临床肺功能检查.ppt

What Pulmonary Function Tests Do You Need ?,Spirometry Lung Volumes Body Plethysmography Diffusing Capacity (DLCO) Arterial Blood Gas Analysis,Water-seal spirometer: 水鼓式,Pneumotach 流速仪,Portable spirometer 便携式,Portable spirometer 动态肺量计,Body box 体描箱,Diffusion,What Information Does PFT Provide ?,The function of the airways The function of pulmonary parenchyma Pulmonary vasculature Respiratory muscle,Spirometry,Detect lung disease (screening) Quantify extent of known disease Determine benefits/risks of therapy Assess surgical risk,Indications,Lung Volumes,Diagnose / assess restrictive lung disease Assess hyperinflation in obstructive disease Assess response to treatment Lung transplantation Lung volume reduction Radiation, chemotherapy,Indications,Diffusion Capacity,Follow progress of interstitial lung disease Assess pulmonary involvement in systemic disease Evaluate gas exchange in obstructive disease Assess pulmonary vascular diseases,Indications,Testing Guidelines,Forceful expiration, no hesitation, at least 6 seconds At least 3 acceptable maneuvers obtained Two largest FVC and FEV1 values within 150 ml Best test = largest FVC + FEV1,Spirometry,Interpretation of Pulmonary Function Testing,Step 1. Examine flow-volume loop,Is it a good PFTs? Is it normal? Characteristic pattern of obstruction? Pattern of restriction? Pattern of upper airway obstruction?,Normal Flow-Volume Loop,Cough,Variable Effort,Severe Obstruction,Restriction,Upper Airway Obstruction,Step 2. Are the data consistent with flow-volume loop?,FVC (VC): an expression of lung size FEV1: influenced by lung size and the dimensions of airway FEV1/FVC: a measure of airway obstruction Reduced FVC with normal FEV1/FVC only suggests restriction. TLC is indicated to confirm the restriction,Criteria for Restriction,Reduced TLC is a Golden standard Reduced FVC with normal FEV1/FVC ratio is sensitive but lacks of specificity,Nonspecific Ventilation Limitation,Reduced FVC and FEV1 Normal FEV1/FVC Normal TLC Restrictive? Obstructive?,Step 3. Examine the response to bronchodilation,FEV1: 12% or more increase and 200ml increase sGaw*: 30-40% or more increase,* Chest 1992; 101:1572-1581,Step 4. Lung volume, diffusion and others,Case 1,A 60 year old female was evaluated for dyspnea on exertion .,Case 1,Case 1,Ref Meas % FVC 3.41 3.02 88 FEV1 2.53 1.23 49 FEV1% 74 41 PEF 6.10 3.95 65,How to interpret the test?,Case 2,A 55 year old male was evaluated preoperatively for cataract surgery.,Case 2,Case 2,Ref Meas % FVC 4.60 1.85 40 FEV1 3.33 0.92 28 FEV1% 72 50 PEF 8.55 3.82 45,How to interpret the test?,Case 3,30 y/o male, 186 cm, 68 kg, severe interstitial fibrosis.,Case 3,Case 3,Ref Meas % FVC 6.01 1.12 19 FEV1 4.89 1.04 21 FEV1% 81 93 TLC 7.45 2.09 28 DLCO 35 9 26,How to interpret the test?,Case 4,BKM 25 y/o male, non-smoker, cough for 1 month, denied shortness of breath or wheezing. Normal physical exam.,Order a chest x-ray,Case 4,Case 4,Ref Meas % FVC 5.25 4.43 84 FEV1 4.44 3.61 81 FEV1% 86 74,How to interpret the test?,Case 4,How to interpret bronchodilator test?,Bronchodilator Test Pre Post %Change FVC 4.43 5.08 15% FEV1 3.61 4.10 14% FEV1% 74 79,Can you make a statement as to the patients underlying lung disease?,Case 5,ZXM 39 y/o female, non-smoker, cough and wheezing 10 days, worsening at night, asthma suspected. Normal physical exam.,Case 5,Ref Meas % FVC 3.32 4.20 127 FEV1 2.86 2.26 79 FEV1% 86 66,How to interpret the test?,Portable spirometry for 14 days Tulobuterol patch 2mg QD for 14 days,Case 5,Portable spirometry 动态肺量测定,Three times daily recordings of spirometry,FEV1,Case 5,Obstruction based on a reduced FEV1% Recurrent morning falls in FEV1 and PEF PEF variability 68% Substantial improvement with treatment Final diagnosis of asthma,Case 6,SW 58 y/o female, 160 cm, 84 kg referred for dyspnea on exertion,Case 6,1) Difficulty to perform spirometry 2) Audible stridor during expiration,Case 6,Case 6,Ref Pre % Post % %Change FVC 3.00 2.39 80 2.38 79 0 FEV1 2.22 1.18 53 0.51 23 -57 FEV1% 74 49 21 -57 TLC 4.73 4.03 85 RV 1.72 1.64 95 RV/TLC% 37 41 DLCO Could not be performed,Case 7,RS 50 y/o male, 170 cm, 64 kg history of COPD, referred for LVRS,Case 7,Case 7,Pred PRE %Pred POST %Pred %Chg FVC 4.43 1.79 40 2.74 62 53 FEV1 3.30 0.63 19 0.92 28 46 FEV1% 74 35 34 -3 TLC 6.45 6.79 105 RV 2.02 3.75 185 DLCO 27.8 8.9 32,Case 7,The patient has severe obstruction based on a markedly decreased FEV1/FVC ratio. Significant hyperinflation is present with an increased RV. The reduced DLCO suggests the presence of anatomic emphysema There is a significant response to bronchodilator,How would you interpret the test?,What therapy do you suggest based on