常規(guī)肺功能測定課件

1、Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 常規(guī)肺功能常規(guī)肺功能(gngnng)(gngnng)測定測定呼吸科呼吸科 李凡李凡第一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital

2、第二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第四頁，共一百零六頁。Songjiang Hospital

3、affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peop

4、leSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliate

5、d Shanghai first peoples hospital s hospital 第九頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital TLC：VC+RV VC： IC+ERV IC： IRV+VT FRV： ERV+RV 第十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hosp

6、ital affiliated Shanghai first peoples hospital s hospital 第十一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai fir

7、st peoples hospital s hospital 一期一期(y q)肺活量和分期肺活量肺活量和分期肺活量第十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital Copd患者(hunzh)第十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated

8、Shanghai first peoples hospital s hospital 第十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospi

9、tal s hospital 第十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第十九頁，共一百零六頁。S

10、ongjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十一頁，共一百零六頁。Songjiang Hospital affiliate

11、d Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSon

12、gjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated

13、 Shanghai first peoples hospital s hospital 第二十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 用力(yng l)肺活量(forced vital capacity)第二十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital a

14、ffiliated Shanghai first peoples hospital s hospital 第二十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第二十九頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first p

15、eoples hospital s hospital 第三十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital

16、第三十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十四頁，共一百零六頁。Songjiang Hos

17、pital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai

18、first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第三十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hosp

19、ital affiliated Shanghai first peoples hospital s hospital 第三十九頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第四十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai fi

20、rst peoples hospital s hospital 第四十一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第四十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hos

21、pital 第四十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 間接測量法動靜脈分流量的測定：肺泡氧分壓=大氣壓水蒸汽分壓肺泡氣PCO2PaO2可直接測定動脈-混合(hnh)靜脈血氧含量差=5第四十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated

22、 Shanghai first peoples hospital s hospital 第四十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第四十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples ho

23、spital s hospital 第四十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第四十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第四十九頁，共一

24、百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 通氣動力(dngl)機制 通氣動力機制又稱呼吸動力機制 主要研究肺通氣的動力肺通氣的阻力 通氣 外環(huán)境與肺泡之間的氣體交換需產(chǎn)生肺泡和外環(huán)境之間的壓力差由呼吸中樞(zhngsh)、神經(jīng)傳導(dǎo)、呼吸肌和呼吸器 官參與。第五十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleS

25、ongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五十一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliat

26、ed Shanghai first peoples hospital s hospital 第五十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples

27、hospital s hospital 第五十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五十七頁，

28、共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital )第五十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第五十九頁，共一百零六頁。Songjiang Hospital

29、 affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六十一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first

30、peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 70% 70%預(yù)計預(yù)計(yj)(yj)值值 Vmax25% 70%Vmax25% 70%預(yù)計值預(yù)計值 2.5/第六十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六十三頁，共一百零六頁。Songjiang Hospit

31、al affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 肺功能測定的臨床(ln chun)應(yīng)用第六十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六十五頁，共一百零六頁。Songjiang Hospital affi

32、liated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 通氣通氣(tng q)指標(biāo)指標(biāo) 阻塞性阻塞性 限制性限制性 混合性混合性FVCN或或 FEV1 FEV1/FVC N或或 MMEF MVV 第六十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s h

33、ospital 第六十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第六十九頁，共一百零六頁。Songj

34、iang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第七十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 第七十一頁，共一百零六頁。Songjiang Hospital affiliated Sh

35、anghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 病例(bngl)一男，71歲，體重88Kg，身高175cm。吸煙1480年支，主訴呼吸困難進行性加重，輕度活動出現(xiàn)氣喘。有家屬性肺疾病史。預(yù)計值實測值實測/預(yù)計 吸入支擴動態(tài)肺容積FVC4.291.94452.76FEV13.291.03311.25FEV1/FVC7753FEF25-752.80.4150.5MVV1255141靜態(tài)(jngti)肺容量TLC6.619.37142RV/TLC3575214DLC

36、O251040第七十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 病例(bngl)一1.如何評價檢測結(jié)果(ji gu)？2.DLCO的減少說明什么？第七十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first people

37、s hospital s hospital 分析(fnx)預(yù)計值實測值實測/預(yù)計吸入支擴劑動態(tài)肺容積FVC4.291.94452.76FEV13.291.0331（38）1.25FEV1/FVC775364FEF25-752.80.4150.5MVV1255141靜態(tài)(jngti)肺容量TLC6.619.37142RV/TLC3575214DLCO251040第七十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples ho

38、spital s hospital 答 案一、評價1.吸入支氣管擴張劑后， FEV1/FVC=0.45， FEV1/pre=0.38，氣流受限，通氣功能障礙。2.TLC和RV/TLC升高，肺過度充氣。3.支氣管擴張試驗：FEV1= 4.5%， FEV1絕對值220ml。陰性4.彌散(msn)功能降低意味著肺氣腫存在。二、 DLCO的減少：1.反映肺實質(zhì)或肺血管的異常，此例是肺氣腫引起。第七十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai fir

39、st peoples hospital s hospital 病例(bngl)二女性，36歲，體重83Kg，身高(shn o)162cm。預(yù)計值實測值實測/預(yù)計 吸入支擴劑動態(tài)肺容積FVC3.693.27893.36FEV13.102.93942.93FEV1/FVC8489FEF25-753.14.0131MVV113121106靜態(tài)肺容量TLC5.044.6292RV/TLC272178DLCO2424100第七十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliate

40、d Shanghai first peoples hospital s hospital 問 題1.該病人有通氣功能障礙嗎？2.檢測數(shù)據(jù)支持你的初步(chb)影像嗎？3.該流量-容積曲線正常嗎？第七十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 分 析預(yù)計值實測值實測/預(yù)計 吸入支擴劑動態(tài)肺容積(rngj)FVC3.693.27893.36（91%）FEV13.102.939

41、42.93（95%）FEV1/FVC848987FEF25-753.14.0131MVV113121106靜態(tài)肺容量TLC5.044.6292RV/TLC272178DLCO2424100第七十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 答 案 沒有通氣功能障礙。 檢測數(shù)據(jù)正常。 呼氣(h q)至2.4L時，出現(xiàn)“膝狀”拐點，此后氣體流量急劇下降，屬于正常變異，尤其女性。曲

42、線到達(dá)拐點前，曲線的形態(tài)取決于氣管最狹窄段，這段曲線稱“氣管平臺”。第七十九頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 病例(bngl)三女性，29歲，體重129Kg，身高165cm預(yù)計(yj)值實測值實測/預(yù)計(yj)吸入支擴劑動態(tài)肺容積FVC3.943.0678FEV13.342.6479FEV1/FVC8586FEF25-753.42.885MVV1209075靜態(tài)肺容

43、量TLC5.184.2382RV/TLC2428117DLCO252496第八十頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 問 題1.有通氣功能障礙嗎？2.所示數(shù)據(jù)可以作何診斷？3.該患者有何特別之處？4.如果患者吸煙(x yn)9年，共72年支，訴氣管炎反復(fù)發(fā)作，伴氣喘及呼吸困難，還要做哪些檢測？第八十一頁，共一百零六頁。Songjiang Hospital affilia

44、ted Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 分 析預(yù)計(yj)值實測值實測/預(yù)計(yj)吸入支擴劑動態(tài)肺容積FVC3.943.0678輕度通氣FEV13.342.6479功能障礙FEV1/FVC8586FEF25-753.42.885MVV1209075靜態(tài)肺容量TLC5.184.2382RV/TLC2428117DLCO252496第八十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai firs

45、t peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 答 案 輕度通氣功能障礙。 TLC較低但正常(zhngchng)，F(xiàn)VC和FEV1成比例降低，但FEV1/FVC正常(zhngchng)，DLCO正常(zhngchng)，提示“非特異性通氣功能障礙”。 病人肥胖，BMI47.7（正常 ） 氣道激發(fā)試驗。第八十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliate

46、d Shanghai first peoples hospital s hospital 說 明非特異性通氣功能異常：FEV1和FVC均下降，但FEV1/FVC正常(zhngchng)，符合限制性疾病，但TLC正常(zhngchng)，所以限制性疾病診斷不成立，故稱。第八十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 氣道激發(fā)(jf)試驗 圖中提示：FEV1下降了21%。 診

47、斷：中度通氣(tng q)功能障礙，引起原因：哮喘和肥胖。第八十五頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 病例(bngl)四男性，76歲，體重779Kg，身高168cm預(yù)計值實測值實測/預(yù)計吸入支擴劑動態(tài)肺容積FVC3.692.4466FEV12.831.3347FEV1/FVC7755FEF25-752.60.7MVV1123027靜態(tài)(jngti)肺容量TLCRV/T

48、LCDLCO第八十六頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 問 題 通氣困難的嚴(yán)重程度？ 引起通氣困難的原因是什么？ 檢測數(shù)據(jù)中有何異常？ 流量-容積曲線(qxin)有何異常？ 還需做其他什么檢測？第八十七頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affil

49、iated Shanghai first peoples hospital s hospital 分 析預(yù)計值實測值實測/預(yù)計動態(tài)(dngti)肺容積FVC3.692.4466中度下降FEV12.831.3347重度下降FEV1/FVC7755嚴(yán)重下降FEF25-752.60.7MVV1123027嚴(yán)重下降第八十八頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 答 案 嚴(yán)重通氣功

50、能障礙 主要為阻塞性通氣功能障礙 MVV下降程度(chngd)大于FEV1下降程度(chngd)，可能存在：配合不好、神經(jīng)肌肉疾病、大氣道疾病。第八十九頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 答 案 流量曲線異常：在FVC的前50%以內(nèi)，流量在1.3L/s，之后(zhhu)曲線出現(xiàn)異常平臺期，是典型的大氣道病變。 需要進一步做“吸氣流速-容量環(huán)”檢測。第九十頁，共一百零六

51、頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 吸氣流速-容量(rngling)環(huán)測定 最大吸氣流量與最大呼氣流量接近一致的降低，提示氣道內(nèi)病變?yōu)楣潭ㄐ圆∽儭?這是一例韋格納氏肉芽腫病人，兩側(cè)主支氣管受累。 支架(zhji)后仍未達(dá)到正常。第九十一頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hosp

52、ital affiliated Shanghai first peoples hospital s hospital 幾種常見的流量(liling)容積環(huán)意義 正常(zhngchng)第九十二頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 幾種常見(chn jin)的流量容積環(huán)意義 阻塞性第九十三頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 幾種常見的流量容積(rngj)環(huán)意義 限制性第九十四頁，共一百零六頁。Songjiang Hospital affiliated Shanghai first peopleSongjiang Hospital affiliated Shanghai first peoples hospital s hospital 幾種常見的流量容