肺功能临床应用20112

肺功能测定的临床应用,首都医科大学附属北京友谊医院王浩彦,肺功能测定内容及质控肺功能障碍类型临床应用,肺功能测定内容,肺通气功能VC, FVC, FEV1, MEFR肺容量RV,TLC肺弥散功能DLco,DLco/VA血气分析气道激发试验心肺运动试验,Normal Trace Showing FEV1 and FVC,1,2,3,4,5,6,1,2,3,4,Volume, liters,Time, seconds,FVC,5,1,FEV1 = 4LFVC = 5LFEV1/FVC = 0.8,流速容积环,Flow l/s,Volume l,FEV 1,Inspiration,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 fullHold the breath and seal the lips tightly around a clean mouthpieceBlast the air out as forcibly and fast as possible. Provide lots of encouragement!Continue blowing until the lungs feel empty,Watch the patient during the blow to assure the lips are sealed around the mouthpieceCheck to determine if an adequate trace has been achievedRepeat the procedure at least twice more until ideally 3 readings within 200 ml are obtained,Performing Spirometry,Flow Volume Curve,Expiratory flow rateL/sec,Volume (L),FVC,Maximum expiratory flow (PEF),Inspiratory flow rateL/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 time Air leak around the mouthpieceSubjects 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,Unacceptable 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,正常参考值,肺通气VC和FVC的差异应在200ml以内FEV1/FVC70% ,老年人65-70%FEV1,FVC 80预计值FEF2575 50预计值SGaw0.1 L/sec / cmH2O/L肺容量TLC 80预计值RV/TLC 80预计值,肺功能障碍类型,阻塞性通气功能障碍限制性通气功能障碍混合性通气功能障碍弥散功能障碍,阻塞性通气功能障碍,FEV1/VC70%如果FEV1/VC临界异常，FEF2575 65%可帮助确认气道阻塞,限制性通气功能障碍,TLC %80%预计值FEV1: % 80%预计值 FVC: % 0.7,混合性通气功能障碍,TLC %80%预计值FEV1/VC70%,弥散功能障碍,DLco 80%预计值DLco/VA80%预计值,弥散功能障碍,DLco 80%预计值DLco/VA80%预计值,临床应用,诊断、监测病情、评价疗效哮喘COPD肺间质疾病肺血管疾病呼吸困难的鉴别诊断手术风险评估,哮喘的肺功能诊断,气流受限FEV1 FEV1/ FVC PEFReversibilityVariabilityHyperresponsitiveness,气流受限的可逆性,FEV1/ FVC20%,气道高反应性,反应气道对诱发物(triggers)的敏感(sensitivity)更容易反应，即药物剂量反应曲线左移反应程度更高，即药物剂量反应曲线的最大反应平台增高或不出现平台SensitiveLimited specificity,药物激发实验,Y,肺量计测定,10min,支气管激发实验流程图,N,药物激发实验结果表示方法,PC20,慢阻肺病情分期,I期: 轻度 FEV1/FVC 80% predictedII期: 中度 FEV1/FVC 0.70 50% FEV1 80% predictedIII期: 重度 FEV1/FVC 0.70 30% FEV1 50% predictedIV期: 极重度 FEV1/FVC 0.70 FEV1 30% predicted or FEV1 50% predicted plus chronic respiratory failure,病例-男性， 65岁,女性,35岁,结节病,男性,66岁,肺血管炎,男性,60岁,过敏性肺炎,女性,63岁, 心肌病，高血压。口服胺碘酮等药物。,胸部手术风险评估,诊断流程 Pellegrino R ,et al.Eur Respir J 2005; 26: 948968,血气基本参数,PaO280100mmHgPaCO23545 mmHgpH 7.357.45HCO3- 2127 (24) mEg/l,预计代偿范围公式,酸碱紊乱的判定,预计代偿范围公式,女性，呕吐一周 pH7.48 PaCO2 48mmHg (6.4kPa) HCO3- 36mmol/L代偿式：PaCO2=0.9HCO3-5预计：PaCO2=正常PaCO2 + PaCO2 =40+0.9(36-24) 5 =45.855.8(mmHg)判断：代谢性碱中毒,case1,HCO3