COPD合并肺性脑病患者应用无创正压通气AVAPS模式与S/T模式的疗效比较OA

Objective To compare the efficacy differences between average volume assured pressure support(AVAPS)and spontaneous/time(S/T)modes in non-invasive positive pressure ventilation(NIPPV)for chronic obstructive pulmonary disease(COPD)patients with pulmonary encephalopathy.Methods A total of 67 patients diagnosed with COPD complicated by pulmonary encephalopathy,admitted to the department of respiratory and critical care medicine,Henan Provincial People's Hospital between February 2025 and February 2026,was selected for this study.After excluding 15 patients who received less than 6 hours of daily NIPPV therapy,52 patients remained for ultimately enrolled.The patients were divided into a control group(27 cases)and a study group(25 cases)using a random number table.Both groups received identical baseline treatment;the control group was assigned the S/T mode,while the study group was assigned the AVAPS mode.Comparative analyses were conducted on parameters including arterial blood gas measurements[pH value,arterial oxygen partial pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2),bicarbonate(HCO3-)],Glasgow coma scale(GCS)scores,heart rate,acidosis,consciousness,oxygenation and respiratory rate(HACOR)scores,measured tidal volume(VT),patient comfort levels,and the 7-day NIPPV failure rate.These assessments were performed before treatment and at intervals of 2,6,12,and 24 hours post-treatment.Results Before treatment,no statistically significant differences were observed between the two groups in terms of pH value,PaO2,PaCO2,HCO3-,VT measurements,GCS score,or HACOR score(all P>0.05).Following the treatment of NIPPV,both groups exhibited an upward trend in pH value,PaO2,and GCS score,whereas PaCO2,HCO3-,and HACOR scores demonstrated a downward trend.Compare with the control group,the study group showed significantly reduced levels of PaCO2 and HCO3-starting at 6 hours post-treatment[6-hour PaCO2(mmHg,1 mmHg≈0.133 kPa):63.18±8.15 vs.66.42±8.72;12-hour PaCO2(mmHg):56.89±7.52 vs.62.52±8.21;24-hour PaCO2(mmHg):53.23±6.94 vs.60.51±7.43;6-hour HCO3-(mmol/L):32.27±2.65 vs.33.85±2.77;12-hour HCO3-(mmol/L):29.46±2.45 vs.31.07±2.53;24-hour HCO3-(mmol/L):28.18±2.24 vs.30.77±2.75;all P<0.05].At both 6 hours and 24 hours post-treatment,the study group exhibited significant increases in VT values[6 hours(mL):594.3±89.7 vs.552.8±148.3,24 hours(mL):581.2±97.5 vs.541.7±194.2;both P<0.05].The study group exhibited a significant reduction in the incidence of gastrointestinal distension and patient-machine conflict(incidence of gastrointestinal distension:20.00%vs.37.04%,incidence of patient-ventilator dyssynchrony:20.00%vs.40.74%;both P<0.05).No statistically significant differences were observed between the two groups regarding treatment failure rate,increased airway secretions,or overall intubation failure rate.Conclusions For patients with COPD complicated by pulmonary encephalopathy,the AVAPS mode demonstrates superior advantages over the S/T mode in NIPPV therapy.It effectively improves ventilation efficiency,significantly reduces CO2 retention and the incidence of adverse events,without increasing short-term treatment failure risk.Therefore,the AVAPS mode holds significant clinical value and warrants widespread adoption.