioxide,PaCO_(2))、血氧饱和度(blood oxygen saturation,SaO_(2))、pH值、最大自主通气量(maximum autonomousventilation,MVV)、最大呼气中期流量(maximum mid expiratory flow,MMEF)、肺总量(total lungvolume,TLC)、功能残气量(functionalresidualcapacity,FRC)及治疗指标等。结果治疗组临床疗效高于对照组(P<0.05)。2组治疗后PaO_(2)、SaO_(2)、pH水平升高,PaCO_(2)水平逐渐下降;且治疗组PaO_(2)、SaO_(2)、pH水平显著高于对照组,PaCO_(2)水平低于对照组(P<0.05)。2组治疗后MVV、MMEF、TLC及FRC水平均显著上升,且治疗组上述指标均高于对照组(P<0.05)。2组院内病死率比较差异无统计学意义(P>0.05);治疗组感染控制、住院天数均短于对照组(P<0.05),且VAP发生率低于对照组(P>0.05)。结论纤维支气管镜肺泡灌洗联合无创呼吸机治疗AECOPD合并呼吸衰竭疗效好,可有效改善血气参数,提高肺功能通气量,且缩短治疗时间。

经鼻高流量湿化氧疗与无创正压通气治疗AECOPD合并呼吸衰竭的临床疗效比较

目的对比分析经鼻高流量湿化氧疗与无创正压通气治疗慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭的疗效。方法选择2021年1月至2023年1月我院收治的AECOPD合并呼吸衰竭患者112例,随机分为两组,各56例。对照组行无创正压通气治疗,试验组行经鼻高流量湿化氧疗治疗。对比两组治疗前后生命体征、血气指标、氧化应激水平变化,并统计不良反应发生率。结果两组治疗后生命体征、血气指标、氧化应激水平均明显改善(P<0.05)。试验组治疗后心率、呼吸频率、平均动脉压与对照组相比,差异无统计学意义(P>0.05)。试验组治疗后动脉血氧分压、动脉血氧饱和度、pH值高于对照组,动脉血二氧化碳分压低于对照组(P<0.05)。试验组治疗后SOD、GSH-Px高于对照组,MDA低于对照组(P<0.05)。试验组总不良反应发生率低于对照组(P<0.05)。结论经鼻高流量湿化氧疗治疗AECOPD合并呼吸衰竭患者疗效优于无创正压通气治疗,前者改善患者血气指标及氧化应激水平效果更优,且不良反应少。

异丙托溴铵与复方异丙托溴铵对AECOPD合并呼吸衰竭患者肺功能及动脉血气分析的影响

目的探讨异丙托溴铵与复方异丙托溴铵对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的肺功能及动脉血气分析的影响。方法选取2021年1月—2022年12月我院收治的80例AECOPD合并呼吸衰竭患者为研究对象,按患者采取的治疗方案不同将其分为对照组和观察组,各40例。对照组行无创呼吸机联合异丙托溴铵治疗,观察组行无创呼吸机联合复方异丙托溴铵治疗。比较两组症状改善情况、肺功能、动脉血气分析指标及不良反应发生情况。结果治疗后,观察组改良英国医学研究委员会呼吸困难量表分级优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组第1秒用力呼气容积占预计值百分比高于对照组,呼气峰值流速快于对照组,组间差异有统计学意义(P<0.05)。治疗后,观察组血氧饱和度高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论无创呼吸机联合复方异丙托溴铵能缓解AECOPD合并呼吸衰竭患者的呼吸困难症状、改善患者肺功能和动脉血气指标。

基于LIPS评分选择有创机械通气时机对AECOPD伴呼吸衰竭患者的有效性及安全性

目的分析基于肺损伤预测评分(LIPS)选择有创机械通气时机治疗慢性阻塞性肺疾病急性加重期(AECOPD)伴呼吸衰竭患者的有效性及安全性。方法回顾性分析2020年1月至2022年12月收治的95例AECOPD伴呼吸衰竭患者的临床资料,将按照临床常规诊治标准实施有创机械通气治疗的47例患者设为对照组,将基于LIPS评分选择有创机械通气时机治疗的48例患者设为观察组,比较2组治疗前后体征指标、呼吸机监测指标、血气指标,并统计2组治疗期间并发症发生情况。结果治疗48 h后,观察组心率、呼气末正压、平均气道压、动脉血二氧化碳分压低于对照组(P<0.05);舒张压、收缩压、血氧饱和度、脉氧饱和度与吸入氧浓度比值、动脉血氧分压与吸入氧浓度比值、动脉血氧分压、动脉血氧饱和度和颈内静脉氧饱和度高于对照组(P<0.05)。观察组治疗期间并发症总发生率低于对照组(P<0.05)。结论基于LIPS评分选择有创机械通气时机治疗AECOPD伴呼吸衰竭患者的效果良好,可较快稳定患者生命体征,改善其呼吸和血气情况,减少并发症的发生,治疗有效性和安全性较高。

无创正压通气用于AECOPD合并呼吸衰竭的护理体会

目的探究个性化护理对于慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭并应用无创正压通气的临床应用价值。方法本研究回顾性选取2019年2月—2021年2月高州市人民医院呼吸内科收治的60例AECOPD合并呼吸衰竭并应用无创正压通气的患者的临床资料,根据随机数表法分为对照组以及研究组,每组30例。行常规护理的设为对照组,行个性化护理的设为研究组。对比两组护理效果。结果护理前两组患者的睡眠质量比较,差异无统计学意义(P>0.05),护理后,研究组更低,差异有统计学意义(P<0.05)。研究组呼吸症状、活动受限、疾病影响评分低于对照组,差异有统计学意义(P<0.05)。研究组发生压力性损伤、排痰障碍、呼吸道干燥、腹胀等不良反应发生率(6.67%)低于对照组(20.00%),但是组间对比,差异无统计学意义(P>0.05)。研究组的护理满意度(96.66%)高于对照组(73.33%),差异有统计学意义(χ^(2)=4.705,P<0.05)。结论对于AECOPD合并呼吸衰竭并应用无创正压通气的患者应用个性化护理能够改善患者的预后,提升生存质量,还能有效地提升患者的护理满意度。

无创机械通气联合雾化吸入药物治疗AECOPD并发呼吸衰竭的临床观察

目的:观察无创机械通气联合雾化吸入药物治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭的临床疗效及安全性。方法:选取经确诊的AECOPD并发呼吸衰竭患者90例,按随机数字表法分为观察组和对照组,各45例。两组患者均给予低流量的供氧、抗感染、平喘、通气、强心、解痉及营养支持等常规治疗。对照组患者进行无创机械通气治疗;观察组患者在对照组基础上给予吸入用布地奈德2 ml混悬+硫酸特布他林雾化液2 ml+异丙托溴铵气雾剂1 ml雾化吸入治疗,bid。两组患者均连续治疗7 d。比较两组患者临床疗效及治疗前后的动脉血气指标[p H值、二氧化碳分压(PaCO_2)、氧分压(PaO_2)]及心率(HR)、呼吸频率(RR)、峰值呼气流速(PEF)水平,并观察不良反应。结果:观察组患者临床总有效率为93.3%,显著高于对照组的73.3%,差异有统计学意义(P<0.05)。治疗前,两组患者动脉血气指标及HR、RR、PEF比较,差异均无统计学意义(P>0.05);治疗后,两组患者pH值、PaO_2、PEF显著升高,PaCO_2、HR、RR显著降低,且观察组优于对照组,差异均有统计学意义(P<0.05)。两组患者均未见明显不良反应发生。结论:无创机械通气联合雾化吸入药物治疗AECOPD并发呼吸衰竭疗效显著,能明显改善患者血气指标及HR、RR、PEF,且安全性较好。

BiPAP无创呼吸机治疗AECOPD并Ⅱ型呼吸衰竭的临床观察

目的总结我科近一年应用双水平正压无创通气(BiPAP)对慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的治疗效果。方法对28例AECOPD并Ⅱ型呼吸衰竭患者给予BiPAP呼吸机通气治疗,观察治疗前后PH、PaO2、PaCO2、SaO2等指标变化。结果 BiPAP呼吸机治疗后4 h及72 h及通气结束后较治疗前PH、PaO2、SaO2均明显升高,PaCO2明显降低(P均<0.05)。治疗后临床症状得到明显改善。结论 BiPAP呼吸机对AECOPD合并Ⅱ型呼吸衰竭疗效显著。

超敏C反应蛋白/白蛋白比值对无创通气治疗AECOPD合并呼吸衰竭患者的预后评估价值

目的探讨超敏C反应蛋白/白蛋白(hs-CRP/Alb)比值对慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者行无创通气(NIV)治疗的预后评估价值。方法连续收集行NIV治疗的AECOPD合并呼吸衰竭患者共50例,记录APACHEⅡ评分、动脉血p H值、血氧分压(PaO_2)、二氧化碳分压(Pa CO_2)、hs-CRP、血清Alb及治疗预后。分析预后良好组与预后不良组间p H值、PaO_2、PaCO_2、hs-CRP/Alb及APACHEⅡ评分的差异,判断hs-CRP/Alb与各项指标之间的相关性,评估hs-CRP/Alb对AECOPD合并呼吸衰竭患者预后的预测能力。结果预后不良组的hs-CRP/Alb值、APACHEⅡ评分显著高于预后良好组(P=0.000、0.005),其p H值也明显低于预后良好组(P=0.000)。同时,hs-CRP/Alb与APACHEⅡ、PaCO_2显著相关(r=0.310、-0.286,P=0.028、0.044),与p H值及PaO_2则无显著相关性(r=-0.236、-0.006,P=0.099、0.966)。p H值、PaO_2、PaCO_2、hs-CRP/Alb及APACHEⅡ评分的ROC曲线下面积分别为0.080、0.401、0.583、0.848及0.743;hs-CRP/Alb预测患者NIV后发生预后不良的界值为2.10,具有较高的敏感度(0.769)和特异度(0.892)。结论 hs-CRP/Alb比值有助于判断AECOPD合并呼吸衰竭患者行NIV治疗的效果,具有良好的预后预测价值。

AECOPD呼吸衰竭患者使用无创呼吸机治疗对其机体血气及炎性指标的影响研究

目的对AECOPD呼吸衰竭患者给予无创呼吸机治疗,评估患者机体血气及炎性指标的影响效果。方法选取2018年5月至2019年5月我院收治的慢性阻塞性肺疾病急性发作合并呼吸衰竭患者82例作为研究对象,41例实施无创呼吸机治疗的患者为研究组,41例实施常规治疗的患者对照组。结果研究组患者接受无创呼吸机治疗后,患者的心率、呼吸频率等血气、炎性指标均优于对照组患者,数据对比差异明显,具有统计学意义(P<0.05)。结论对慢性阻塞性肺疾病急性发作合并呼吸衰竭的患者给予无创呼吸机治疗,对降低患者心率及呼吸频率水平有着积极的作用。