ABSTRACT
Objective:To investigate the effects of noninvasive positive pressure ventilation combined with positive expiratory pressure device on pulmonary function, inflammatory factors and short-term prognosis in older adult patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which provide objective evidence for clinical treatment and prognosis evaluation of this disease.Methods:Eighty-three older adult patients with AECOPD who received treatment in Taizhou Central Hospital, China between January 2016 and December 2018 were included in this study. They were randomly assigned to undergo either noninvasive positive pressure ventilation (control group, n = 38) or noninvasive positive pressure ventilation combined with positive expiratory pressure device (study group, n = 45) for 7 days. Pulmonary function, blood gas indexes, inflammatory factor levels and curative effect were compared between the two groups. Results:After treatment, partial pressure of oxygen (PaO 2) and oxygenation index (PaO 2/FiO 2) in each group were significantly increased, and partial pressure of carbon dioxide (PaCO 2) was significantly decreased, compared with before treatment (all P < 0.05). The degree of improvement in PaO 2, PaCO 2 and PaO 2/FiO 2 in the study group was greater than that in the control group ( t = 2.261, 6.854, 2.040, all P < 0.05). The ratio of forced expiratory volume in the first second (FEV 1) to forced vital capacity (FEV 1/FVC), the ratio of FEV1 to predicted value (FEV 1/Pre), and the maximum voluntary ventilation (MVV) per minute in each group were significantly increased compared with before treatment. After treatment, the degree of increase in FEV 1/FVC, FEV 1/Pre, and MVV in the study group was greater than that in the control group ( t = 2.442, 2.120, 2.944, all P < 0.05). After treatment, serum levels of inerleukin-8, tumor necrosis factor-α, and high-sensitivity C-reactive protein in each group were significantly decreased compared with before treatment (all P < 0.05). After treatment, the degree of decrease in serum levels of inerleukin-8, tumor necrosis factor-α, and high-sensitivity C-reactive protein in the study group was significantly greater than that in the control group ( t =7.978, 10.857, 8.543, all P < 0.05). Length of hospital stay, duration of antibiotic use, chronic obstructive pulmonary disease assessment test score and St. George's Respiratory Questionnaire score in the study group were (7.52 ± 1.38) days, (7.14 ± 1.38) days, (18.95 ± 4.76) points, (1.73 ± 4.21) points, respectively, which were significantly shorter/lower than those in the control group [(8.55 ± 1.47) days, (8.25 ± 1.45) days, (8.07 ± 5.81) points, (55.97 ± 5.28) points, t = -2.510, -2.722, -7.943, -10.351, all P < 0.05]. Conclusion:Noninvasive positive pressure ventilation combined with positive expiratory pressure device can effectively improve the pulmonary function of older adult patients with AECOPD, decrease the level of inflammatory factors, and improve short-term prognosis. This study is highly innovative and scientific and is of significance for clinical promotion.