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.

Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia

Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.

Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pregnant Patient: A Case Series

Rationale: Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. Currently, there are no guidelines for the management of respiratory failure in pregnancy. Objectives: To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. Methods: We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the paO2/FiO2 ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. Measurements and Main Results: Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 305/7 ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the paO2/FiO2 ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and paO2/FiO2 ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in pa/FiO2 ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. Conclusion: The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease： a meta-analysis

Background The evidence for non-invasive positive pressure ventilation （NIPPV） used in patients with severe stable chronic obstructive pulmonary disease （COPD） is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life （HRQL）, survival and mortality in severe stable COPD patients. Methods Randomized controlled trials （RCTs） and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated. Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference （WMD） for the partial pressure of carbon dioxide in artery （PaCO2） was -3.52 （-5.26, -1.77） mmHg and for the partial pressure of oxygen in artery （PaO2） 2.84 （0.23, 5.44） mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference （SMD） for the forced expiratory volume in 1 second （FEV1） was 0.00 （0.29, 0.29）. And the benefits for exercise tolerance, mood, survival and mortality remained unclear. Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

Need for oxygen therapy and ventilatory support in premature infants in a hospital in Southern Brazil

BACKGROUND Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term.A preterm infant(PI)is classified when gestational age(GA)<37 wk.AIM To analyze prognostic indicators related to the use of oxygen therapy,noninvasive ventilation(continuous positive airway pressure)and mechanical ventilation(MV)in PI.METHODS This is a retrospective cohort.The sample was composed of PIs from a private hospital in southern Brazil.We included neonates with GA<37 wk of gestation in the period of January 1,2018 to December 31,2018.For data collection,electronic records were used in the Tasy Philips^(TM)system,identifying the variables:maternal age,type of birth,prenatal information,GA,Apgar score,birth weight,neonatal morbidities,vital signs in the 1st hour at birth,need for oxygen therapy,continuous positive airway pressure and MV,hospitalization in the neonatal intensive care unit,length of stay and discharge or death.RESULTS In total,90 PI records were analyzed.The median(p25-p75)of GA was 34.0(31.9-35.4)wk,and there were 45(50%)males.The most common morbidity among PIs was the acute respiratory discomfort syndrome,requiring hospitalization in the neonatal intensive care unit in 76(84.4%)cases.The utilization rate of oxygen therapy,continuous positive airway pressure and MV was 12(13.3%),37(41.1%)and 13(14.4%),respectively.The median(p25-p75)length of stay was 12.0(5.0-22.2)d,with 10(11.1%)deaths.A statistical association was observed with the use of MV and GA<28 wk,lower maternal age,low birth weight,Apgar<8 and neonatal deaths.CONCLUSION The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.

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.

家庭无创机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效观察

目的评估长期家庭无创正压机械通气治疗稳定期慢性阻塞性肺疾病(COPD)患者的疗效。方法将42例经住院治疗后处于重度COPD合并Ⅱ型呼吸衰竭稳定期患者分为长期家庭无创正压机械通气(HNIPPV)+常规治疗组(观察组22例)和常规治疗组(对照组20例)。随访治疗1年后,比较两组患者的动脉血气、肺功能、6min步行距离(6MWD)、呼吸困难评分、焦虑评分、1年内病情恶化住院次数等6项指标。结果治疗1年后,观察组动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、6MWD、呼吸困难评分、焦虑评分、1年内病情恶化住院次数均改善,观察组较对照组改善明显,差异有统计学意义(P<0.05)。两组患者治疗1年后肺功能指标[用力肺活量(FVC)及一秒用力呼气容积(FEV1)]均有所下降,但组间比较差异无统计学意义(P>0.05),两组患者治疗1年期间无死亡病例或其他原因退出病例。结论 HNIPPV治疗可以改善重度COPD患者呼吸衰竭,减少急性加重次数,改善血气指标,提高生活质量,对于重度稳定期COPD合并高碳酸血症患者是一种有效的治疗手段。

布地奈德福莫特罗、噻托溴铵、家庭无创正压通气对慢性阻塞性肺疾病患者影响的研究

目的比较布地奈德福莫特罗、噻托溴铵以及布地奈德福莫特罗联合家庭无创正压通气对稳定期慢性阻塞性肺疾病患者的影响。方法选取2015年1月至2017年1月我院收治的42例气流受限程度为中度及以上的慢性阻塞性肺疾病患者,经治疗进入疾病稳定期后将患者按照数字分配原则随机分为A、B、C组,各14例。A组给予布地奈德福莫特罗干粉(每日2次,每次320/9微克)联合噻托溴铵粉(每日1次,每次18微克)吸入治疗,B组给予噻托溴铵粉吸入治疗(每日1次,每次18微克),C组在A组的基础上联合家庭无创正压通气治疗。随访1年,比较上述3组患者慢性阻塞性肺疾病评估测试(CAT)呼吸问卷评分、血气分析指标、慢性阻塞性肺病急性加重并住院治疗次数、住院时间、随访期间住院治疗费用、死亡率。结果治疗前3组患者CAT评分、PO_2、PCO_2差异无统计学意义(P>0.05),治疗1年后3组患者CAT评分、PO_2、PCO_2均较治疗前改善,差异有统计学意义(P<0.05),C组CAT评分、PO_2、PCO_2、疾病急性加重并住院治疗次数、住院时间、随访期间住院治疗费用较其余两组改善明显,差异有统计学意义(P<0.05),A组与B组组间比较差异无统计学意义(P>0.05);随访期间A、B、C组各死亡1例,3组患者死亡率比较差异无统计学意义(P>0.05)。结论长效支气管舒张药物配合正规吸入技术可有效改善患者症状及血气指标,家庭无创正压通气可进一步降低疾病急性加重并住院治疗次数以及住院花费,提高患者生活质量,降低医疗成本。

家庭无创机械通气对重度慢性阻塞性肺疾病合并高碳酸血症患者的疗效观察及其对凝血功能的影响

目的探讨长期家庭无创正压机械通气(HNIPPV)在稳定期重度慢性阻塞性肺疾病(COPD)伴持续性高碳酸血症患者中的疗效及其对凝血功能的影响。方法将86例经住院治疗处于稳定期的重度COPD患者[动脉血二氧化碳分压(PaCO2)≥55 mmHg]分为常规治疗+HNIPPV组(研究组)46例和常规治疗组(对照组)40例。分别记录观察前(治疗前)、观察1年后的呼吸困难分级评分、肺功能、动脉血气分析、6分钟行走距离(6 MWD)、每年住院次数、血浆纤维蛋白原及D二聚体等指标。结果治疗一年后,研究组动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、6 MWD、呼吸困难评分、1年内病情恶化住院次数均有所改善,血浆纤维蛋白原及D二聚体降低,研究组较对照组改善明显,差异有统计学意义(P<0.05)。两组患者治疗一年后肺功能指标[用力肺活量(FVC)及一秒用力呼气容积(FEV1)]均有所下降,研究组下降幅度小于对照组,组间比较差异有统计学意义(P<0.05)。结论 HNIPPV治疗可以改善重度COPD患者血气指标,减少急性加重次数,减缓肺功能下降的速度,提高运动耐量,改善患者的血液高凝状态,对于稳定期重度慢阻肺合并高碳酸血症患者是一种有效的治疗方法。

家庭无创正压机械通气联合呼吸操锻炼用于稳定期慢性阻塞性肺疾病患者的效果评估

目的探讨家庭无创正压机械通气联合呼吸操锻炼用于稳定期慢性阻塞性肺疾病(COPD)患者的效果。方法选取2019年1月~2020年6月浙江省丽水市人民医院康复医学科门诊就诊的稳定期COPD患者76例,随机分为两组,每组各38例。对照组予家族无创双水平正压呼吸机治疗,观察组在对照组基础上加呼吸操锻炼,两组治疗16周。观察两组治疗前后氧代谢指标及血清炎性指标的变化,并比较临床效果。结果治疗16周后,两组的VO_(2)和ERO_(2)显著下降,SvO_(2)显著上升(P<0.05或P<0.01),且观察组下降或上升幅度更显著(均P<0.05);两组血清hs-CRP水平和PCT水平显著下降(P<0.05或P<0.01),且观察组下降幅度更显著(均P<0.05);观察组临床总有效率(94.74%)高于对照组(78.95%)(P<0.05)。结论家庭无创正压机械通气联合呼吸操锻炼用于稳定期COPD患者的效果确切,不仅可提升机体氧代谢功能,而且可控制气道炎症反应。

Efficacy of high-flow nasal cannula on acute exacerbation of chronic obstructive pulmonary disease: A meta-analysis

Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on PubMed,Web of Science,the Cochrane Library,Embase,CBM(Chinese Biomedicine Database),CNKI(China National Knowledge Infrastructure),Wanfang Database and VIP were performed for randomized controlled trials(RCTs)which explored the effects of HFNC on patients with AECOPD.The retrieval time was from the establishment of each database to July 2019.RevMan5.3 software was used for statistical analysis.Results:A total of 12 articles were included,involving 812 patients.The results showed that:(1)Compared with conventional oxygen therapy,HFNC could improve patients'arterial partial oxygen pressure(PaO2)(MD=12.70,95%CI(7.00,18.40),Z=4.37,P<0.0001),reduce partial arterial blood carbon dioxide(PaCO2)(MD=-10.99,95%CI(-14.42,-7.55),Z=6.26,P<0.00001)and reduce endotracheal intubation rate(OR=0.19,95%CI(0.04,0.93),Z=2.05,P=0.04),shorten the hospitalization time(SMD=-0.74,95%CI(-1.11,-0.37),Z=3.95,P<0.0001).(2)Compared with non-invasive positive pressure ventilation,it has fewer adverse reactions(OR=0.18,95%CI(0.09,0.35),Z=5.08,P<0.00001)and shorter hospital stay(SMD=-0.57,95%CI(-0.90,-0.23),Z=3.33,P=0.0009).Conclusion:HFNC can improve the patients’hypoxia symptoms and CO2 retention,reduce the rate of tracheal intubation,and alleviate adverse reactions.However,Limited by the quality and region of the included studies,more high-quality are needed to test it.

居家无创正压通气COPD病人延续康复护理方案的构建及应用研究

目的:德尔菲法构建居家无创正压通气慢性阻塞性肺疾病(COPD)病人延续康复护理方案,探究其应用效果。方法:通过文献检索筛选居家无创正压通气COPD病人延续康复护理初级条目池,遴选函询专家,经德尔菲法专家函询对指标进行评价,结合重要性评分、评价意见对指标进行筛选、修订,据此制定居家无创正压通气COPD病人延续康复护理方案;选择医院2020年4月—2021年8月收治的居家无创正压通气COPD病人100例,按随机数字表法分为两组,对照组采取常规延续护理,观察组在对照组基础上应用居家无创正压通气COPD病人延续康复护理方案,比较两组病人自我管理能力及康复生活质量。结果:研究第1轮、第2轮函询专家权威度系数分别为0.890,0.892,第1轮、第2轮函询问卷回收率分别为93.75%、100.00%,第1轮、第2轮函询意见协调度分别为0.428(χ~2=84.439,P=0.001)、0.431(χ~2=95.284,P=0.001);经两轮专家函询筛选得到一级指标4个,二级指标15个,三级指标39个,从护理评估、实施周期/路径、护理项目、效果评价入手设计居家无创正压通气COPD病人延续康复护理方案,涉及健康宣教、用药指导、肺功能锻炼、症状管理、家庭氧疗指导、心理疏导、营养支持多方面;观察组病人自我管理能力测定量表(ESCA)4个维度评分均高于对照组(P<0.05),观察组病人圣乔治呼吸问卷(SGRQ)3个分问卷评分均低于对照组(P<0.05)。结论:德尔菲法构建居家无创正压通气COPD病人延续康复护理方案科学性与可靠性强,其在居家无创正压通气COPD病人中的应用能提升其自我管理能力,有助于改善生活质量。

家庭无创正压机械通气对稳定期重度慢性阻塞性肺疾病患者的疗效和安全性观察

目的探索与评估家庭无创正压机械通气(HNPPV)长期治疗重度慢性阻塞性肺疾病(COPD)稳定期患者的疗效和安全性。方法将40例经住院治疗处于稳定期的重度 COPD 患者[动脉血二氧化碳分压(PaCO_2)≥55 mm Hg(1 mm Hg=0.133 kPa)]分为常规治疗+HNPPV 组(治疗组)20例和常规治疗组(对照组)20例。分别记录观察前(治疗前)、观察2年后的呼吸困难分级评分、辅助呼吸肌评分、心理情绪评分、肺功能、动脉血气、6分钟行走距离(6MWD);采用超声心动图测定肺动脉平均压(mPAP)、病死率及每年住院次数等指标。结果治疗组与对照组的年龄、性别、身高、体重、呼吸困难分级评分、辅助呼吸肌评分、焦虑评分、抑郁评分、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、用力肺活量(FVC)、第一秒用力呼气容积(FEV_1)、6MWD、mPAP、每年住院次数均具有可比性(t 值分别为1.08、1.15、1.20、1.09、0.86、0.54、0.00、0.00、0.43、0.96、0.76、0.38、0.26、0.24、0.87,P 均>0.05)。2年后治疗组死亡3例(3/20),对照组死亡8例(8/20),两组比较差异无统计学意义(X^2=3.27,P>0.05)。2年后治疗组呼吸困难分级评分、辅助呼吸肌评分、焦虑评分、抑郁评分、PaCO_2、PaO_2、6MWD、mPAP、每年住院次数分别为(2.4±0.5)分、(2.6±0.6)分、(6.9±2.1)分、(6.1±1.6)分、(49.5±2.2)mm Hg、(60.8±4.7)mm Hg、(213±45)m、(30.3±2.2)mm Hg、(1.4±0.4)次/年,与对照组[(3.9±0.3)分、(4.8±0.4)分、(11.2±2.6)分、(11.6±2.1)分、(61.5±2.3)mm Hg、(52.8±2.4)mm Hg、(127±23)m、(36.4±2.3)mm Hg、(3.9±0.3)次/年]比较差异均有统计学意义(t 值分别为9.53、10.83、4.92、7.83、14.07、5.41、6.07、4.81、10.22,P 均<0.01)。结论长期家庭无创正压机械通气对有选择性稳定期重度 COPD 患者疗效较为肯定。

慢性阻塞性肺疾病并呼吸衰竭患者的家庭机械通气治疗现状调查

目的了解北京市通州区慢性阻塞性肺疾病(简称慢阻肺)伴呼吸衰竭患者家庭机械通气(HMV)的治疗效果。方法纳入北京市通州区家庭拥有双水平无创呼吸机和制氧机进行HMV治疗的慢阻肺并呼吸衰竭患者共20例,其中4例在随访期间去世,1例失访,共15例完成随访。在随访开始和1年结束时收集患者一般资料,测定实际体重等营养状况,测试慢阻肺评估、Borg呼吸困难和呼吸疲劳评分、Hamilton抑郁量表评分和Hamilton焦虑量表评分,行动脉血气分析。随访期间每月进行1次电话随访。结果与随访开始时比较,在1年随访结束时实际体重等营养状况指标、慢阻肺评估测试、Borg呼吸困难和呼吸疲劳评分、Hamilton抑郁量表评分和Hamilton焦虑量表评分以及p H和Pa O2无显著差别(P>0.05),Pa CO2显著降低(P<0.05)。随访年度同随访前1年比较,患者因慢阻肺急性加重的住院次数显著减少(P<0.05)。结论 HMV治疗和对HMV患者进行随访管理可显著降低慢阻肺并呼吸衰竭患者的二氧化碳水平,减少患者因慢阻肺急性加重导致的住院次数。

我国家庭无创呼吸机研究的文献计量学分析

目的系统分析我国家庭无创呼吸机相关研究的发展现状，为今后的研究提供参考。方法检索中国生物医学文献数据库、中国期刊全文数据库、万方数据库以及维普数据库进行检索，并采用文献计量学方法对我国家庭无创呼吸机相关研究的文献进行统计和分析。结果纳入的214篇文献分布于135种期刊上，文献发表数量呈明显的上升趋势；文献来自28个省市地区，发文量最多的地区为河南、北京、广东等地；文献以实验性研究为主（39．72％），研究内容集中在呼吸机对患者疾病的疗效方面（47．67％）。研究的平均干预时间为12．33个月，平均随访时间间隔为6．33周。结论为家庭无创呼吸机带机患者提供科学有效的长期医疗服务支持、优化家庭无创通气的管理流程并制订科学系统的家庭无创呼吸机临床规范，应是未来家庭无创呼吸机相关研究应重视的研究方向。

家庭无创正压通气治疗矽肺合并Ⅱ型呼吸衰竭临床研究

目的探究矽肺合并Ⅱ型呼吸衰竭患者采用基础治疗联合家庭无创正压通气(NPPV)治疗的效果。方法入组85例矽肺合并Ⅱ型呼吸衰竭患者,回顾分析其临床资料,根据其治疗方法分为无创通气治疗组(A组)和基础治疗组(B组)。分析两组患者治疗前后各类指标,包括生命体征、实验室指标、6分钟步行距离(6MWD)、改良呼吸困难指数(mMRC),记录随访1年中两组患者住院频次、住院天数、年死亡率等。结果随访1年结束后,A组患者的心率(HR)、呼吸频率(RR)、血氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2%)、6MWD、mMRC较B组有显著改善,其差异具有统计学意义(P<0.05);住院频次、住院天数均低于B组,其差异具有统计学意义(P<0.05);但两组间年死亡率差异无统计学意义(P>0.05)。结论家庭NPPV治疗矽肺合并Ⅱ型呼吸衰竭效果显著,表现为临床症状改善、生活质量提升、减少住院频次、缩减住院时间、降低医保负担。

家庭无创正压机械通气在慢性阻塞性肺疾病中的应用及进展

家庭无创正压机械通气（DNPPV）是指通过鼻罩或口鼻罩等将患者与呼吸机相连，在家庭环境中对其实施正压辅助通气。DNPPV在稳定期慢性阻塞性肺疾病患者中已得到越来越广泛的运用。综述从DNPPV的开展情况、安全性、长期并发症、注意事项等方面对其进行讨论。旨在提高临床和社区医师与护理人员认识DNPPV水平，促进患者及家属更有效实施DNPPV。

慢性阻塞性肺疾病的家庭无创通气治疗

家庭无创通气(HMV)通常采用无创正压通气(NPPV),已经明确HMV治疗神经肌肉障碍性疾病,胸廓畸形和睡眠呼吸障碍性疾病导致的呼吸衰竭可以延长生命,缓解症状和改善生活质量。HMV治疗慢性阻塞性肺疾病(COPD)的结论不尽一致,HMV治疗重度COPD患者可缓解呼吸困难,多数研究表明HMV可改善生活质量,减少COPD急性加重。近期的研究表明,HMV时采用较高吸气压力支持水平治疗伴二氧化碳潴留的稳定期COPD患者,可以改善气体交换,肺功能和呼吸困难,减少COPD急性加重,而且具有较好的治疗依从性。