《肺功能临床应用》PPT课件

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1、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NormalTraceShowingFEV1andFVC1234561234Volume,litersTime,secondsFVC51FEV1=4LFVC=5LFEV1/FVC=0.8流速容积环Flow[l/s]Volume[l]FEV1InspirationExpirationP

2、IFFIF50FVCFEF75FEF50FEF25PEF1s肺容量PerformingSpirometryBreathinuntilthelungsarefullHoldthebreathandsealthelipstightlyaroundacleanmouthpieceBlasttheairoutasforciblyandfastaspossible.Providelotsofencouragement!ContinueblowinguntilthelungsfeelemptyWatchthepatientdu

3、ringtheblowtoassurethelipsaresealedaroundthemouthpieceChecktodetermineifanadequatetracehasbeenachievedRepeattheprocedureatleasttwicemoreuntilideally3readingswithin200mlareobtainedPerformingSpirometryFlowVolumeCurveExpiratoryflowrateL/secVolume(L)FVCMaximumexpi

4、ratoryflow(PEF)InspiratoryflowrateL/secRVTLCSpirometry-QualityControlMostcommoncauseofinconsistentreadingsispoorpatienttechniqueSub-optimalinspirationSub-maximalexpiratoryeffortDelayinforcedexpirationShortenedexpiratorytimeAirleakaroundthemouthpieceSubjectsmus

5、tbeobservedandencouragedthroughouttheprocedureUnacceptableTrace-PoorEffortVolume,litersTime,secondsMaybeaccompaniedbyaslowstartInadequatesustainingofeffortVariableexpiratoryeffortNormalVolume,litersTime,secondsUnacceptableTrace–StopEarlyNormalVolume,litersTime

6、,secondsUnacceptableTrace–SlowStartNormalVolume,litersTime,secondsUnacceptableTrace-CoughingNormalVolume,litersTime,secondsUnacceptableTrace–ExtraBreathNormal正常参考值肺通气VC和FVC的差异应在200ml以内FEV1/FVC>70%,老年人65-70%FEV1,FVC>80％预计值FEF25－75％>50％预计值SGaw>0.1L/sec/cmH2O/L肺容

7、量TLC>80％预计值RV/TLC<40%弥散功能DLco/VA>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/VC<70%如果FEV1/VC临界异常，FEF25－75％<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:%<80%预计值FEV1/VC:>0.7混合性通气功能障碍TLC%<80%预计值FEV1/VC<70%弥散功能障碍DLco<80%预计值DLco/VA<80%预计值弥散功能障碍

8、DLco<80%预计值DLco/VA<80%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FEV1FEV1/FVCPEFReversibilityVariabilityHyperresponsitiveness气流受限的可逆性FEV1/FVC<75%吸入200-400ugSabut