呼吸系统课件：肺功能检查

Pulmonaryfunctiontest

(Lungfunctiontest)Pulmonaryfunctiontest

(Lung呼吸系统课件：肺功能检查Lungfunctiontest/pulmonaryfunctiontest(PFT)PurposeAssistdiagnosis—COPD,asthma,ILDPerioperativeassessmentMonitoringdiseaseprogressionLaborappraisalLungfunctiontest/pulmonaryPFT-componentsLungvolumesVentilationGasexchangeBloodflowPFT-componentsLungvolumesLungvolumesBasallungvolumesTidalvolume,VTInspiratoryreservedvolume,IRVExpiratoryreservedvolume,ERVResidualvolume,RVBasallungcapacitiesInspiratorycapacityVitalcapacityFunctionalresidualcapacityTotallungcapacityLungvolumesBasallungvolumes1.LungVolumeandSubdivisionsVTIRVERVRVICFRCVCRVTLCNormalrespirationbasallineForcedexpiratorybasalline500mlForcedinspiratorybasalline1.LungVolumeandSubdivisioClinicalSignificance---Volume残气容积(RV)Normal:

male1615ml,female1245

Inc-：Lunghyperinflation,e.g.emphysemaDec-:Lungvolumereduction,e.g.ARDS,ILD功能残气量（FRC）:ERV+RVNormal:3112ml,female2348mlInc-：Lunghyperinflation,e.g.emphysemaDec-:Lungvolumereduction,e.g.ARDS,ILDClinicalSignificance---VolumeClinicalSignificance---capacity肺活量（VC）:IC+ERVNormal:male4217ml;female3105mlVC%<80%isabnormal.Decreased:restrictiveventilationdisorder/severeobstructiveventilationdisorderClinicalSignificance---capaciClinicalSignificance---capacity深吸气量(IC):VT+IRVNormal:male2617ml,female1970mlDec-:Inspiratorymusclefunctiondecline;lungexpansionislimited功能残气量（FRC）:ERV+RVNormal:3112ml,female2348mlInc-：Lunghyperinflation,e.g.emphysemaDec-:Lungvolumereduction,e.g.ARDS,ILDClinicalSignificance---capaciClinicalSignificance---capacity肺总量（TLC）：VC+RVNormal:male5766ml；female4353mlDec-:restrictiveventilationdisorderInc-:obstructivepulmonarydisorderRV/TLC%(residualairrate)normal:<35%emphysema:>40%oldpersoncanbe50%ClinicalSignificance---capaciVentilationVentilation2.FunctionTestItiscalledasdynamiclungvolumes.

Fastspirometrictracetoillustratetimedventilationtests(airvolumeandairflowduringbreathing).2.FunctionTestItiscalledaVentilationVentilationFunctionTestLungventilationvolume肺通气量VE(minuteventilation)每分静息通气量MVV(maximalvoluntaryventilation)最大通气量Forcedvitalcapacity(FVC用力肺活量)Maximalmid-expiratoryflow(最大呼气中段流量MMEF/MMF)Alveolarventilation(VA)·FunctionTestLungventilation2.1VE(minuteventilation)

=VT×RR/minnormal:4~6liter<3L:hypoventilation>10L:hyperventilation2.1VE(minuteventilation)MVVEvaluationofventilatoryreserveEvaluationofchestsurgicaldanger:MVV>50%:MVV<50%:RiskMVV<30%:ContraindicationMVVEvaluationofventilatoryr2.2MVV(maximalvoluntaryventilation)VentilationreservesMVV%=(MVV-VE)/MVV×100%Normal:>95%Abnormal:<86%Severeabnormal<70%Riskevaluationforthoracicsurgery>60%2.2MVV(maximalvoluntaryve2.3FVC(ForcedVitalCapacity)Thevolumethatafterfullinspiration,toexpirewiththemostforceandthemostrate.2.3FVC(ForcedVitalCapacityFEV1FEV1(forcedexpiratoryvolumeinthefirstsecond)Normal:male3.179L,female2.314LFEV1/Predictvalue<80%:obstructiveventilationdisorderFEV1/FVC%(thefirstrate)FEV1/FVC%:83%FEV2/FVC%:96%FEV3/FVC%:99%Normal:>80%FEV1/FVC%<70%:IrreversibleobstructiveventilationdisorderFEV1FEV1(forcedexpiratoryvo呼吸系统课件：肺功能检查FVCCurve83%Normal96%99%FVCFVCCurve83%Normal96%99%FVC2.4MMEF(maximalmid-expiratoryflow,MMF最大呼气中段流速)Themeanflowbetween25%and75%forcedexpiration.Normal:male3452ml/s,female2836ml/sSignificance:toevaluatethesmallairwayobstructioninearlystage2.4MMEF(maximalmid-expirato10075502500234LungdiseasenormalFlowL/sVmax75%Vmax50%Vmax25%Flow-VolumeCurve（V-VCurve）流量容积曲线

Volume10075502500234Lungdiseasenormflow-volumeloopgraphicallydepictstherateofairflowontheY-axisandthetotalvolumeinspiredorexpiredontheX-axisflow-volumeloopgraphicallyde2.5VA(alveolarventilation)Theairvolumeenteredrespiratorybronchioliandthealveoliduringaminute.GasexchangeVD(deadspace)=150mlVA=(VT–VD)×RR/minNormalVD/VT=0.3-0.4VD/VT:effectiveventilationincreasedVD/VT:effectiveventilationdecreased2.5VA(alveolarventilation2.6ClinicalValuesofVentilationTestEvaluatefunctionofventilationGradesofdysfunctionTypeofventilationdisorderEvaluatedegreeofobstructiveemphysemaEvaluatereversibleofobstruction2.6ClinicalValuesofVentil(1)Evaluatefunctionofventilation

Airrateindex气速指数=Normal=1<1阻塞性>1限制性MVVactive/predictive%VCactive/predictive%(1)Evaluatefunctionofventi(2)DegreesofLungDisfunction

VCorMVVact/pre%FEV1%/FVC%Normal>80>70Mildreduce80-7170-61Mediatereduce70-5160-41Severereduce50-21<=40Respiratoryfailure<=20(2)DegreesofLungDisfunctio(3)ClassificationofVentilativeFunctionDisorder(3)ClassificationofVentila(4)DegreesofObstructiveEmphysema

RV/TLC(%)Normal<=35%Mildemphysema36-45Mediateemphysema46-55Severeemphysema>=56(4)DegreesofObstructiveEmp(5)气道阻塞可逆性测定

BronchodilatorReversibilityTesting(5)气道阻塞可逆性测定1)BronchialDilationTest

支气管舒张试验Method:todetermineFEV1andFEV1/FVC%beforeandafterß2-agonistinhalationimprovedrate=Positive:>12%andimprovedvolume>200mlSignificance:ReversibleobstructionFEV1After-FEV1beforeFEV1before×100%1)BronchialDilationTest

支2)BronchialProvocationTest

支气管激发试验Method:toinhalehistamine/acetylcholinefromlowtohighconcentrationtilltheFEV1decrease≥20%.Calculatedrugvolume(PD20FEV1).Histamine:PD20FEV1<7.8μmolAcetylcholine:PD20FEV1<12.8μmolPositive:indicateairwayhyper-responsiveness2)BronchialProvocationTest3)PEFVariableRatePEF(peakexpiratoryflow):themostflowduringforcedexpiration.Itindicatestheforceofrespiratorymuscleandairwayobstruction.PEFvariability=PEFvariability≥20%:asthmaPEFmax-PEFmin1/2(PEFmax+PEFmin)×100%3)PEFVariableRatePEF(peak3.GasExchangeTestGasdistribution:Ventilation/perfusionratio(V/Q)P(A-a)O2:5-15mmHgDiffusioncapacity(DL)

··3.GasExchangeTestGasdistri3.1GasdistributionMethod:NitrogenwashoutAsinglenitrogenbreath:Thebreathto750ml-1250mlofinstantaneousexpiratorynitrogenconcentrationdifference.Normalvalue:△N2%<1.5%Multiplenitrogenbreath(sevenminutes):N2%<2.5%withinsevenminutes3.1GasdistributionMethod:NBothtestscanestimatefunctionalresidualcapacityandthedegreeofnonuniformityofgasdistributioninthelungsThemultiple-breathtestmoreaccuratelymeasuresabsolutelungvolumes.IndividualswithhighairflowresistanceandlowlungcompliancecantakelongerthannormaltoremoveallthenitrogenBothtestscanestimatefuncti3.2Ventilation/perfusionscanTheventilation/perfusionratio(orV/Qratio)istheratiooftheamountofairreachingthealveolitotheamountofbloodreachingthealveoli.Theactualvalueisapproximately0.8.Ameasurementusedtoassesstheefficiencyandadequacyofthematchingoftwovariables.3.2Ventilation/perfusionsca3.3DiffusioncapacityDiffusioncapacityisameasurementofthelung'sabilitytotransfergases.Thetestmeasuresnotjustdiffusionacrossthealveolar-capillarymembrane,butalsotakesintoaccountfactorsaffectingthechemicalcombinationofagivengaswithhemoglobin.Valuesbetween75%and125%ofaveragediffusioncapacityinthehealthypopulationareconsiderednormal.3.3DiffusioncapacityDiffusiCarbonmonoxide(CO)isusedasthetestgastomeasurethediffusingcapacity(Dlco).Normal:DLCO:male=18～38;female=20～24ml/mmHg/minDLCO≥80%PredictDiffusiondysfunction:DLCO＜80%PredictCarbonmonoxide(CO)isusedaReduced:Disordersthatdamagethealveolarwallssuchasemphysema,whichleadstoalossofeffectivesurfacearea.Disordersthatthickenthealveolarwallssuchaspulmonaryfibrosis.Interstitiallungdiseasessuchashypersensitivitypneumonitisordust-inhalationdiseasessuchasasbestosis.AnemiaIncreased:polycythemia红细胞增多症.Reduced:4.SmallAirwayFunctionTestSmallairway:diameter≤2mmClosingvolume(CV闭和容积):N2orHewashoutmethods,orbodyplethysmographyMaximumexpiratoryflow-volumecurve(MEFV):Flow-VolumeCurve（V-VCurve）流速-容积曲线·4.SmallAirwayFunctionTestSBodyplethysmographyBodyplethysmography4.1Closingvolume(CV闭和容积)Thealveolilacksupportingcartilageandsodependonotherfactorstokeepthemopen.Thereisnormallyenoughairwithinthelungstokeeptheseairwaysopenthroughoutbothinhalationandexhalation.4.1Closingvolume(CV闭和容积)TheMethod:Closedvolumecurve

闭合气量曲线Method:Closedvolumecurve

CV:thevolumeofgasinthelungsinexcessoftheresidualvolume(RV)atthetimewhensmallairwaysinthelowersectionsofthelungscloseduringmaximalexhalation.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。CV:thevolumeofgasinthelClosingcapacity(CC):theamountofairremaininginthelungswhenthesmallairwaysbegintoclose.闭合总量：小气道开始闭合时存留于肺内的气量.Theclosingcapacity(CC)isequaltoCVplusRV.Closingcapacity(CC):theamNormalvaluesCV/VC%:30years<15%,increased<0.5%*(age-30)CC/TLC%:<45%NormalvaluesCV/VC%:CVnormallyincreaseswithage.Thisalsoincreasedinobstructiveairwaysdisease,suchasasthma,chronicobstructivepulmonarydisease,andPneumoconiosis.Itcanbeusedtodetectthediseaseinhigh-riskpatientsbeforeclinicalsignsappear.CVnormallyincreaseswithageFlow-VolumeCurve（V-VCurve）Flow-VolumeCurve（V-VCurve）4.2Maximumexpiratoryflow-volumecurve(MEFV)Vmax50:theinstantaneousvolumeofVC50%Vmax25:theinstantaneousvolumeofVC25%Vmax50/Vmax25:Smallairwaydisorder:active/predictive%<70%,andVmax50/Vmax25<2.54.2Maximumexpiratoryflow-vo10075502500234LungdiseasenormalFlowL/sVmax75%Vmax50%Vmax25%Flow-VolumeCurve（V-VCurve）流量容积曲线

Volume10075502500234LungdiseasenormThemostcommonparametersVitalcapacity(VC)Forcedvitalcapacity(FVC)Forcedexpiratoryvolume(FEV)at1.0seconds(FEV1)Forcedexpiratoryflow25–75%(FEF25–75)Maximalvoluntaryventilation(MVV)DLCORV/TLCThemostcommonparametersVita呼吸系统课件：肺功能检查Seeyoulater!Seeyoulater!Pulmonaryfunctiontest

(Lungfunctiontest)Pulmonaryfunctiontest

(Lung呼吸系统课件：肺功能检查Lungfunctiontest/pulmonaryfunctiontest(PFT)PurposeAssistdiagnosis—COPD,asthma,ILDPerioperativeassessmentMonitoringdiseaseprogressionLaborappraisalLungfunctiontest/pulmonaryPFT-componentsLungvolumesVentilationGasexchangeBloodflowPFT-componentsLungvolumesLungvolumesBasallungvolumesTidalvolume,VTInspiratoryreservedvolume,IRVExpiratoryreservedvolume,ERVResidualvolume,RVBasallungcapacitiesInspiratorycapacityVitalcapacityFunctionalresidualcapacityTotallungcapacityLungvolumesBasallungvolumes1.LungVolumeandSubdivisionsVTIRVERVRVICFRCVCRVTLCNormalrespirationbasallineForcedexpiratorybasalline500mlForcedinspiratorybasalline1.LungVolumeandSubdivisioClinicalSignificance---Volume残气容积(RV)Normal:

male1615ml,female1245

Inc-：Lunghyperinflation,e.g.emphysemaDec-:Lungvolumereduction,e.g.ARDS,ILD功能残气量（FRC）:ERV+RVNormal:3112ml,female2348mlInc-：Lunghyperinflation,e.g.emphysemaDec-:Lungvolumereduction,e.g.ARDS,ILDClinicalSignificance---VolumeClinicalSignificance---capacity肺活量（VC）:IC+ERVNormal:male4217ml;female3105mlVC%<80%isabnormal.Decreased:restrictiveventilationdisorder/severeobstructiveventilationdisorderClinicalSignificance---capaciClinicalSignificance---capacity深吸气量(IC):VT+IRVNormal:male2617ml,female1970mlDec-:Inspiratorymusclefunctiondecline;lungexpansionislimited功能残气量（FRC）:ERV+RVNormal:3112ml,female2348mlInc-：Lunghyperinflation,e.g.emphysemaDec-:Lungvolumereduction,e.g.ARDS,ILDClinicalSignificance---capaciClinicalSignificance---capacity肺总量（TLC）：VC+RVNormal:male5766ml；female4353mlDec-:restrictiveventilationdisorderInc-:obstructivepulmonarydisorderRV/TLC%(residualairrate)normal:<35%emphysema:>40%oldpersoncanbe50%ClinicalSignificance---capaciVentilationVentilation2.FunctionTestItiscalledasdynamiclungvolumes.

Fastspirometrictracetoillustratetimedventilationtests(airvolumeandairflowduringbreathing).2.FunctionTestItiscalledaVentilationVentilationFunctionTestLungventilationvolume肺通气量VE(minuteventilation)每分静息通气量MVV(maximalvoluntaryventilation)最大通气量Forcedvitalcapacity(FVC用力肺活量)Maximalmid-expiratoryflow(最大呼气中段流量MMEF/MMF)Alveolarventilation(VA)·FunctionTestLungventilation2.1VE(minuteventilation)

=VT×RR/minnormal:4~6liter<3L:hypoventilation>10L:hyperventilation2.1VE(minuteventilation)MVVEvaluationofventilatoryreserveEvaluationofchestsurgicaldanger:MVV>50%:MVV<50%:RiskMVV<30%:ContraindicationMVVEvaluationofventilatoryr2.2MVV(maximalvoluntaryventilation)VentilationreservesMVV%=(MVV-VE)/MVV×100%Normal:>95%Abnormal:<86%Severeabnormal<70%Riskevaluationforthoracicsurgery>60%2.2MVV(maximalvoluntaryve2.3FVC(ForcedVitalCapacity)Thevolumethatafterfullinspiration,toexpirewiththemostforceandthemostrate.2.3FVC(ForcedVitalCapacityFEV1FEV1(forcedexpiratoryvolumeinthefirstsecond)Normal:male3.179L,female2.314LFEV1/Predictvalue<80%:obstructiveventilationdisorderFEV1/FVC%(thefirstrate)FEV1/FVC%:83%FEV2/FVC%:96%FEV3/FVC%:99%Normal:>80%FEV1/FVC%<70%:IrreversibleobstructiveventilationdisorderFEV1FEV1(forcedexpiratoryvo呼吸系统课件：肺功能检查FVCCurve83%Normal96%99%FVCFVCCurve83%Normal96%99%FVC2.4MMEF(maximalmid-expiratoryflow,MMF最大呼气中段流速)Themeanflowbetween25%and75%forcedexpiration.Normal:male3452ml/s,female2836ml/sSignificance:toevaluatethesmallairwayobstructioninearlystage2.4MMEF(maximalmid-expirato10075502500234LungdiseasenormalFlowL/sVmax75%Vmax50%Vmax25%Flow-VolumeCurve（V-VCurve）流量容积曲线

Volume10075502500234Lungdiseasenormflow-volumeloopgraphicallydepictstherateofairflowontheY-axisandthetotalvolumeinspiredorexpiredontheX-axisflow-volumeloopgraphicallyde2.5VA(alveolarventilation)Theairvolumeenteredrespiratorybronchioliandthealveoliduringaminute.GasexchangeVD(deadspace)=150mlVA=(VT–VD)×RR/minNormalVD/VT=0.3-0.4VD/VT:effectiveventilationincreasedVD/VT:effectiveventilationdecreased2.5VA(alveolarventilation2.6ClinicalValuesofVentilationTestEvaluatefunctionofventilationGradesofdysfunctionTypeofventilationdisorderEvaluatedegreeofobstructiveemphysemaEvaluatereversibleofobstruction2.6ClinicalValuesofVentil(1)Evaluatefunctionofventilation

Airrateindex气速指数=Normal=1<1阻塞性>1限制性MVVactive/predictive%VCactive/predictive%(1)Evaluatefunctionofventi(2)DegreesofLungDisfunction

VCorMVVact/pre%FEV1%/FVC%Normal>80>70Mildreduce80-7170-61Mediatereduce70-5160-41Severereduce50-21<=40Respiratoryfailure<=20(2)DegreesofLungDisfunctio(3)ClassificationofVentilativeFunctionDisorder(3)ClassificationofVentila(4)DegreesofObstructiveEmphysema

RV/TLC(%)Normal<=35%Mildemphysema36-45Mediateemphysema46-55Severeemphysema>=56(4)DegreesofObstructiveEmp(5)气道阻塞可逆性测定

BronchodilatorReversibilityTesting(5)气道阻塞可逆性测定1)BronchialDilationTest

支气管舒张试验Method:todetermineFEV1andFEV1/FVC%beforeandafterß2-agonistinhalationimprovedrate=Positive:>12%andimprovedvolume>200mlSignificance:ReversibleobstructionFEV1After-FEV1beforeFEV1before×100%1)BronchialDilationTest

支2)BronchialProvocationTest

支气管激发试验Method:toinhalehistamine/acetylcholinefromlowtohighconcentrationtilltheFEV1decrease≥20%.Calculatedrugvolume(PD20FEV1).Histamine:PD20FEV1<7.8μmolAcetylcholine:PD20FEV1<12.8μmolPositive:indicateairwayhyper-responsiveness2)BronchialProvocationTest3)PEFVariableRatePEF(peakexpiratoryflow):themostflowduringforcedexpiration.Itindicatestheforceofrespiratorymuscleandairwayobstruction.PEFvariability=PEFvariability≥20%:asthmaPEFmax-PEFmin1/2(PEFmax+PEFmin)×100%3)PEFVariableRatePEF(peak3.GasExchangeTestGasdistribution:Ventilation/perfusionratio(V/Q)P(A-a)O2:5-15mmHgDiffusioncapacity(DL)

··3.GasExchangeTestGasdistri3.1GasdistributionMethod:NitrogenwashoutAsinglenitrogenbreath:Thebreathto750ml-1250mlofinstantaneousexpiratorynitrogenconcentrationdifference.Normalvalue:△N2%<1.5%Multiplenitrogenbreath(sevenminutes):N2%<2.5%withinsevenminutes3.1GasdistributionMethod:NBothtestscanestimatefunctionalresidualcapacityandthedegreeofnonuniformityofgasdistributioninthelungsThemultiple-breathtestmoreaccuratelymeasuresabsolutelungvolumes.IndividualswithhighairflowresistanceandlowlungcompliancecantakelongerthannormaltoremoveallthenitrogenBothtestscanestimatefuncti3.2Ventilation/perfusionscanTheventilation/perfusionratio(orV/Qratio)istheratiooftheamountofairreachingthealveolitotheamountofbloodreachingthealveoli.Theactualvalueisapproximately0.8.Ameasurementusedtoassesstheefficiencyandadequacyofthematchingoftwovariables.3.2Ventilation/perfusionsca3.3DiffusioncapacityDiffusioncapacityisameasurementofthelung'sabilitytotransfergases.Thetestmeasuresnotjustdiffusionacrossthealveolar-capillarymembrane,butalsotakesintoaccountfactorsaffectingthechemicalcombinationofagivengaswithhemoglobin.Valuesbetween75%and125%ofaveragediffusioncapacityinthehealthypopulationareconsiderednormal.3.3DiffusioncapacityDiffusiCarbonmonoxide(CO)isusedasthetestgastomeasurethediffusingcapacity(Dlco).Normal:DLCO:male=18～38;female=20～24ml/mmHg/minDLCO≥80%PredictDiffusiondysfunction:DLCO＜80%PredictCarbonmonoxide(CO)isusedaReduced:Disordersthatdamagethealveolarwallssuchasemphysema,whichleadstoalossofeffectivesurfacearea.Disordersthatthickenthealveolarwallssuchaspulmonaryfibrosis.Interstitiallungdiseasessuchashypersensitivitypneumonitisordust-inhalationdiseasessuchasasbestosis.AnemiaIncreased:polycythemia红细胞增多症.Reduced:4.SmallAirwayFunctionTestSmalla