英文版肺功能检查.ppt

PulmonaryFunctionTesting RespiratoryDepartmentoftheSecondAffiliatedHospitalofGuangzhouMedicalUniversityHuaxingHuang Historyofpulmonaryfunctiontesting Morethan300years watersealedspirometer wedged typedspirometer drum typedspirometer digitalizedspirometerIn1679 BORELLImeasuredlungvolumefirstly In1846 HUTCHINSONputforwardtheconceptofvitalcapacity In1919 NIANSTROHLputforwardtheconceptofforcedvitalcapacity In1967 DOLLFUSSputforwardtheconceptofdiseaseofsmallairway In1979 ATSsetuptheworkstandardsofpulmonaryfunctiontesting ClinicalPraticeofPulmonaryFunctionTesting DiagnosticObjectiveAssessmentMonitoringEvaluationsforDisability Impairment LungvolumeandcapacityVentilationfunctionDiffusionfunctionMechanicsofbreathing MainProgramsofPulmonaryFunctionTesting Lungvolume Lungvolumemeansthemaximalvolumeofgascontainedbyalung Lungvolume tidalvolume VT inspiratoryreservevolume IRV expiratoryreservevolume ERV residualvolume RV Lungcapacity inspiratorycapacity IC vitalcapacity VC functionalresidualcapacity FRV totallungcapacity TLC Curveoflungcapacity Vitalcapacity Themaximumvolumeofairthatcanbeinspiredbyforcefulexpiration Residualvolume Inspiratoryreservevolume Expiratoryreservecapacity Totallungcapacity Tidalvolume Functionalreservevolume Tidalvolume VT Thevolumeofairinspiredorexpiredwitheachnormalbreath 8 15ML KG Inspiratorycapacity IC Inspiratoryreservevolume IRV IC themaximumvolumeofairthatcanbeinspiredbyforcefulexpiration ItisequaltoVTplusIRV IRV themaximumextravolumeofairthatbeinspiredoverandabovethenormaltidalvolume Theserevealthemaximamexpansionoflungandchestatstaticstate Expiratoryreservevolume ERV Themaximumextravolumeofairthatbeinspiredoverandabovethenormaltidalvolume Itreflectsthepowerofexpiratorymuscleandabdominalmuscle Vitalcapacity VC Thelargestamountofairthatcanbeexpiredafteramaximalinspiratoryeffortfrequently VCvariesamongnormalbodies soratiosofmeasuredVCtopredictedVCareusedforjudgment Gradingstandard ratioofmeasuredVCtopredictedVC 80 normal60 79 mildlyreduced40 59 moderatelyreduced 40 severelyreduced CommondiseaseswithreducedVT Diseaseswithinjuredlungtissue pneumonia atelectasis pulmonaryinterstitialfibrosis pulmonaryedemaRestrictedmovementinthoraxorlung thoracocyllosis obesity pneumothorax pleuraleffusion ascitesAirwayobstruction chronicbronchitis asthma COPD FunctionalReservecapacity FRC Theamountofairthatremainsinthelungsattheendofnormalexpiration It sequaltoERVplusRV Itcanstabilizepartialpressureofalveolus FRC Pred120 increasedFRC FRC Pred80 reducedFRC 1 CausesforincreasedFRC 1 reducedpulmonaryelasticity emphysema 2 airwayobstruction asthma COPD2 CausesforreducedFRC 1 injuredlungtissue 2 restrictedmovementinthoraxorlung FunctionalReservecapacity FRC Residualvolume RV Theairleftinthelungsafteramaximalexpiratoryeffort IthavethesamephysiologicalmeaningtoFRC Totallungcapacity TLC Themaximumvolumetowhichthelungscanbeexpandedwiththegreatesteffort It sequaltoVCplusRV CommoncausesforreducedTLC atelectasis PIF pneumothorax pleuraleffusionCommoncausesforincreasedTLC asthma emphysema RatioofRVtoTLC RV TLC It susedtogradetheemphysema RV TLC 35 normal36 45 mildemphysema46 55 moderateemphysema 56 severeemphysema Ventilationfunction Pulmonaryventilationmeansthattheinfloworoutflowofairbetweentheatmo sphereandthelungalveoli Ventilationfunctionmeasurementincludes minuteventilation MV alveolarventilation VA maximalvoluntaryventilation MVV timedvitalcapacity TVC Minuteventilation MV MVmeansthegasvolumeinhaledorexhaledinoneminute It sequaltoVTmultiplybyrespiratoryrate MV VT RRAtstaticstate MVrangesfrom5to8L MV 10LhyperventilationMV 3Lhypoventilation Alveolarventilation VA Theamountofairreachingthealveoliperminuteatrest Anatomicdeadspace thespaceintheconducingzoneoftheairwaysoccupiedbygasthatdoesnotexchangewithbloodinthepulmonaryvessels suchasthespaceinnoseandpharynx Alveolardeadspace someofthealveolithemselvesarenonfunctionaloronlypartiallyfunctionalbecauseofabsentorpoorbloodflowthroughadjacentpulmonarycapillaries Physiologicaldeadspace VD Anatomicdeadspace Alveolardeadspace VA MV VD RR VAvariesinbodiesandrangesfrom3to5 5L VAreflectstheeffectiveventilation ReductionofMVVandincreaseddeadspacewillresultinalveolarhypo ventilation Deadspacethatresultsfromdeepandslowbreathingislessthanthatofshallowandrapidbreathing SolessrespiratoryrateandmoreVTwillbebetterforVA Alveolarventilation VA Maximalvolumtaryventilation MVV Thetotalamountofnewairmovedintotherespiratorypassagesbydeepestandfasterbreathingineachminute Itdependsonlungvolume complianceoflungandthorax airwayresistanceandrespiratorymuscle MVV Pred80 normalDamagegrading MVV Pred60 79 mildlyreduced40 59 moderatelyreduced 40 severelyreduced Increasedairwayresistance asthmaThoracicdeformityorneuromusculardiseases kyphoscoliosis Guillian BarresyndromeDiseasesoflungtissue pulmonaryedema MaincausesofreducedMVV TimedVitalCapacity TVC FVCFEV1FEV1 FVC MMEFPEF TimedVitalCapacity TVC FVC forcedvitalcapacity Thisistheamountofairexpelledfromthelungsafterfirstfillingthelungstomaximumextentandthenexpiringrapidlyandforcefully FEV1 forcedexpiratoryvolumeinonesecond istheamountthatcanbegotinthefirstsecondwhenFVCismeasured FEV1 FVC ratioofFEV1toFVC TimedVitalCapacity TVC MMEF maximalmid expiratory AfterFVCdividedintofouraverageparts dividetheamountofthetwomiddlepartsbythecorrespondingexpiratorytime MMEFwillbegot TimedVitalCapacity TVC FVC Pred 80 FEV1 Pred 80 FEV1 FVC 70 80 FEV1 Predcanbeusedtoevaluatethedamagedegreeofventilationanddifferentiateobstructiveventilationdysfunctionfromrestrictiveventilationdysfunction Time Volumecurve restrictive obstructive ClinicalSignificanceInnormalbody FVCisclosedtoVC Increasedintrapleuralpressuremakessmallairwaycloseinearlierstageofexpiration Atthissituation FVCislessthanVC IthappenstopatientswithCOPD Evaluateventilationdysfunction obstructivediseases FEV1 FVC reduced flatcurverestrictivediseases FEV1 FVC normalorincreased gradientcurve GradingClassificationofVentilationFunctioninCOPD bronchialdilatorused PEF peakexpiratoryflow Themaximalflowduringaforcefulexpiration PEFshouldbemeasuredinthemorning afternoonandbeforesleeping PEFR PEFmaximum PEFminimum 2PEFmaximum PEFminimumPEFhelptoevaluatethechageofairwayresistance 100 Classificationofventilationdysfunction ObstructiveventilationdysfunctionRestrictiveventilationdysfunctionMixedventilationdysfunction Characteristicsofventilationdysfunction Characteristicsofventilationdysfunction Diffusionfunction Gasexchangefunctionmeansthecourseofgasexchange includingtheexchangeofO2andCO2betweenalveolusandblood bloodandhistocyte Itinvolveslungventilation bloodperfusion ventilation perfusionratioanddiffusionfunction Diffusionfunctioncanbemeasuredtoevaluategasexchangefunctiontosomeextent Diffusionfunction Thegasexchangebetweenalveolusandbloodcapillaryfromthehighpartialpressuresidetothelowside Relativefactors molecularweight solubility gaspartialpressuregradient diffusionarea diffusiondistance GasExchange PO2 104mmHgPCO2 40mmHg PO2 104mmHgPCO2 40mmHg PO2 40mmHgPCO2 45mmHg ClinicalsignificanceFactorsthatcanreducethecapacityofdiffusion Reducedeffectivediffusionarea atelectasis airwayobstruction pulmonaryembolismIncreaseddiffusiondistance PIF pulmonaryedema sarcoidosis alveolarcellcarcinomaThecapacityofdiffusionalsodependsongaspartialpressure Flow Volumecurve F Vloop It sarecordaboutthecoursethattakearapidexpirationtotheextentofRVafteramaximalinspirationtotheextentofTLC TheflowrisesrapidlyatthebeginningofforcefulexpirationandreachesthepointofPEFsoon WiththereductionofVC theflowgoesdownperpendicularlyalmost PEFandVmax75reflectthemainairwayresistanceandrespiratorymusclestrength Vmax50andVmax25reflectsmallairwayresistance Descendingbranchsinkstothevolumeaxisinobstructivediseases butVCmaynotreduce Inrestrictivediseases thecurvesrisesharplyandthedescendingbranchessinknearlyperpendicularly TheyhavereducedVC Flow Volumecurve F Vloop flow volume TypesofFlow VolumecurvesofDifferent