肺功能检查呼吸系统ppt课件.ppt

Pulmonary function test(Lung function test)Lung function test/pulmonary function test(PFT)n nPurposeAssist diagnosisAssist diagnosisCOPD,asthma,ILD COPD,asthma,ILD Perioperative assessmentPerioperative assessmentMonitoring disease progressionMonitoring disease progressionLabor appraisalLabor appraisalPFT-ponentsn nLung volumesn nVentilationn nGas exchangen nBlood flowLung volumesBasal lung volumesBasal lung volumesn nTidal volume,VTTidal volume,VTn nInspiratory reserved volume,IRVInspiratory reserved volume,IRVn nExpiratory reserved volume,ERVExpiratory reserved volume,ERVn nResidual volume,RVResidual volume,RVBasal lung capacitiesBasal lung capacitiesn nInspiratory capacityInspiratory capacityn nVital capacityVital capacityn nFunctional residual capacityFunctional residual capacityn nTotal lung capacityTotal lung capacity1.Lung Volume and SubdivisionsVTIRVERVRVICFRCVCRVTLCNormal respiration basal lineForced expiratory basal line500mlForced inspiratory basal lineClinical Significance-Volumen n残气容积残气容积(RV)Normal:Normal:male1615ml,female 1245male1615ml,female 1245 Inc-Inc-：Lung hyperinflation,e.g.emphysemaLung hyperinflation,e.g.emphysema Dec-:Lung volume reduction,e.g.ARDS,ILDDec-:Lung volume reduction,e.g.ARDS,ILDn n功能残气量（功能残气量（FRC）:ERV+RVNormal:3112ml,female 2348mlInc-：Lung hyperinflation,e.g.emphysemaDec-:Lung volume reduction,e.g.ARDS,ILDClinical Significance-capacityn n肺活量（肺活量（VC）:IC+ERVNormal:male 4217ml;female 3105ml Normal:male 4217ml;female 3105ml VC%80%is abnormal.Decreased:restrictive ventilation disorder/severe obstructive ventilation disorder Clinical Significance-capacityn n深吸气量深吸气量(IC):VT+IRV Normal:male2617ml,female 1970ml Normal:male2617ml,female 1970ml Dec-:Inspiratory muscle function decline;lung Dec-:Inspiratory muscle function decline;lung expansion is limitedexpansion is limitedn n功能残气量（功能残气量（FRC）:ERV+RV Normal:3112ml,female 2348mlNormal:3112ml,female 2348mlInc-Inc-：Lung hyperinflation,e.g.emphysemaLung hyperinflation,e.g.emphysemaDec-:Lung volume reduction,e.g.ARDS,Dec-:Lung volume reduction,e.g.ARDS,ILDILDClinical Significance-capacityn n肺总量（肺总量（TLC）：VC+RV Normal:maleNormal:male5766ml5766ml；female4353mlfemale4353ml Dec-:restrictive ventilation disorderDec-:restrictive ventilation disorderInc-:obstructive pulmonary disorderInc-:obstructive pulmonary disordern nRV/TLC%(residual air rate)normal:35%normal:40%emphysema:40%old person can be 50%old person can be 50%Ventilation2.Function Testn nIt is called as dynamic lung volumes.n nFast spirometric trace to illustrate timed ventilation tests(air volume and air flow during breathing).VentilationFunction Testn nLung ventilation volume肺通气量肺通气量VE(minute ventilation)VE(minute ventilation)每分静息通气量每分静息通气量每分静息通气量每分静息通气量MVV(maximal voluntary ventilation)MVV(maximal voluntary ventilation)最最最最大通气量大通气量大通气量大通气量n nForced vital capacity(FVC 用力肺活量用力肺活量)n nMaximal mid-expiratory flow(最大呼最大呼气中段流量气中段流量MMEF/MMF)n nAlveolar ventilation(VA)2.1 VE(minute ventilation)=VTRR/minnormal:46 liter10L:hyperventilationMVVn nEvaluation of ventilatory reserven nEvaluation of chest surgical danger:MVV 50%:MVV 50%:RiskMVV 95%Normal:95%Abnormal:86%Abnormal:86%Severe abnormal 70%Severe abnormal 60%60%2.3 FVC(Forced Vital Capacity)n nThe volume that after full inspiration,to expire with the most force and the most rate.FEV1n nFEV1(forced expiratory volume in the FEV1(forced expiratory volume in the first second)first second)Normal:male 3.179L,female 2.314LNormal:male 3.179L,female 2.314L FEV1/Predict value 80%:obstructive FEV1/Predict value 80%Normal:80%FEV1/FVC%70%:Irreversible obstructive FEV1/FVC%70%:Irreversible obstructive ventilation disorderventilation disorderFVC Curve83%Normal 96%99%FVC2.4 MMEF(maximal mid-expiratory flow,MMF最大呼气中段流速)n nThe mean flow between 25%and 75%forced expiration.n nNormal:male 3452ml/s,female 2836ml/sn nSignificance:to evaluate the small airway obstruction in early stage10075502500234Lung diseasenormalFlowL/sVmax 75%Vmax 50%Vmax 25%Flow-Volume Curve（V-V Curve）流量容积曲线 Volumeflow-volume loopgraphically depicts the rate of airflow on the Y-axis and the total volume inspired or expired on the X-axis2.5 VA(alveolar ventilation)n nThe air volume entered respiratory bronchioli and the alveoli during a minute.n nGas exchangen nVD(dead space)=150mln nVA=(VT VD)RR/minNormal VD/VT=0.3-0.4Normal VD/VT=0.3-0.4 VD/VT :effective ventilation VD/VT :effective ventilation increasedincreased VD/VT :effective ventilation VD/VT :effective ventilation decreaseddecreased2.6 Clinical Values of Ventilation Testn nEvaluate function of ventilationGrades of dysfunctionGrades of dysfunctionType of ventilation disorderType of ventilation disordern nEvaluate degree of obstructive emphyseman nEvaluate reversible of obstruction(1)Evaluate function of ventilation n nAir rate indexAir rate index气速指数气速指数气速指数气速指数n n=n nNormal=1 Normal=1 n n111限制性限制性限制性限制性MVV active/predictive%VC active/predictive%(2)Degrees of Lung Disfunction VC or MVV act/pre%FEV1%/FVC%VC or MVV act/pre%FEV1%/FVC%Normal 80 70Normal 80 70Mild reduce 80-71 70-61Mild reduce 80-71 70-61Mediate reduce 70-51 60-41Mediate reduce 70-51 60-41Severe reduce 50-21 =40Severe reduce 50-21 =40Respiratory failure =20Respiratory failure =20(3)Classification of Ventilative Function DisorderObstructioObstruction nRestriction Restriction MixMixFEV1/FVCFEV1/FVCSignificantly Significantly lowerlowerN or higherN or higherlowerlowerMVV MVV Significantly Significantly lowerlowerN or lowerN or lowerlowerlowerVCVCN or lowerN or lowerSignificantly Significantly lowerlowerlowerlowerRate indexRate index111=1=1RVRVhigherhigherN or lowerN or lowerUncertainUncertainTLCTLCN or higherN or higherlowerlowerUncertainUncertain(4)Degrees of Obstructive Emphysema RV/TLC(%)Normal =56(5)(5)气道阻塞可逆性测定气道阻塞可逆性测定 Bronchodilator Reversibility Testing1)Bronchial Dilation Test 支气管舒张试验n nMethod:to determine FEV1 and FEV1/FVC%before and after 2-agonist inhalationn nimproved rate=n nPositive:12%and improved volume 200mln nSignificance:Reversible obstruction FEV1 After-FEV1before FEV1 before 100%2)Bronchial Provocation Test支气管激发试验n nMethod:to inhale histamine/acetylcholine from low to high concentration till the FEV1 decrease 20%.Calculate drug volume(PD20FEV1).n nHistamine:PD20FEV17.8 moln nAcetylcholine:PD20FEV112.8 moln nPositive:indicate airway hyper-responsiveness3)PEF Variable Raten nPEF(peak expiratory flow):the most flow during forced expiration.It indicates the force of respiratory muscle and airway obstruction.n nPEF variability=n nPEF variability20%:asthmaPEFmax-PEFmin1/2(PEFmax+PEFmin)100%3.Gas Exchange Testn nGas distribution:n nVentilation/perfusion ratio(V/Q)n nP(A-a)O2:5-15mmHgn nDiffusion capacity(DL)3.1 Gas distributionn nMethod:Nitrogen washout n nA single nitrogen breath:The breath to 750ml-1250ml of instantaneous expiratory nitrogen concentration difference.Normal value:N2%1.5%n nMultiple nitrogen breath(seven minutes):N2%2.5%within seven minutesn nBoth tests can estimate functional residual capacity and the degree of nonuniformity of gas distribution in the lungsn nThe multiple-breath test more accurately measures absolute lung volumes.n nIndividuals with high airflow resistance and low lung pliance can take longer than normal to remove all the nitrogen3.2 Ventilation/perfusion scann nThe ventilation/perfusion ratio(or V/Q ratio)is the ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli.n nThe actual value is approximately 0.8.n nA measurement used to assess the efficiency and adequacy of the matching of two variables.3.3 Diffusion capacityn nDiffusion capacity is a measurement of the Diffusion capacity is a measurement of the lungs ability to transfer gases.lungs ability to transfer gases.n nT The test measures not just he test measures not just diffusiondiffusion across the across the alveolar-capillary membrane,but also takes into alveolar-capillary membrane,but also takes into account factors affecting the chemical account factors affecting the chemical b bination ination of a given gas with of a given gas with hemoglobinhemoglobin.n nValues between 75%and 125%of average Values between 75%and 125%of average diffusion capacity in the healthy population are diffusion capacity in the healthy population are considered normal.considered normal.n nCarbon monoxide(CO)is used as the test gas Carbon monoxide(CO)is used as the test gas to measure the diffusing capacity(Dlco).to measure the diffusing capacity(Dlco).n nNormal:Normal:DLCO:male=18DLCO:male=1838;female=2038;female=2024 24 ml/mmHg/minml/mmHg/min DLCO 80%Predict DLCO 80%Predict n nDiffusion dysfunction:Diffusion dysfunction:DLCO DLCO 80%Predict80%Predictn nReduced:Reduced:Disorders that damage the alveolar walls such as Disorders that damage the alveolar walls such as emphysema,which leads to a loss of effective emphysema,which leads to a loss of effective surface areasurface area.Disorders that Disorders that thickenthicken the alveolar walls such as the alveolar walls such as pulmonary fibrosis.pulmonary fibrosis.Interstitial lung diseases such as hypersensitivity Interstitial lung diseases such as hypersensitivity pneumonitis or dust-inhalation diseases such as pneumonitis or dust-inhalation diseases such as asbestosis.asbestosis.Anemia Anemia n nIncreased:polycythemiaIncreased:polycythemia红细胞增多症红细胞增多症.4.Small Airway Function Testn nSmall airway:diameter 2mmn nClosing volume(CV闭和容积闭和容积):N2 or He washout methods,or body plethysmographyn nMaximum expiratory flow-volume curve(MEFV):Flow-Volume Curve Flow-Volume Curve（V-V CurveV-V Curve）流速）流速）流速）流速-容积曲线容积曲线容积曲线容积曲线Body plethysmography4.1 Closing volume(CV闭和容积)n nThe alveoli lack supporting cartilage and so depend on other factors to keep them open.n nThere is normally enough air within the lungs to keep these airways open throughout both inhalation and exhalation.Method:Closed volume curve 闭合气量曲线闭合气量曲线n nCV:the volume of gas in the lungs in excess of the residual volume(RV)at the time when small airways in the lower sections of the lungs close during maximal exhalation.n n指深呼气至残气位（此时肺低垂部位小气道开始关闭）时，所能继续呼出的气量。n nClosing capacity(CC):the amount of air Closing capacity(CC):the amount of air remaining in the lungs when the small remaining in the lungs when the small airways begin to close.airways begin to close.n n闭合总量：小气道开始闭合时存留于肺内的气量闭合总量：小气道开始闭合时存留于肺内的气量闭合总量：小气道开始闭合时存留于肺内的气量闭合总量：小气道开始闭合时存留于肺内的气量.n nThe closing capacity(CC)is equal to CV The closing capacity(CC)is equal to CV plus RV.plus RV.Normal valuesn nCV/VC%:30 years15%,30 years15%,increased 0.5%*(age-30)increased 0.5%*(age-30)n nCC/TLC%:45%45%n nCV normally increases with age.n nThis also increased in obstructive airways disease,such as asthma,chronic obstructive pulmonary disease,and Pneumoconiosis.n nIt can be used to detect the disease in high-risk patients before clinical signs appear.Flow-Volume Curve（V-V Curve）4.2 Maximum expiratory flow-volume curve(MEFV)n nVmax50:the instantaneous volume of VC50%n nVmax25:the instantaneous volume of VC25%n nVmax50/Vmax25:Small airway disorder:Small airway disorder:active/predictive%70%,and active/predictive%70%,and Vmax50/Vmax25 2.5Vmax50/Vmax25 2.510075502500234Lung diseasenormalFlowL/sVmax 75%Vmax 50%Vmax 25%Flow-Volume Curve（V-V Curve）流量容积曲线 VolumeThe most mon parametersn nVital capacity(VC)Vital capacity(VC)n nForced vital capacity(FVC)Forced vital capacity(FVC)n nForced expiratory volume(FEV)at 1.0 Forced expiratory volume(FEV)at 1.0 seconds(seconds(FEV1FEV1)n nForced expiratory flow 25Forced expiratory flow 25 75%(FEF 2575%(FEF 25 75)75)n nMaximal voluntary ventilation(MVV)Maximal voluntary ventilation(MVV)n nDLCODLCOn nRV/TLCRV/TLCSee you later!