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Objective:To explore the predictive value of HACOR score [heart rate (H), acidosis (A), consciousness (C), oxygenation (O), and respiratory rate (R)] on the clinical outcome of non-invasive positive pressure ventilation in patients with pulmonary encephalopathy due to chronic obstructive pulmonary disease (COPD).Methods:A prospective study was conducted. The patients with COPD combined with pulmonary encephalopathy who were admitted to Henan Provincial People's Hospital from January 1, 2017 to June 1, 2021 and initially received non-invasive positive pressure ventilation were enrolled. Besides non-invasive positive pressure ventilation, standard medical treatments were delivered to these patients according to guidelines. The need for endotracheal intubation was judged as failure of non-invasive ventilation treatment. Early failure was defined as the need for endotracheal intubation within 48 hours of treatment, and late failure was defined as the need for endotracheal intubation 48 hours and later. The HACOR score at different time points after non-invasive ventilation, the length of intensive care unit (ICU) stay, the total length of hospital stay, and the clinical outcome were recorded. The above indexes of patients with non-invasive ventilation were compared between successful and failed groups. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive effect of HACOR score on the failure of non-invasive positive pressure ventilation in the treatment of COPD with pulmonary encephalopathy.Results:A total of 630 patients were evaluated, and 51 patients were enrolled, including 42 males (82.35%) and 9 females (17.65%), with a median age of 70.0 (62.0, 78.0) years old. Among the 51 patients, 36 patients (70.59%) were successfully treated with non-invasive ventilation and discharged from the hospital eventually, and 15 patients (29.41%) failed and switched to invasive ventilation, of which 10 patients (19.61%) were defined early failure, 5 patients (9.80%) were late failure. The length of ICU and the total length of hospital stay of the non-invasive ventilation successful group were significantly longer than those of the non-invasive ventilation failure group [length of ICU stay (days): 13.0 (10.0, 16.0) vs. 5.0 (3.0, 8.0), total length of hospital stay (days): 23.0 (12.0, 28.0) vs. 12.0 (9.0, 15.0), both P < 0.01]. The HACOR score of patients at 1-2 hours in the non-invasive ventilation failure group was significantly higher than that in the successful group [10.47 (6.00, 16.00) vs. 6.00 (3.25, 8.00), P < 0.05]. However, there was no significant difference in HACOR score before non-invasive ventilation and at 3-6 hours between the two groups. The ROC curve showed that the area under the ROC curve (AUC) of 1-2 hour HACOR score after non-invasive ventilation for predicting non-invasive ventilation failure in COPD patients with pulmonary encephalopathy was 0.686, and the 95% confidence interval (95% CI) was 0.504-0.868. When the best cut-off value was 10.50, the sensitivity was 60.03%, the specificity was 86.10%, positive predictive value was 91.23%, and negative predictive value was 47.21%. Conclusions:Non-invasive positive pressure ventilation could prevent 70.59% of COPD patients with pulmonary encephalopathy from intubation. HACOR score was valuable to predict non-invasive positive pressure ventilation failure in pulmonary encephalopathy patients due to COPD.
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OBJECTIVE@#To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound.@*METHODS@#A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO@*RESULTS@#On day 3, 7 and 10 of treatment, PaO@*CONCLUSION@#Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.
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Humanos , Pontos de Acupuntura , Terapia por Acupuntura , Diafragma , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapiaRESUMO
Objective To investigate the clinical efficacy and prognosis of lung transplantation in the treatment of cystic fibrosis (CF). Methods Clinical data of one patient with end-stage CF undergoing allogeneic bilateral lung transplantation were retrospectively analyzed. Clinical characteristics, diagnostic methods and treatment strategies of the CF recipient were summarized. Results The recipient had suffered from relevant symptoms since childhood including repeated cough and purulent sputum for 30 years, complicated with recurrent pulmonary infection combined with acute exacerbation, chronic sinusitis and extremely severe malnutrition. Prior to lung transplantation, the patient had to depend upon the invasive ventilator due to respiratory muscle weakness, and admitted to intensive care unit (ICU) for a long time. Imaging examination revealed multiple cystic columnar bronchiectasis accompanied with infection in bilateral lungs. The diagnosis of CF was further confirmed by sweat test and gene detection. The recipient underwent bilateral lung transplantation on August 17, 2017 and received rehabilitation treatment. The lung function was gradually restored to normal. The recipient had obtained the same quality of life to the healthy counterparts since the date of manuscript submission (over 2 years). Conclusions Lung transplantation is an efficacious treatment for end-stage CF, which can not only save patients' lives, but also significantly improve the quality of life of patients.
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Objective To analyze the effect of adaptive ventilation mode ventilation on respiratory,blood gas and inflammatory response in COPD patients with type Ⅱ respiratory failure.Methods 90 COPD patients with type Ⅱ respiratory failure who were treated in our hospital from January 2015 to December 2016 were selected as the subjects.The patients were divided into observation group and control group according to the random number table method,45 cases in each group.The patients in the observation group were treated with adaptive ventilation mode,and the control group was treated with synchronous and intermittent arterial ventilation combined with pressure-supported ventilation mode for mechanical ventilation.The use of ventilator,respiratory parameters,blood gas and inflammatory response were observed in both two groups.Results The respiration rate and ventilation time[(14.21 ±0.72)times/min,(13.97 ± 3.61) d] in the observation group were lower than those in the control group [(16.85 ± 0.94) times/rin,(16.24 ±3.96)d],the tidal volume[(612.58 ± 49.47)mL] in the observation group was higher than that in the control group [(526.35 ± 30.29) mL],the differences were statistically significant (t =14.956 7,2.841 8,9.972 1,all P ＜ 0.05).The airway peak pressure,airway platform pressure and mean airway pressure of the observation group [(20.64 ± 1.71) cmH2 O,(17.96 ± 2.62) cmH2O,(9.27 ± 0.62) cmH2 O] were lower than those in the control group [(23.73 ± 1.65) cmH2 O,(21.47 ± 2.81) cmH2O,(9.98 ± 0.53) cmH2 O],the differences were statisticallysignificant (t =8.723 1,6.128 6,5.839 2,all P ＜ 0.05).There were no significant differences in the levels of arterial blood gas (pH),PaO2,PaCO2,P (A-a)O2 and SpO2 between the observation group and the control group (all P ＞0.05).The levels of CRP,α1-AGP,PCT,IL-6 and TNF-α in the observation group were (90.71 ± 29.68) rg/L,(1.26 ± 0.52) g/L,(2.27 ± 1.03) pg/L,(115.79 ± 24.54) mg/L,(45.65 ± 4.39) mg/L,which were lower than those in the control group[(123.54 ± 40.62) mg/L,(3.73 ± 1.12) g/L,(6.49 ± 1.36) pg/L,(127.43 ±28.91) mg/L,(53.78 ± 5.65) mg/L],the differences were statistically significant (t =4.377 6,13.418 3,16.593 4,2.059 1,7.622 3,all P ＜ 0.05).Conclusion Adoptive ventilation mode can improve the ventilation status of COPD patients with type Ⅱ respiratory failure,promote the recovery of spontaneous respiration,reduce the ventilation time and reduce the inflammatory response.It is suggested to be widely used in clinical practice.
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Objective to observe the effect of lung and spleen mixture on lung spleen deficiency AECOPD with Ⅱ respiratory failure of TCM symptoms integral,nutrition,blood gas and related indicators.Methods in accordance with AECOPD with Ⅱ type of respiratory failure need to use the noninvasive or have a respirator assisted ventilation,and conform to the type of TCM for patients with spleen-deficiency type,40 cases were divided into two groups,control group to the conventional western medicine therapy and Chinese medicine group on the basis of western medicine treatment for reasons of Yifeijianpi mixture,oral or tube feeding,a week for a period of treatment,observation of patients before and after treatment of TCM symptoms and physical signs integral,APACHE Ⅱ score,serum albumin,pre-albumin,neutrophil percentage,CRP and blood gas analysis and related indicators was conducted.Results The results show that the TCM group can improve the patients' TCM symptoms and physical signs integral,there was significant difference between the two groups after treatment (P＜ 0.05);compare the serum albumin,pre-albumin,transferrin,neutrophil percentage,CRP and arterial blood gas between two groups of patients after treatment,Chinese medicine group is superior to the control group,with statistical significance (P＜ 0.05);And compared with control group,the APACHE Ⅱ improvement situation of Chinese medicine group were superior to control group after the treatment after a week,with statistical significance (P＜ 0.05).Conclusion on the basis of using conventional western medicine treatment,treatment based on the theory of ridging raw gold formulae of Yifeijianpi mixture has good effect in the treatment of AECOPD combined type Ⅱ respiratory failure,and can improve the nutritional status of patients and the indicators of arterial blood gas analysis.
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Objective:To investigate the efficacy of non-invasive ventilation in chronic obstructive pulmonary disease (COPD) with type Ⅱrespiratory failure. Methods: Ninety two cases with COPD patients with typeⅡrespiratory failure were randomly divided into observation group and control group. Basic treatment was given. While non-invasive ventilation was given to observation group and nasal catheter oxygen was given to control group. Results:The total effective rate of observation group was higher than control group(x2=18.90, P<0.01);the improvement of pH, PaCO2, PaO2, RR, HR and SaO2 in observation group was better(t=6.43, t=-5.23, t=4.38, t=6.28, t=-8.53, t=9.31;P<0.05). Conclusion:Treatment of non-invasive ventilation combined with basic therapy in COPD patients with typeⅡrespiratory failure can significantly alleviate their condition and improve prognosis.
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Objective To assess the effect of non-invasive positive pressure ventilation (NIPPV) in trea-ting acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure. Methods Sixty-two AECOPD patients complicated with type Ⅱ respiratory failure was randomly divided into two groups: treated group of 30 patients and control group of 32 patients. The control group was treated with reg-ular medicine, the treated group were treated with NIPPV additional to regular medicine. The pH value, PaO_2, PaCO_2 and lactic acid level in blood gas were measured before and after treatment. Results The level of PH, PaO_2, PaCO_2 and lactic acid at 24 hours after treatment in the treated groups were 7.36 (SD:0.05), 84.0 (SD :8.9) ,57.0 (SD:7.9) and 1.63 (SD:1.15) respectively, which were significantly different to those of the control group (7.34 [SD:0.03] ,53.0[SD:12.4] ,62.0[SD:9.4] and 2.54[SD:1.28] ,respectively) (P <0.05). Conclusinons NIPPV is effective in treating patients with AECOPD and type Ⅱ respiratory failture.
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Objective To investigate the effects of two weaning modes of mandatory rate ventilation (MRV) and SIMV+PSV on respiratory mechanics in patients with type Ⅱ respiratory failure. Methods A total of 30 patients with type Ⅱ respiratory failure were sem randomly divided into two groups. Patients with type Ⅱ respiratory failure received ventilation in CMV mode or CMV/ACMV modes and then SIMV+PSV. When patients could be weaned, MRV mode was adopted in MRV group, but SIMV+PSV modes were adopted in the control group. After continuous operation in each mode for 60 min and when the tidal volume (VT) and minute ventilation (MV) in MRV mode were the same as those in SIMV+PSV mode, PIP, PP, Pm, PEEPi, blood gas changes, and weaning success in the two groups were observed during ventilation. Results PIP, PP, and Pm in patients in MRV mode were significantly lower than those in SIMV+PSV modes ( P 0.05), but the synchronism in patients in MRV group was better. Conclusion MRV is a more adaptable weaning mode for patients with type Ⅱ respiratory failure.