1、肺功能測定的臨床應(yīng)用,首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院 王浩彥,肺功能測定內(nèi)容及質(zhì)控 肺功能障礙類型 臨床應(yīng)用,肺功能測定內(nèi)容,肺通氣功能 VC, FVC, FEV1, MEFR 肺容量 RV,TLC 肺彌散功能 DLco,DLco/VA 血氣分析 氣道激發(fā)試驗 心肺運動試驗,Normal Trace Showing FEV1 and FVC,1,2,3,4,5,6,1,2,3,4,Volume, liters,Time, seconds,FVC,5,1,FEV1 = 4L FVC = 5L FEV1/FVC = 0.8,流速容積環(huán),Flow l/s,Volume l,FEV 1,Inspirat

2、ion,Expiration,PIF,FIF 50,FVC,FEF 75,FEF 50,FEF 25,PEF,1 s,肺容量,Performing Spirometry,Breath in until the lungs are full Hold the breath and seal the lips tightly around a clean mouthpiece Blast the air out as forcibly and fast as possible. Provide lots of encouragement! Continue blowing until the lu

3、ngs feel empty,Watch the patient during the blow to assure the lips are sealed around the mouthpiece Check to determine if an adequate trace has been achieved Repeat the procedure at least twice more until ideally 3 readings within 200 ml are obtained,Performing Spirometry,Flow Volume Curve,Expirato

4、ry flow rate L/sec,Volume (L),FVC,Maximum expiratory flow (PEF),Inspiratory flow rate L/sec,RV,TLC,Spirometry - Quality Control,Most common cause of inconsistent readings is poor patient technique Sub-optimal inspiration Sub-maximal expiratory effort Delay in forced expiration Shortened expiratory t

5、ime Air leak around the mouthpiece Subjects must be observed and encouraged throughout the procedure,Unacceptable Trace - Poor Effort,Volume, liters,Time, seconds,May be accompanied by a slow start,Inadequate sustaining of effort,Variable expiratory effort,Normal,Volume, liters,Time, seconds,Unaccep

6、table Trace Stop Early,Normal,Volume, liters,Time, seconds,Unacceptable Trace Slow Start,Normal,Volume, liters,Time, seconds,Unacceptable Trace - Coughing,Normal,Volume, liters,Time, seconds,Unacceptable Trace Extra Breath,Normal,正常參考值,肺通氣 VC和FVC的差異應(yīng)在200ml以內(nèi) FEV1/FVC70% ,老年人65-70% FEV1,FVC 80預(yù)計值 FEF

7、2575 50預(yù)計值 SGaw0.1 L/sec / cmH2O/L 肺容量 TLC 80預(yù)計值 RV/TLC 80預(yù)計值,肺功能障礙類型,阻塞性通氣功能障礙 限制性通氣功能障礙 混合性通氣功能障礙 彌散功能障礙,阻塞性通氣功能障礙,FEV1/VC70% 如果FEV1/VC臨界異常，F(xiàn)EF2575 65%可幫助確認氣道阻塞,限制性通氣功能障礙,TLC % 0.7,混合性通氣功能障礙,TLC %80%預(yù)計值 FEV1/VC70%,彌散功能障礙,DLco 80%預(yù)計值 DLco/VA80%預(yù)計值,彌散功能障礙,DLco 80%預(yù)計值 DLco/VA80%預(yù)計值,臨床應(yīng)用,診斷、監(jiān)測病情、評價療效

8、哮喘 COPD 肺間質(zhì)疾病 肺血管疾病 呼吸困難的鑒別診斷 手術(shù)風(fēng)險評估,哮喘的肺功能診斷,氣流受限 FEV1 FEV1/ FVC PEF Reversibility Variability Hyperresponsitiveness,氣流受限的可逆性,FEV1/ FVC75% 吸入200-400ug Sabutamol即刻或治療數(shù)天 FEV1改善率12%； FEV1增加200ml,FEV1改善率,=,吸藥后FEV1- 吸藥前FEV1,吸藥前FEV1,100%,氣流受限的可變性,PEF變異率 Diurnal variability PEF first thing in the morning;

9、last thing at night (PEFnight-PEFmorning)/mean daily PEF PEF(minmum ) PEF(recent best) 20%,氣道高反應(yīng)性,反應(yīng)氣道對誘發(fā)物(triggers)的敏感(sensitivity) 更容易反應(yīng)，即藥物劑量反應(yīng)曲線左移 反應(yīng)程度更高，即藥物劑量反應(yīng)曲線的最大反應(yīng)平臺增高或不出現(xiàn)平臺 Sensitive Limited specificity,藥物激發(fā)實驗,Y,肺量計測定,10min,支氣管激發(fā)實驗流程圖,N,藥物激發(fā)實驗結(jié)果表示方法,PC20,慢阻肺病情分期,I期: 輕度 FEV1/FVC 80% predict

10、ed II期: 中度 FEV1/FVC 0.70 50% FEV1 80% predicted III期: 重度 FEV1/FVC 0.70 30% FEV1 50% predicted IV期: 極重度 FEV1/FVC 0.70 FEV1 30% predicted or FEV1 50% predicted plus chronic respiratory failure,病例-男性， 65歲,女性,35歲,結(jié)節(jié)病,男性,66歲,肺血管炎,男性,60歲,過敏性肺炎,女性,63歲, 心肌病，高血壓?？诜返馔人幬?。,胸部手術(shù)風(fēng)險評估,診斷流程 Pellegrino R ,et al.Eur Respir J 2005; 26: 948968,血氣基本參數(shù),PaO280100mmHg PaCO23545 mmHg pH 7.357.45 HCO3- 2127 (24) mEg/l,預(yù)計代償范圍公式,酸堿紊亂的判定,預(yù)計代償范圍公式,女性，嘔吐一周 pH7.48 PaCO2 48mmHg (6.4kPa) HCO3- 36mmol/L 代償式：PaCO2=0.9HCO3-5 預(yù)計：PaCO2=正常PaCO2 + PaCO2 =40+0.9(36-24) 5 =45.855.8(mmHg) 判斷：代謝性堿中毒