肺功能检查韩江娜

Pulmonary Function Testing,For medical students of PUMC Sept. 7th, 2005,What Pulmonary Function Tests Do You Need ?,SpirometryLung VolumesBody PlethysmographyDiffusing Capacity (DLCO)Arterial Blood Gas Analysis,Spirometer：最古老的水鼓式,Volume displacement spirometer 滚筒式,Pneumotach流速仪,Portable spirometer便携式,Pocket sized spirometer,Body box体描箱,Diffusion,What Information Does PFT Provide ?,The function of the airwaysThe function of pulmonary parenchymaPulmonary vasculatureRespiratory muscle,SpirometryIndications,Detect lung disease (screening)Quantify extent of known diseaseMeasure effect of environmental exposureDetermine benefits/risks of therapyAssess surgical riskEvaluate disability or impairment,Lung VolumesIndications,Diagnose / assess restrictive lung diseaseAssess hyperinflation in obstructive diseaseAssess response to treatmentLung transplantationLung volume reductionRadiation, chemotherapy,Diffusion Capacity (DLCO)Indications,Follow progress of interstitial lung diseaseAssess pulmonary involvement in systemic diseaseEvaluate gas exchange in obstructive diseaseAssess pulmonary vascular diseases Quantify disability in interstitial lung disease,Data Quality in Spirometry,Equipment standardization, calibration, and quality controlTest performance guidelines, criteria for acceptability of resultsTechnologist/technician training,Testing Guidelines,Forceful expiration, no hesitation, at least 6 secondsAt least 3 acceptable maneuvers obtainedTwo largest FVC and FEV1 values within 200 mlBest test = largest FVC + FEV1,Spirometry,Interpretation of Spirometry,Look at 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,Are the Data Consistent with Flow-Volume Curve?,FVC (VC): an expression of lung sizeFEV1: influenced by lung size and the dimensions of airwayFEV1/FVC: a measure of airway obstruction (Tiffeneau coefficient)Reduced FVC only suggests restriction,Criteria for Restriction,Reduced TLC is a Golden standardReduced FVC with normal FEV1/FVC ratio is sensitive but lacks of specificity,Examine the response to bronchodilation,FEV1:12% or more increase and 200ml increasesGaw*:30-40% or more increase,* Chest 1992; 101:1572-1581,Case 1,A 60 year old female was evaluated for dyspnea on exertion .,Case 1,Case 1,How to interpret the test?,Case 2,A 55 year old male was evaluated preoperatively for cataract surgery.,Case 2,Case 2,How to interpret the test?,Case 3,30 y/o male, 186 cm, 68 kgSevere interstitial fibrosis,Case 3,Case 3,RefMeas%FVC6.011.1219 FEV14.891.0421FEV1%8193TLC7.452.0928DLCO 359 26,How to interpret the test?,Case 4,TD 29 y/o male, 185 cm, 80 kg, smoker, recurrent chest infections, having a morning cough, deniedshortness of breath or wheezing.,Case 4,Case 4,RefMeas%FVC5.846.79116 FEV14.534.2995FEV1%7763TLC7.929.04114RV2.081.9292Raw0.994.03406sGaw0.230.05524,How to interpret the test?,Case 4,How to interpret bronchodilator test (spirometry, sGaw)?,Bronchodilator TestPrePost%ChangeFVC6.796.81 0 FEV14.294.56 6%Raw4.031.39-66%sGaw0.055 0.151 175%,Can you make a statement as to the patients underlyinglung disease?,Case 5,PF56 y/o female, 165 cm, 100 kgcough and dyspnea on exertion, exercise-induced bronchospasm suspected.,Case 5,SpirometryRefMeas%FVC3.283.50107 FEV12.452.4098FEV1%7569,How to interpret the spirometry?,What other tests do you order to answer the clinical question?,Case 5,Case 5,Hyperventilation Challenge,Case 5,Hyperventilation Challenge,Case 5,Hyperventilation ChallengePrePost%ChangeFVC3.502.14-39% FEV12.401.03-57%PEF6.222.52-59%,What is the patients response to hyperventilation challenge?,Case 6,SW58 y/o female, 160 cm, 84 kgreferred for dyspnea on exertion,Case 6,1) Difficulty to perform spirometry2) Audible stridor during expiration,Case 6,Case 6,Ref Pre % Post % %ChangeFVC3.00 2.39 80 2.38 79 0FEV12.22 1.18 53 0.51 23 -57FEV1% 74 49 21 -57TLC4.73 4.03 85RV1.72 1.64 95RV/TLC% 37 41DLCOCould not be performed,Sum