Clinical effect of BiPAP non-invasive ventilation on acute exacerbation of chronic obstructive pulmonary disease with acute left heart failure / 中国基层医药

ABSTRACT

Objective@#To observe the effect of BiPAP non-invasive assisted ventilation on acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with acute left heart failure.@*Methods@#From January 2017 to December 2018, 100 AECOPD patients with acute left heart failure admitted to the Central Hospital of Yiwu were randomly divided into observation group and control group according to random number table method, with 50 cases in each group.The control group received routine treatment such as oxygen inhalation, anti-infection, spasmolysis and asthma relief, phlegm resolving, diuresis and cardiotonic therapy.The observation group used BiPAP non-invasive auxiliary ventilation therapy on the basis of routine treatment.The basic vital signs[heart rate(HR), systolic blood pressure(SBP), respiratory rate(RR)] and blood gas analysis[partial pressure of arterial oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), oxygen saturation(SaO2), pH value] before treatment and 48h after treatment were compared between the two groups.The levels of N-terminal pro-brain natriuretic peptide were observed and compared before treatment and 24h, 48h after treatment.The therapeutic effect of the two groups was compared.@*Results@#The basic vital signs(HR, SBP, RR) and blood gas analysis (PaO2, PaCO2, SaO2, pH value) of the two groups were improved after treatment, and the improvement degrees of the observation group were better than those of the control group(control group HR t=12.352, P=0.000; RR t=7.872, P=0.000; SBP t=10.469, P=0.000; observation group HR t=20.032, P=0.000; RR t=12.319, P=0.000; SBP t=13.911, P=0.000; intergroup comparison after treatment HR t=6.711, P=0.000; RR t=3.742, P=0.000; SBP t=4.172, P=0.000; the control group pH t=13.115, P=0.000, SaO2 t=3.134, P=0.001; PaO2 t=3.812, P=0.000; PaCO2 t=5.335, P=0.000; the observation group pH t=24.980, P=0.000; SaO2 t=5.305, P=0.000; PaO2 t=7.357, P=0.000; PaCO2 t=10.172, P=0.000; intergroup comparison after treatment pH t=7.394, P=0.000; SaO2 t=2.851, P=0.002; PaO2 t=3.467, P=0.000; PaCO2 t=4.063, P=0.000). The N-terminal pro-brain natriuretic peptide in the observation group decreased significantly after 24 hours of treatment compared with the control group, but the difference was no statistically significant(t=0.996, P=0.161). The N-terminal pro-brain natriuretic peptide levels in the observation group were significantly lower than those in the control group at 48 and 72 hours after treatment(t=6.043, P=0.000; t=12.897, P=0.000). The effective rate in the observation group was 88.00%(44/50), which was higher than 72.00%(36/50) in the control group(χ2=4.000, P=0.046).@*Conclusion@#BiPAP noninvasive assisted ventilation can effectively relieve symptoms, lessen the work of respiratory muscles, reduce cardiac load, improve myocardial oxygen supply, improve cardiac function, improve patients' oxygenation, improve hypoxemia and hypercapnia, reduce mortality and improve prognosis of AECOPD patients complicated with acute left heart failure.