临床肺功能检查PFT-MED-课件

PulmonaryFunctionTests

临床肺功能检查WhatPulmonaryFunctionTestsDoYouNeed?SpirometryLungVolumesBodyPlethysmographyDiffusingCapacity(DLCO)ArterialBloodGasAnalysisWater-sealspirometer:水鼓式Pneumotach

流速仪Portablespirometer

便携式Portablespirometer

动态肺量计Bodybox

体描箱DiffusionWhatInformationDoesPFTProvide?ThefunctionoftheairwaysThefunctionofpulmonaryparenchymaPulmonaryvasculatureRespiratorymuscleSpirometryDetectlungdisease(screening)QuantifyextentofknowndiseaseDeterminebenefits/risksoftherapyAssesssurgicalriskIndicationsLungVolumesDiagnose/assessrestrictivelungdiseaseAssesshyperinflationinobstructivediseaseAssessresponsetotreatmentLungtransplantationLungvolumereductionRadiation,chemotherapyIndicationsDiffusionCapacityFollowprogressofinterstitiallungdiseaseAssesspulmonaryinvolvementinsystemicdiseaseEvaluategasexchangeinobstructivediseaseAssesspulmonaryvasculardiseasesIndicationsTestingGuidelinesForcefulexpiration,nohesitation,atleast6secondsAtleast3acceptablemaneuversobtainedTwolargestFVCandFEV1valueswithin150mlBesttest=largestFVC+FEV1SpirometryInterpretationof

PulmonaryFunctionTesting

Step1.Examineflow-volumeloop

IsitagoodPFT’s?Isitnormal?Characteristicpatternofobstruction?Patternofrestriction?Patternofupperairwayobstruction?NormalFlow-VolumeLoopCoughVariableEffort

SevereObstructionRestrictionUpperAirwayObstructionStep2.Arethedataconsistentwithflow-volumeloop?

FVC(VC):anexpressionoflungsizeFEV1:influencedbylungsizeandthedimensionsofairwayFEV1/FVC:ameasureofairwayobstructionReducedFVCwithnormalFEV1/FVConlysuggestsrestriction.TLCisindicatedtoconfirmtherestrictionCriteriaforRestrictionReducedTLCisaGoldenstandardReducedFVCwithnormalFEV1/FVCratioissensitivebutlacksofspecificityNonspecificVentilationLimitationReducedFVCandFEV1NormalFEV1/FVCNormalTLCRestrictive?Obstructive?Step3.Examinetheresponsetobronchodilation

FEV1:12%ormoreincreaseand200mlincreasesGaw*:30-40%ormoreincrease*Chest1992;101:1572-1581Step4.Lungvolume,diffusionandothersCase1A60yearoldfemalewasevaluatedfordyspneaonexertion.

Case1Case1

Ref Meas %FVC 3.41 3.02 88FEV1

2.53 1.23 49

FEV1% 74 41PEF 6.10 3.95 65Howtointerpretthetest?Case2A55yearoldmalewasevaluatedpreoperativelyforcataractsurgery.

Case2Case2

Ref Meas %FVC 4.60 1.85 40FEV1

3.33 0.92 28

FEV1% 72 50PEF 8.55 3.82 45Howtointerpretthetest?Case330y/omale,186cm,68kg,severeinterstitialfibrosis.Case3Case3

Ref Meas %FVC 6.01 1.12 19FEV1

4.89 1.04 21

FEV1% 81 93TLC 7.45 2.09 28DLCO 35 9 26Howtointerpretthetest?Case4BKM25y/omale,non-smoker,coughfor1month,deniedshortnessofbreathorwheezing.Normalphysicalexam.

Orderachestx-rayCase4Case4

Ref Meas %FVC 5.25 4.43 84FEV1

4.44 3.61 81

FEV1% 86 74Howtointerpretthetest?Case4

Howtointerpretbronchodilatortest?

BronchodilatorTest

Pre Post %ChangeFVC 4.43 5.08 15%FEV1

3.61 4.10 14%

FEV1% 7479Canyoumakeastatementastothepatient’sunderlying

lungdisease?

Case5ZXM39y/ofemale,non-smoker,coughandwheezing10days,worseningatnight,asthmasuspected.Normalphysicalexam.

Case5

Ref Meas %FVC 3.32 4.20 127FEV1

2.86 2.26 79

FEV1% 86 66Howtointerpretthetest?Portablespirometryfor14daysTulobuterolpatch2mgQDfor14daysCase5Portablespirometry

动态肺量测定ThreetimesdailyrecordingsofspirometryFEV1Case5ObstructionbasedonareducedFEV1%RecurrentmorningfallsinFEV1andPEFPEFvariability68%SubstantialimprovementwithtreatmentFinaldiagnosisofasthmaCase6SW 58y/ofemale,160cm,84kgreferredfordyspneaonexertionCase61)Difficultytoperformspirometry2)AudiblestridorduringexpirationCase6Case6

Ref Pre % Post %%ChangeFVC 3.00 2.39 80 2.38 79 0FEV1

2.22 1.18 53 0.51 23 -57FEV1% 74 49 21 -57TLC 4.73 4.03 85RV 1.72 1.64 95RV/TLC% 37 41DLCO

Couldnotbeperformed Case7RS 50y/omale,170cm,64kg historyofCOPD,referredforLVRSCase7Case7

Pred PRE %Pred POST %Pred %ChgFVC 4.43 1.79 40 2.74 62 53FEV1

3.30 0.63 19 0.92 28 46FEV1% 74 35 34 -3TLC 6.45 6.79 105RV 2.02 3.75 185DLCO

27.8 8.9 32 Case7ThepatienthassevereobstructionbasedonamarkedlydecreasedFEV1/FVCratio.SignificanthyperinflationispresentwithanincreasedRV.ThereducedDLCOsuggeststhepresenceofanatomicemphysemaThereisasignificantresponsetobronchodilatorHowwouldyouinterpretthetest?Whattherapydoyousuggestbasedonther