肺功能臨床應(yīng)用20112課件

肺功能測定的臨床應(yīng)用肺功能測定內(nèi)容及質(zhì)控肺功能障礙類型臨床應(yīng)用肺功能測定內(nèi)容肺通氣功能VC,FVC,FEV1,MEFR肺容量RV,TLC肺彌散功能DLco,DLco/VA血氣分析氣道激發(fā)試驗心肺運動試驗流速容積環(huán)

Flow[l/s]Volume[l]FEV1InspirationExpirationPIFFIF50FVCFEF75FEF50FEF25PEF1s肺容量PerformingSpirometryBreathinuntilthelungsarefullHoldthebreathandsealthelipstightlyaroundacleanmouthpieceBlasttheairoutasforciblyandfastaspossible.Providelotsofencouragement!ContinueblowinguntilthelungsfeelemptyFlowVolumeCurveExpiratoryflowrateL/secVolume(L)FVCMaximumexpiratoryflow(PEF)InspiratoryflowrateL/secRVTLCSpirometry-QualityControlMostcommoncauseofinconsistentreadingsispoorpatienttechniqueSub-optimalinspirationSub-maximalexpiratoryeffortDelayinforcedexpirationShortenedexpiratorytimeAirleakaroundthemouthpieceSubjectsmustbeobservedandencouragedthroughouttheprocedureUnacceptableTrace-PoorEffortVolume,litersTime,secondsMaybeaccompaniedbyaslowstartInadequatesustainingofeffortVariableexpiratoryeffortNormalVolume,litersTime,secondsUnacceptableTrace–SlowStartNormalVolume,litersTime,secondsUnacceptableTrace-CoughingNormalVolume,litersTime,secondsUnacceptableTrace–ExtraBreathNormal肺功能障礙類型阻塞性通氣功能障礙限制性通氣功能障礙混合性通氣功能障礙彌散功能障礙阻塞性通氣功能障礙FEV1/VC<70%如果FEV1/VC臨界異常，F(xiàn)EF25－75％

<65%可幫助確認(rèn)氣道阻塞限制性通氣功能障礙TLC%<80%預(yù)計值FEV1:%<80%預(yù)計值FVC:%<80%預(yù)計值FEV1/VC:>0.7彌散功能障礙DLco<80%預(yù)計值DLco/VA<80%預(yù)計值彌散功能障礙DLco<80%預(yù)計值DLco/VA<80%預(yù)計值臨床應(yīng)用診斷、監(jiān)測病情、評價療效哮喘COPD肺間質(zhì)疾病肺血管疾病呼吸困難的鑒別診斷手術(shù)風(fēng)險評估氣流受限的可逆性FEV1/FVC<75%吸入200-400ugSabutamol即刻或治療數(shù)天FEV1改善率≥12%；FEV1增加≥200mlFEV1改善率=吸藥后FEV1-吸藥前FEV1

吸藥前FEV1×100%

氣流受限的可變性PEF變異率DiurnalvariabilityPEFfirstthinginthemorning;lastthingatnight(PEFnight-PEFmorning)/meandailyPEFPEF(minmum)PEF(recentbest)>20%Y肺量計測定10min支氣管激發(fā)實驗流程圖N藥物激發(fā)實驗結(jié)果表示方法PC20慢阻肺病情分期I期:輕度 FEV1/FVC<0.70 FEV1

>80%predicted

II期:中度FEV1/FVC<0.7050%<FEV1<80%predictedIII期:重度 FEV1/FVC<0.7030%<FEV1<50%predictedIV期:極重度FEV1/FVC<0.70 FEV1<30%predictedor

FEV1<50%predictedplus

chronicrespiratoryfailure病例-男性，65歲

預(yù)計值用藥前實測/預(yù)計%用藥后用藥后變化%

實測值實測值FVC(L)4.312.35542.402FEV1(L)3.011.19401.39FEV1/FVC(%)4952FEV25%-75%2.830.76270.8410（L/sec）VC(L)4.312.3955TLC(L)6.776.85101RV/TLC(%)3665女性,35歲,結(jié)節(jié)病月FEV1/FVC%VC%DLco%Kco%激素092604284開始490836285減量1487865270加量1779967389維持小劑量男性,66歲,肺血管炎月FEV1/FVC%VC%DLco%Kco%Hb083951051246.60.37610781898.93818938519.510791008210411.9男性,60歲,過敏性肺炎月FEV1/FVCFEV1VCDLcoKco%pred%pred%pred%pred%pred0885851234388210299111130激素治療后女性,63歲,

心肌病，高血壓。口服胺碘酮等藥物。

胸部手術(shù)風(fēng)險評估

診斷流程

PellegrinoR

,etal.EurRespirJ2005;26:948–968血氣基本參數(shù)PaO2 80～100mmHgPaCO2 35～45mmHgpH 7.35～7.45HCO3-21～27(24)mEg/l預(yù)計代償范圍公式類型原發(fā)代償性質(zhì)代償式時間極限呼酸PaCO2HCO3－急性HCO3－＝PaCO2×0.25～10min30mmol/L慢性HCO3－＝PaCO2×0.353～5d45mmol/L呼堿PaCO2HCO3－急性HCO3－＝PaCO2×0.25～10min18mmol/L慢性HCO3－＝PaCO2×0.53～5d12mmol/L酸堿紊亂的判定預(yù)計代償范圍公式類型原發(fā)代償性質(zhì)代償式時間極限代酸HCO3－PaCO2PaCO2＝1.5×HCO3－

＋8±212～24h10mmHg代堿HCO3－PaCO2PaCO2＝0.9×HCO3－

±524～36h55mmHg女性，嘔吐一周

pH7.48PaCO248mmHg(6.4kPa)HCO3-36mmol/L代償式：ΔPaCO2=0.9×ΔHCO3-±5預(yù)計：PaCO2=正常PaCO2+ΔPaCO2=40+0.9×(36-24)±5=45.8~55.8(mmHg)判斷：代謝性堿中毒case1HCO3PaCO2