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Clinical Study on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure
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作者 Jianhua Yu 《Journal of Clinical and Nursing Research》 2024年第5期293-298,共6页
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 fai... 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. 展开更多
关键词 chronic obstructive pulmonary disease Respiratory failure Non-invasive positive pressure ventilation Therapeutic effect Inflammatory factor
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Impact of noninvasive positive pressure ventilation on the gene expression of ubiquitin system of skeletal muscle in patients with acute exacerbation of chronic obstructive pulmonary disease
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作者 Hui Wang Jingping Yang +1 位作者 Xiyuan Xu Tieying Tian 《Discussion of Clinical Cases》 2016年第4期1-5,共5页
Objective:To investigate the change and relativity of noninvasive positive pressure ventilation(NIPPV)on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstruc... Objective:To investigate the change and relativity of noninvasive positive pressure ventilation(NIPPV)on the gene expression of ubiquitin system of skeletal muscle in patient with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:80 patients with AECOPD were divided into two groups based on whether the NIPPV treatment was given or not,38 cases in the study group and 42 in the control group.The blood gas analysis and pulmonary function were monitored and recorded before and 14 days after treatment.A skeletal muscle biopsy was performed 14 days after therapy.The mRNA expression of ribosomal protein S21(RPS21)and ubiquitin in skeletal muscle cell were measured by RT-PCR.Results:After 14 days treatment,the levels of PaCO_(2),PaO_(2),PH and FEV_(1)% in the NIPPV group improved much better than in the control group(p<.05).The gene expression of RPS21 and ubiquitin was obviously lower in the study group than in the control group(p<.05).The level of RPS21 was negatively related with PaO_(2),PH and FEV1%,and the level of ubiquitin was negatively related with PaO_(2) and FEV1%,but positively correlated with PaCO_(2).The area under the ROC curves of RPS21,ubiquitin,PaCO_(2) and FEV_(1)% were 0.771,0.885,0.821 and 0.734 respectively in the study group.The cut-off points were 103.978,8.128,45.350 and 51.350 respectively.The sensitivity evaluation of acid poisoning was 90.9%,and the specificities for each were 75%,75%,50% and 50%.Conclusions:NIPPV is effective for AECOPD patients through the gene expression of ubiquitin system of skeletal muscle. 展开更多
关键词 noninvasive positive pressure ventilation Acute exacerbation of chronic obstructive pulmonary disease Skeletal muscle Gene expression
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Influence of Leakage from Non-Invasive Positive Pressure Ventilation Mask on FiO<sub>2</sub>Value Delivered by Home Oxygen Therapy Concentrator: A Bench Study on Simulating Patients with Chronic Obstructive Pulmonary Disease
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作者 Kazuto Doi Mitsuhiro Nishitani +3 位作者 Mayumi Doi Yukoh Yaegashi Masaru Ando Junichi Kadota 《Health》 2018年第7期919-927,共9页
Introduction: During the application of non-invasive positive pressure ventilation (NPPV) therapy in home mechanical ventilation (HMV), leaks in the NPPV mask may occur owing to the position of the mask due to conditi... Introduction: During the application of non-invasive positive pressure ventilation (NPPV) therapy in home mechanical ventilation (HMV), leaks in the NPPV mask may occur owing to the position of the mask due to conditions such as skin disorders. Methods: To investigate whether such a leak affects FiO2 supplied to the alveoli, we simulated a patient with chronic obstructive pulmonary disorder during NPPV in HMV. In addition, FiO2 was measured in the portion assumed to be the mouth and lungs while setting the flow of the oxygen concentrator and leak amount based on a previous study. Results: FiO2 supplied to the lungs increased statistically significantly upon increasing the amount of leak (P Conclusions: We observed that FiO2 supplied to alveoli can be reduced by a leak in the NPPV mask. Because our results differ from those previously reported, we believe that further studies should reassess the selection of respirators and oxygen concentrators. 展开更多
关键词 MASK Oxygen ventilation positive-pressure ventilation chronic obstructive pulmonary Disorder
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Helmet-based noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: A case report 被引量:4
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作者 Mi Hwa Park Min Jeong Kim +2 位作者 Ah Jin Kim Man-Jong Lee Jung-Soo Kim 《World Journal of Clinical Cases》 SCIE 2020年第10期1939-1943,共5页
BACKGROUND Noninvasive ventilation(NIV)reduces intubation rates,mortalities,and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).He... BACKGROUND Noninvasive ventilation(NIV)reduces intubation rates,mortalities,and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Helmet-based NIV is better tolerated than oronasal mask-based ventilation,and thus,allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks.CASE SUMMARY A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough,sputum,and dyspnea of several days’duration.For 10 mo,he had been on oxygen at home by day and had used an oronasal mask-based NIV at night.At intensive care unit admission,he breathed using respiratory accessory muscles.Hypercapnia and signs of infection were detected,and infiltration was observed in the right lower lung field by chest radiography.Thus,we diagnosed AECOPD by communityacquired pneumonia.After admission,respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary.However,the patient refused this option,and thus,we selected helmet-based NIV as a salvage treatment.After 3 d of helmet-based NIV,his consciousness level and hypercapnia recovered to his pre-hospitalization level.CONCLUSION Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective. 展开更多
关键词 Acute exacerbation of chronic obstructive pulmonary disease noninvasive ventilation HELMET Case report
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Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation 被引量:17
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作者 Rong-rong Song Yan-ping Qiu +1 位作者 Yong-ju Chen Yong Ji 《World Journal of Emergency Medicine》 CAS 2012年第1期29-34,共6页
BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmon... BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind. 展开更多
关键词 Acute exacerbations of chronic obstructive pulmonary disease Acute respiratory failure Mechanical ventilation Sequential weaning of invasive-noninvasive ventilation Fiberoptic bronchscopy Bronchoalveolar lavage pulmonary infection control window Side effect Success rate
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Clinical study of NFNC in the treatment of acute exacerbation chronic obstructive pulmonary disease patients with respiratory failure 被引量:1
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作者 Xiang Chen Ling Dai +6 位作者 Jin-Zhu Ma Xin-Xu Chu Liang Dai Jian-Ming Liu Si-Wei Guo Xin-Wei Ru Xue-Shi Zhuang 《World Journal of Clinical Cases》 SCIE 2023年第32期7770-7777,共8页
BACKGROUND Most patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)have respiratory failure that necessitates active correction and the improvement of oxygenation is particularly important d... BACKGROUND Most patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)have respiratory failure that necessitates active correction and the improvement of oxygenation is particularly important during treatment.High flow nasal cannula(HFNC)oxygen therapy is a non-invasive respiratory aid that is widely used in the clinic that improves oxygenation state,reduces dead space ventilation and breathing effort,protects the loss of cilia in the airways,and improves patient comfort.AIM To compare HFNC and non-invasive positive pressure ventilation in the treatment of patients with AECOPD.METHODS Eighty AECOPD patients were included in the study.The patients were in the intensive care department of our hospital from October 2019 to October 2021.The patients were divided into the control and treatment groups according to the different treatment methods with 40 patients in each group.Differences in patient comfort,blood gas analysis and infection indices were analyzed between the two groups.RESULTS After treatment,symptoms including nasal,throat and chest discomfort were significantly lower in the treatment group compared to the control group on the 3rd and 5th days(P<0.05).Before treatment,the PaO_(2),PaO_(2)/FiO_(2),PaCO_(2),and SaO_(2)in the two groups of patients were not significantly different(P>0.05).After treatment,the same indicators were significantly improved in both patient groups but had improved more in the treatment group compared to the control group(P<0.05).After treatment,the white blood cell count,and the levels of C-reactive protein and calcitonin in patients in the treatment group were significantly higher compared to patients in the control group(P<0.05).CONCLUSION HFNC treatment can improve the ventilation of AECOPD patients whilst also improving patient comfort,and reducing complications.HFNC is a clinically valuable technique for the treatment of AECOPD. 展开更多
关键词 Acute exacerbation chronic obstructive pulmonary disease HFNC noninvasive positive pressure ventilation Application value
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Effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure 被引量:1
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作者 You-Ming Zhu Hui Hu Ye Zeng 《Journal of Hainan Medical University》 2017年第3期44-48,共5页
Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and... Objective:T o analyze the effect of adjuvant noninvasive positive pressure ventilation on blood gas parameters, cardiac function and inflammatory state in patients with chronic obstructive pulmonary disease (COPD) and type II respiratory failure. Methods:90 patients with COPD and type II respiratory failure were randomly divided into observation group and control group (n=45). Control group received conventional therapy, observation group received conventional therapy+adjuvant noninvasive positive pressure ventilation, and differences in blood gas parameters, cardiac function, inflammatory state, etc., were compared between two groups of patients 2 weeks after treatment. Results:Arterial blood gas parameters pH and alveolar-arterial partial pressure of oxygen [P(A-a)O2] levels of observation group were higher than those of control group while, potassium ion (K+), chloride ion (Cl-) and carbon dioxide combining power (CO2CP) levels were lower than those of control group 2 weeks after treatment;echocardiography parameters Doppler-derived tricuspid lateral annular systolic velocity (DTIS) and pulmonary arterial velocity (PAV) levels were lower than those of control group (P<0.05) while pulmonary artery accelerating time (PAACT), left ventricular end-diastolic dimension (LVDd) and right atrioventricular tricuspid annular plane systolic excursion (TAPSE) levels were higher than those of control group (P<0.05);serum cardiac function indexes adiponectin (APN), Copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C (CysC), growth differentiation factor-15 (GDF-15) and heart type fatty acid binding protein (H-FABP) content were lower than those of control group (P<0.05);serum inflammatory factors hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-8, IL-10, and transforming growth factor-β1 (TGF-β1) content were lower than those of control group (P<0.05). Conclusions:Adjuvant noninvasive positive pressure ventilation can optimize the blood gas parameters, cardiac function and inflammatory state in patients with COPD and type II respiratory failure, and it is of positive significance in improving the overall treatment outcome. 展开更多
关键词 chronic obstructive pulmonary disease Type II RESPIRATORY failure noninvasive positive pressure ventilation Blood gas PARAMETERS
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The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues
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作者 Patrick O’Connell 《Open Journal of Respiratory Diseases》 2015年第2期50-54,共5页
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, chr... 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. 展开更多
关键词 Continuous positive AIRWAY pressure Non-Invasive ventilation Acute pulmonary EDEMA ASTHMA chronic obstructive pulmonary disease PREHOSPITAL Hospital
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Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study 被引量:30
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作者 ZHU Guang-fa ZHANG Wei ZONG Hua XU Qiu-fen LIANG Ying 《Chinese Medical Journal》 SCIE CAS CSCD 2007年第24期2204-2209,共6页
Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation (NPPV), increasing clinical reports showed it was effective in patie... Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation (NPPV), increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure, especially hypercapnic acute respiratory failure (HARF). To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy, a prospective case-control study was conducted at a university respiratory intensive care unit (RICU) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) during the past 3 years. Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups, which were carefully matched for age, sex, COPD course, tobacco use and previous hospitalization history, according to the severity of encephalopathy, 22 patients with Glasgow coma scale (GCS) 〈10 served as group A and 21 with GCS 〉10 as group B. Results Compared with group B, group A had a higher level of baseline arterial partial CO2 pressure ((102±27) mmHg vs (74±17) mmHg, P〈0.01), lower levels of GCS (7.5±1.9 vs 12.2±1.8, P〈0.01), arterial pH value (7.18±0.06 vs 7.28±0.07, P〈0.01) and partial 02 pressure/fraction of inspired 02 ratio (168±39 vs 189±33, P〈0.05). The NPPV success rate and hospital mortality were 73% (16/22) and 14% (3/22) respectively in group A, which were comparable to those in group B (68% (15/21) and 14% (3/21) respectively, all P〉0.05), but group A needed an average of 7 cmH20 higher of maximal pressure support during NPPV, and 4, 4 and 7 days longer of NPPV time, RICU stay and hospital stay respectively than group B (P〈0.05 or P〈0.01). NPPV therapy failed in 12 patients (6 in each group) because of excessive airway secretions (7 patients), hemodynamic instability (2), worsening of dyspnea and deterioration of gas exchange (2), and gastric content aspiration (1). Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD; a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD. 展开更多
关键词 acute respiratory failure HYPERCAPNIA ENCEPHALOPATHY chronic obstructive pulmonary disease noninvasive positive pressure ventilation
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Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis 被引量:21
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作者 SHI Jia-xin XU Jin SUN Wen-kui SU Xin ZHANG Yan SHI Yi 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第1期140-146,共7页
Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease (COPD). Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane... Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease (COPD). Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane trials databases were searched. Randomized controlled trials of patients with severe, stable COPD and receiving noninvasive positive pressure ventilation, compared with sham ventilation or no ventilation, were reviewed. The mortality, physiological and health related parameters were pooled to yield odds ratio (OR), weighted mean differences or standardized mean differences (SMD), with 95% confidence interval (CI). Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria. Pooled analysis for parallel, randomized controlled trials showed noninvasive positive pressure ventilation: (1) Did not affect the 12- or 24-month mortality (OR 0.82, 95% Ch 0.48 to 1.41); (2) Improved the arterial carbon dioxide tension (SMD -0.88, 95% Ch -1.43 to -0.34); (3) Did not improve forced expiratory volume in one second (SMD 0.20, 95% CI: -0.06 to 0.46), maximal inspiratory pressure (SMD 0.01, 95% Ch -0.28 to 0.29) or 6-minute walk distance (SMD 0.17, 95% Ch -0.16 to 0.50); (4) Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients. Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation. Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality, pulmonary function, or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease. 展开更多
关键词 chronic obstructive pulmonary disease META-ANALYSIS noninvasive positive pressure ventilation STABLE
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Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial 被引量:9
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作者 WANG Chen 《Chinese Medical Journal》 SCIE CAS CSCD 2005年第24期2034-2040,共7页
Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV... Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation· 展开更多
关键词 pulmonary disease chronic obstructive acute exacerbation respiratory muscle fatigue noninvasive positive pressure ventilation endotracheal intubation
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Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease: a meta-analysis 被引量:10
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作者 CHEN Hong LIANG Bin-miao XU Zhi-bo TANG Yong-jiang WANG Ke XIAO Jun YI Qun SUN Jian FENG Yu-lin 《Chinese Medical Journal》 SCIE CAS CSCD 2011年第23期4063-4070,共8页
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 ... 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. 展开更多
关键词 pulmonary disease chronic obstructive non-invasive positive pressure ventilation META-ANALYSIS
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Effects of extrinsic positive end-expiratory pressure on cardiopulmonary function in patients with chronic obstructive pulmonary disease
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作者 孔维民 王辰 +2 位作者 杨媛华 黄克武 姜超美 《Chinese Medical Journal》 SCIE CAS CSCD 2001年第9期16-19,103,共5页
Objective To choose one optimal extrinsic positive end-expiratory pressure (PEEPe) for ventilated patients with chronic obstructive pulmonary disease (COPD) and to compare two methods for choosing the optimal level o... Objective To choose one optimal extrinsic positive end-expiratory pressure (PEEPe) for ventilated patients with chronic obstructive pulmonary disease (COPD) and to compare two methods for choosing the optimal level of PEEPe.Methods Ten ventilated patients with COPD were included in the study. First, static intrinsic positive end-expiratory pressure (PEEPi,st) was measured when PEEPe was zero, and the PEEPi,st was called PEEPi,stz. PEEPe at 0%, 40%, 50%, 60%, 70%, 80%, 90% and 100% of PEEPi,stz, respectively, were applied randomly. Respiratory mechanics, hemodynamics, and oxygen dynamics were recorded 30 minutes after the level of PEEPe was changed.Results When PEEPe was not higher than 80% of PEEPi,stz, no measurement changed significantly. When PEEPe was increased to 90% and 100% of PEEPi,stz, PEEPi,st, peak inspiratory pressure, plateau pressure, pulmonary capillary wedge pressure and central venous pressure increased significantly, P<0.01. Cardiac output and left ventricular work index decreased significantly, P<0.01. Oxygen delivery decreased significantly, P<0.05. When PEEPe was increased to 100% of PEEPi,stz, the right ventricular work index decreased significantly, P<0.05.Conclusion Eighty percent of PEEPi,stz was the upper limit of PEEPe. The results of the two methods used to set the level of PEEPe were identical. 展开更多
关键词 obstructive pulmonary disease · mechanical ventilation · intrinsic positive end expiratory pressure · extrinsic positive end expiratory pressure
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无创通气间歇期经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重临床效果及对患者气管插管率、血气指标的影响 被引量:1
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作者 吕玉颖 曹志新 马玉平 《陕西医学杂志》 CAS 2024年第7期922-925,957,共5页
目的:分析无创通气(NIV)间歇期经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重(AECOPD)临床效果及对气管插管率、血气指标的影响。方法:回顾性收治的105例AECOPD患者资料,将患者分为对照组52例[接受无创通气(NIV)治疗与常规氧疗... 目的:分析无创通气(NIV)间歇期经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重(AECOPD)临床效果及对气管插管率、血气指标的影响。方法:回顾性收治的105例AECOPD患者资料,将患者分为对照组52例[接受无创通气(NIV)治疗与常规氧疗]和观察组53例(接受NIV联合HFNC治疗),比较两组患者临床指标、血气指标、治疗失败原因及不良反应。结果:观察组呼吸支持时间、NIV间歇歇息次数、NIV每日平均使用时间、ICU住院时间均短(小)于对照组(均P<0.05),两组气管插管率比较差异无统计学意义(P>0.05);治疗后两组动脉血氧分压(PaO_(2))比治疗前明显升高,动脉血二氧化碳分压(PaCO_(2))比治疗前明显降低(P<0.05),但两组治疗后PaO_(2)、PaCO_(2)水平比较差异无统计学意义(均P>0.05);观察组患者呼吸困难加重率、治疗不耐受率均低于对照组(均P<0.05),两组CO_(2)潴留加重率、低氧血症加重率比较差异无统计学意义(均P>0.05);观察组不良反应发生率显著低于对照组(P<0.05)。结论:NIV间歇期给予HFNC治疗AECOPD患者对气管插管率及血气指标的影响与常规氧疗差异不显著,但可改善患者其他临床指标,减少治疗失败情况及不良反应。 展开更多
关键词 慢性阻塞性肺疾病急性加重 无创通气间歇期 经鼻高流量湿化氧疗 气管插管 血气指标 不良反应
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经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期患者的应用价值 被引量:1
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作者 郭泳梅 黎艳聪 张道敏 《中华保健医学杂志》 2024年第2期169-172,共4页
目的探讨经鼻高流量湿化氧疗(HFNC)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的疗效及适用条件。方法回顾性分析中山市小榄人民医院呼吸内科2021年1月~2022年12月收治并好转出院的60例AECOPD患者的临床资料,所有患者均在抗感染、止咳... 目的探讨经鼻高流量湿化氧疗(HFNC)对慢性阻塞性肺疾病急性加重期(AECOPD)患者的疗效及适用条件。方法回顾性分析中山市小榄人民医院呼吸内科2021年1月~2022年12月收治并好转出院的60例AECOPD患者的临床资料,所有患者均在抗感染、止咳化痰、平喘等治疗的基础上,给予呼吸支持治疗。按照呼吸支持治疗方式不同分为HFNC组(30例)与无创正压通气(NPPV)组(30例)。比较两组患者生命体征(心率、呼吸)、血气分析[氧分压(PaO_(2))、氧合指数(PaO_(2)FiO_(2))]情况。根据年龄及PaO_(2)FiO_(2)分层,分析HFNC组患者血气分析指标的变化情况。结果治疗前,两组患者心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)组间比较,差异无统计学意义(P>0.05)。治疗后,两组患者心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)组间比较,差异无统计学意义(P>0.05);HFNC组治疗前后心率、PaO_(2)、PaO_(2)FiO_(2)比较[(85.47±13.21)次min vs.(97.67±22.62)次min、(95.92±27.33)mmHg vs.(80.3±19.02)mmHg、(321.23±78.73)mmHg vs.(278.40±67.21)mmHg],差异有统计学意义(P<0.05);NPPV组治疗前后心率、呼吸次数、PaO_(2)、PaO_(2)FiO_(2)比较[(90.33±12.02)次min vs.(105.70±22.03)次min、(20.67±0.76)次min vs.(24.93±2.45)次min、(91.54±34.81)mmHg vs.(70.86±24.03)mmHg、(311.03±113.14)mmHg vs.(240.53±86.28)mmHg],差异有统计学意义(P<0.05)。根据年龄及PaO_(2)FiO_(2)分层,与治疗前比较,HFNC组患者年龄≥71岁、PaO_(2)FiO_(2)在201~300 mmHg之间的患者治疗后PaO_(2)、PaO_(2)FiO_(2)明显上升,差异有统计学意义(P<0.05)。结论HFNC及NPPV均可改善AECOPD患者的氧合功能,效果相当,可作为NPPV的备选方案。HFNC尤其适用于年龄71岁及以上、PaO_(2)FiO_(2)在201~300 mmHg的人群。 展开更多
关键词 经鼻高流量湿化氧疗 慢性阻塞性肺疾病急性加重期 无创正压通气
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持续气道正压通气依从性对慢阻肺-阻塞性睡眠呼吸暂停重叠综合征患者肺功能和急性加重的影响
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作者 刘东利 王莉 +1 位作者 栾强强 折艳涛 《临床肺科杂志》 2024年第12期1793-1798,共6页
目的观察持续气道正压通气(CPAP)依从性对阻塞性睡眠呼吸暂停(OSA)和慢性阻塞性肺疾病(简称慢阻肺)重叠综合征(OS)患者肺功能和急性加重的影响。方法选取2021年2月至2023年2月的OS患者80例,向其宣教良好遵守CPAP和日常正确使用装置的说... 目的观察持续气道正压通气(CPAP)依从性对阻塞性睡眠呼吸暂停(OSA)和慢性阻塞性肺疾病(简称慢阻肺)重叠综合征(OS)患者肺功能和急性加重的影响。方法选取2021年2月至2023年2月的OS患者80例,向其宣教良好遵守CPAP和日常正确使用装置的说明,≥70%的夜晚平均每晚使用CPAP≥4h者40例定义为依从性良好,纳入观察组,其余40例纳入对照组。比较两组治疗前后肺功能、血气参数、慢阻肺相关症状和急性加重情况。结果中位CPAP治疗时间观察组为5.5(4.6,6.7)h/夜,对照组为0.6(0,3.3)h/夜。治疗后观察组PaO 2、FEV 1预测值%、FVC预测值%、TLC预测值%、6MWT均高于治疗前及对照组治疗后,PaCO 2和HCO-3、RV/TLC、CAT和mMRC均低于治疗前及对照组治疗后。观察组治疗后12个月内急性加重和加重入院次数较前降低,且低于对照组治疗后。CPAP使用时间与慢阻肺加重次数呈负相关(r=-0.259,P=0.047)。CPAP依从性差的患者比依从性好的患者更易发生慢阻肺急性加重(β=0.362,95%CI:0.075~0.649,P=0.015)。结论CPAP依从性好的OS患者治疗期间慢阻肺急性加重次数较前减少,肺功能和慢阻肺相关症状有所改善。 展开更多
关键词 慢性阻塞性肺疾病 持续气道正压通气 阻塞性睡眠呼吸暂停 重叠综合征 治疗依从性
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专职护理小组结合精细化护理在BiPAP呼吸机治疗慢阻肺急性加重期合并呼吸衰竭患者中的应用
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作者 华辉 王进静 夏彩霞 《包头医学院学报》 CAS 2024年第10期78-81,96,共5页
目的:分析专职护理小组结合精细化护理在无创正压通气(non-invasive positive pressure ventilation,NPPV)呼吸机治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭患... 目的:分析专职护理小组结合精细化护理在无创正压通气(non-invasive positive pressure ventilation,NPPV)呼吸机治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭患者中的应用价值。方法:选取江苏省东台市人民医院2021年4月至2022年4月BiPAP(bilevel positive airway pressure,BiPAP)呼吸机治疗的AECOPD合并呼吸衰竭患者82例,随机分为对照组(n=41)、观察组(n=41),对照组为常规护理,观察组为专职护理小组结合精细化护理,比较两组患者肺功能、血气指标及并发症发生率。结果:护理前,两组患者肺功能比较差异无统计学意义(P>0.05),护理后观察组更优(P<0.05);护理前,两组患者血气指标比较差异无统计学意义(P>0.05),护理后观察组较对照组更优(P<0.05),且观察组患者并发症发生率较对照组更低(P<0.05)。结论:对AECOPD合并呼吸衰竭患者,采用专职护理小组结合精细化护理可改善肺功能、血气指标,降低并发症发生率。 展开更多
关键词 专职护理小组 精细化护理 无创正压通气呼吸机 慢性阻塞性肺疾病
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经鼻高流量湿化治疗仪治疗慢阻肺急性加重期伴呼吸性酸中毒患者的效果
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作者 赵红侠 董伟 +2 位作者 杨美艳 庞宇 李凌维 《中外医学研究》 2024年第14期62-66,共5页
目的:分析经鼻高流量湿化治疗仪应用于慢阻肺急性加重期伴呼吸性酸中毒的治疗效果,探讨其对患者血气指标及肺功能的影响。方法:回顾性分析2022年1月—2023年10月在北京市昌平区医院呼吸与危重症学科治疗的100例慢阻肺急性加重伴呼吸性... 目的:分析经鼻高流量湿化治疗仪应用于慢阻肺急性加重期伴呼吸性酸中毒的治疗效果,探讨其对患者血气指标及肺功能的影响。方法:回顾性分析2022年1月—2023年10月在北京市昌平区医院呼吸与危重症学科治疗的100例慢阻肺急性加重伴呼吸性酸中毒患者的临床资料。根据治疗方式的不同分为两组,各50例。观察组接受经鼻高流量湿化氧疗,对照组接受无创正压通气治疗。比较两组的血气指标、肺功能指标、治疗效果及不良反应发生情况。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组血气指标、肺功能指标比较,差异无统计学意义(P>0.05);治疗后,两组pH值、氧分压(PaO_(2))、氧合指数(OI)均高于治疗前,二氧化碳分压(PaCO_(2))低于治疗前,且观察组pH值、PaO_(2)、OI高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。治疗后,两组第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气峰流速值(PEF)、第1秒用力呼气容积/用力肺活量(FEV_(1)/FVC%)均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:经鼻高流量湿化氧疗、无创正压通气治疗都是慢阻肺急性加重期伴呼吸性酸中毒辅助通气的有效方法,而经鼻高流量湿化氧疗可有效提高治疗效果,改善患者血气指标及肺功能,不良反应少,安全性更高。 展开更多
关键词 慢阻肺急性加重期伴呼吸性酸中毒 经鼻高流量湿化氧疗 无创正压通气 动脉血气指标 肺功能
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BAL与NPPV治疗COPD伴肺不张患者的效果
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作者 王戈 《中外医学研究》 2024年第28期57-61,共5页
目的:探讨纤支镜肺泡灌洗(BAL)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)伴肺不张患者的效果。方法:选取2020年2月—2023年2月浠水县中医院呼吸科收治的84例COPD伴肺不张患者。根据随机数表法将其分为治疗组和对照组,各42例。两... 目的:探讨纤支镜肺泡灌洗(BAL)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)伴肺不张患者的效果。方法:选取2020年2月—2023年2月浠水县中医院呼吸科收治的84例COPD伴肺不张患者。根据随机数表法将其分为治疗组和对照组,各42例。两组均给予常规药物治疗,治疗组采用BAL治疗,对照组采用NPPV治疗。比较两组治疗前后呼吸困难、肺功能指标、动脉血气指标、相关指标。结果:治疗后,两组改良的医学研究委员会呼吸困难量表(mMRC)评分降低,治疗组mMRC评分低于对照组,差异有统计学意义(P<0.05)。治疗后,两组用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值的百分比(FEV_(1)%pred)均升高,治疗组FVC、FEV_(1)、FEV_(1)%pred均高于对照组,差异有统计学意义(P<0.05)。治疗后,两组动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))均显著升高,动脉血二氧化碳分压(PaCO_(2))降低,治疗组SaO_(2)、PaO_(2)均高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。治疗后,两组可溶性触发受体表达的基因1(sTREM-1)和高迁移率族蛋白B1(HMGB1)水平均显著降低,治疗组sTREM-1、HMGB1水平均低于对照组,差异有统计学意义(P<0.05)。结论:BAL与NPPV治疗均能有效改善COPD伴肺不张患者的症状和肺功能,且BAL治疗的效果优于NPPV治疗。两种治疗方式均能降低COPD伴肺不张患者的sTREM-1、HMGB1水平,提示两种治疗方式均能减轻炎症反应,且BAL治疗的抗炎作用优于NPPV治疗。 展开更多
关键词 纤支镜肺泡灌洗 无创正压通气 慢性阻塞性肺疾病 肺不张 可溶性触发受体表达的基因 1 高迁移率族 蛋白 B1
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吴茱萸热罨包联合穴位贴敷治疗COPD无创通气患者腹胀的效果 被引量:1
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作者 陈慧红 谢湘梅 +3 位作者 刘琴 樊婕 闵琴 胡晓莹 《实用临床医学(江西)》 CAS 2024年第1期91-94,共4页
目的观察吴茱萸热罨包联合穴位贴敷治疗慢性阻塞性肺疾病(COPD)无创通气患者并发腹胀的效果。方法选取南昌大学第二附属医院呼吸与危重症医学科收治的60例COPD无创通气腹胀患者作为研究对象,按照随机数字表法将其分为观察组和对照组,每... 目的观察吴茱萸热罨包联合穴位贴敷治疗慢性阻塞性肺疾病(COPD)无创通气患者并发腹胀的效果。方法选取南昌大学第二附属医院呼吸与危重症医学科收治的60例COPD无创通气腹胀患者作为研究对象,按照随机数字表法将其分为观察组和对照组,每组30例。对照组予常规治疗及护理,观察组在对照组基础上加用吴茱萸热罨包联合穴位贴敷,2组均连续治疗3 d。比较2组患者治疗前后的肠鸣音次数、腹围及临床疗效。结果治疗后观察组每分钟肠鸣音次数多于对照组(P<0.05),腹围小于对照组(P<0.05),治疗总有效率高于对照组(P<0.05)。结论吴茱萸热罨包联合穴位贴敷治疗COPD无创通气患者并发腹胀,可促进患者肠道蠕动,改善腹胀状况。 展开更多
关键词 慢性阻塞性肺疾病 无创正压通气 腹胀 吴茱萸热罨 穴位贴敷
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