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1、PulmonaryFunctionTesting1PPT学习交流PulmonaryFunctionTestingHowmuchairvolumecanbemovedinandoutofthelungsHowfasttheairinthelungscanbemovedinandoutHowstiffarethelungsandchestwall-aquestionaboutcomplianceThediffusioncharacteristicsofthemembranethroughwhichthegasmoves(determinedbyspecialtests)Howthelungsres
2、pondtochestphysicaltherapyprocedures2PPT学习交流Evaluatingthepatientpriortosurgery2Screeningforthepresenceofobstructiveandrestrictivediseases3 1Usedforthefollowingreasons3PPT学习交流vitalcapacityAvitalcapacityisanimportantpreoperativeassessmenttool.Significantreductionsinvitalcapacity(lessthan20cc/Kgofideal
3、bodyweight)indicatesthatthepatientisatahigherriskforpostoperativerespiratorycomplications.Thisisbecausevitalcapacityreflectsthepatientsabilitytotakeadeepbreath,tocough,andtocleartheairwaysofexcesssecretions.4PPT学习交流ContentsDocumenting the progression of pulmonary disease - restrictive or obstructive
4、4Evaluatingthepatientsconditionforweaningfromaventilator.3 3Documenting the effectiveness of therapeutic intervention3 5Usedforthefollowingreasons5PPT学习交流BronchialclassificationBronchialclassification6PPT学习交流pulmonaryalveolipulmonaryalveoliRB呼吸性细支气管呼吸性细支气管AD肺泡管肺泡管A肺泡肺泡7PPT学习交流impactfactorsimpactfact
5、orsgenderandbodysizewhichhaveanimpactonthelungfunctionofoneindividualcomparedtoanother.Raceenvironmentalfactorsandaltitude8PPT学习交流9PPT学习交流Static lung parameterIRVERVVTVCSpirometryFRCRV10PPT学习交流TerminologyandDefinitionsTerminologyandDefinitionsFVC-ForcedVitalCapacityFEV1-ForcedExpiratoryVolumeinOneSe
6、condFEV1/FVC-FEV1Percent(FEV1%)-TFEV1/FVCratio.FEV3-ForcedExpiratoryVolumeinThreeSecondsFEV3/FVC-FEV3%-ThisnumberistheratioofFEV3totheFVC-11PPT学习交流PEFR-PeakExpiratoryFlowRateFEF-ForcedExpiratoryFlow-ForcedexpiratoryFlowisameasureofhowmuchaircanbeexpiredfromthelungs.FEF25%,FEF50%,andFEF75%ofFVC.FEF25
7、%-75%-MVV-MaximalVoluntaryVentilation12PPT学习交流WhatCanAPFTBeUsedForWhatCanAPFTBeUsedForPulmonaryfunctionabnormalitiescanbegroupedintotwomaincategories:obstructivedefects.restrictivedefects.13PPT学习交流ObstructedAirflowObstructedAirflowbereducedforanumberofreasons：narrowingoftheairwaysduetobronchialsmoot
8、hmusclecontractionasisthecaseinasthmanarrowingoftheairwaysduetoinflammationandswellingofbronchialmucosaandthehypertrophyandhyperplasiaofbronchialglandsasisthecaseinbronchitismaterialinsidethebronchialpassagewaysphysicallyobstructingtheflowofairasisthecaseinexcessivemucusplugging,inhalationofforeigno
9、bjectsorthepresenceofpushingandinvasivetumors14PPT学习交流destructionoflungtissuewiththelossofelasticityandhencethelossoftheexternalsupportoftheairwaysasisthecaseinemphysemaexternalcompressionoftheairwaysbytumorsandtraumaObstructedAirflowObstructedAirflow15PPT学习交流RestrictedAirflowRestrictedAirflowExtrin
10、sicRestrictiveLungDisorders1.Scoliosis,Kyphosis2.AnkylosingSpondylitis3.PleuralEffusion(fluidinthepleuralcavity)4.Pregnancy5.GrossObesity6.Tumors7.Ascites8.Painoninspiration-pleurisy,ribfractures16PPT学习交流NeuromuscularRestrictiveLungDisorders1.GeneralizedWeaknessmalnutritio2.Paralysisofthediaphragm3.
11、MyastheniaGravis4.MuscularDystrophy5.Poliomyelitis6.AmyotrophicLateralSclerosis-LouGerigsDiseaseRestrictedAirflowRestrictedAirflow17PPT学习交流RestrictedAirflowRestrictedAirflowIntrinsicRestrictiveLungDisorders1.Sarcoidosis（结节病）2.Tuberculosis（结核）3.Pnuemonectomy(lossoflung)4.Pneumonia（肺炎）18PPT学习交流Criteri
12、onforObstructiveandRestrictiveCriterionforObstructiveandRestrictiveDiseaseDiseaseFVC（用力肺活量）（用力肺活量）Inobstructivediseases,thelungsairvolumewillbemoreslowlyexpelledandwillbeasmallervolumeoverthetimecourseoftheFVCtestthanwouldbeexpectedinanormal,healthyindividual.Inpatientswithrestrictivelungdisease,the
13、FVCwillbesmallerbecausetheamountofairthatcanbeforcefullyinhaledorexhaledfromthelungsissmallertostartwithbecauseofdisease.19PPT学习交流CriterionforObstructiveandRestrictiveCriterionforObstructiveandRestrictiveDiseaseDiseaseSinceFVCwillbesmallerinobstructivedisordersandinrestrictivedisorders(usuallynoonew
14、orriesabouttheFVCunlessitis80%-85%ofpredictedvolumes),FVCalonecannotbeusedtodiagnoseobstructiveandrestrictivedisordersallbyitself20PPT学习交流CriterionforObstructiveandRestrictiveCriterionforObstructiveandRestrictiveDiseaseDiseaseThepatientmayrepeatthetestafterinhalingabronchodilator.animprovedFVC-often
15、timesa10%-15%improvement.ThissimpleclinicalteststronglysuggeststhattheFVCwaslowduetoobstructivephenomenon.IftheFVCdidnotchange,itsuggeststheFVCwaspossiblylowduetorestrictivepathologies.21PPT学习交流AnotherstrategythatcanhelpyoudecideifthelowFVCisduetoobstructiveorrestrictiveprocessesistohavethepatientpe
16、rformaSlowVitalCapacity(SVC)Test.Thistestisperformedbyhavingthepatientslowlyandcompletelyblowoutalloftheairfromtheirlungs.CriterionforObstructiveandRestrictiveCriterionforObstructiveandRestrictiveDiseaseDisease22PPT学习交流FVCFVCIfthevitalcapacityimprovesafteraSVCtest,thenitcanbeassumedthattheoriginalsm
17、allFVCwascausedbyairwaycollapseanddoesnotindicatethepresenceofrestrictivedisease.IfthevitalcapacitydoesnotimproveeitherwiththeinhalationofabronchodilatorordoesnotimprovewiththeadministrationofaSVCtest,thenrestrictivepathologiesmustbeconsideredasapossiblecauseforthesmallvitalcapacityresults.23PPT学习交流
18、FEV1FEV1 FEV1%FEV1%FEV1Healthyindividualstobeabletoexpell75%-80%highlydiagnosticofobstructivediseasFEV1%alowFEV1andtheFEV1%islow-obstructivepathologiesalowFEV1andsowilltheFVCthe%FEV1maywellbecalculatedtobebetween85%-100%ofnormal.-restrictivedisease24PPT学习交流通气功能的临床意义通气功能的临床意义-临床上常用第临床上常用第1秒用力秒用力呼出气量呼
19、出气量(FEV1)应应1.2升升,若若1.2胸外手胸外手术禁忌术禁忌.-一秒率一秒率(FEV1%)其正其正常值大于常值大于75%. 判断通判断通气障碍性质气障碍性质- 阻塞性通气障碍：阻塞性通气障碍： FEV1% ,FVCFEV1% ,FVC均减小均减小均减小均减小(70-60%)(80%).FEV1%=FEV1/FVC10025PPT学习交流FEF25%-75%FEF25%-75%thepresenceofobstructiveairwaydisease.thefirstquarteroftheFVCtestisinparteffectedbythepatientseffortinoverc
20、omingtheinertialforceswhichresistthoracicwallexpansion.lastquarterofaFVCtestispollutedbythepatientsdiminishingphysicaleffort,theinstigationofbronchospasmduringforcedexpirationmostrepresentativeoftrueexpiratorypatencyandisthereforeaverysensitivetestforthepresenceofobstructivedisease.26PPT学习交流Dynamic
21、lung parameter27PPT学习交流通气功能的临床意义通气功能的临床意义 最大呼气中期流量最大呼气中期流量(MMEF): 将将FVC曲线起始至终止两曲线起始至终止两点平均分为四等分，点平均分为四等分， 取其中间取其中间2/4段段(MEF75 MEF25)的肺容量与其所用的呼气时间之比所得之值的肺容量与其所用的呼气时间之比所得之值, 見見下图下图 MMEF=AB/CD 单位单位: L/sec。 MMEF反映的是呼气的非用力反映的是呼气的非用力 部分部分,至一定程度用力时流量恒至一定程度用力时流量恒 定不变定不变,流量的流量的大小取决小气大小取决小气 道的直径道的直径,反映了小气道气流阻
22、反映了小气道气流阻 塞塞.比比FEVF1,FEV1%能灵敏地能灵敏地 反映小气道阻塞情况反映小气道阻塞情况. 28PPT学习交流HowDoYouTellIfThePatientIsNormalorHasHowDoYouTellIfThePatientIsNormalorHasMild,ModerateorSeverePulmonaryDisease?Mild,ModerateorSeverePulmonaryDisease?Thereareanumberofsystemswhichphysiciansusetodeterminetheseverityofdisease.Hereisjuston
23、ewaythatisverycommonlyused:NormalPFTOutcomes-85%ofpredictedvaluesMildDisease-65%but50%but65%ofpredictedvaluesSevereDisease-50%ofpredictedvalues29PPT学习交流ThePFTBeforeandAfterAerosolThePFTBeforeandAfterAerosolBronchodilatorsBronchodilatorsBeta-2selectivesympathomimetic（沙丁胺醇）（沙丁胺醇）Thisassessesthedegreeo
24、freversibilityoftheairwayobstruction.FVC,FEV1andFEF25%-75%improve,thenitcanbesaidthatthepatienthasareversibleairwayobstructionlFVC:anincreaseof10%ormorelFEV1:anincreaseof200mlor15%ofthebaselineFEV1lFEF25%-75%:anincreaseof20%ormore30PPT学习交流asystematicwaytoreadthePFTasystematicwaytoreadthePFTStep1.Loo
25、kattheforcedvitalcapacity(FVC)toseeifitiswithinnormallimits.Step2.Lookattheforcedexpiratoryvolumeinonesecond(FEV1)anddetermineifitiswithinnormallimits.Step3.IfbothFVCandFEV1arenormal,thenyoudonothavetogoanyfurther-thepatienthasanormalPFTtest.31PPT学习交流asystematicwaytoreadtheasystematicwaytoreadthePFT
26、PFTStep4.IfFVCand/orFEV1arelow,thenthepresenceofdiseaseishighlylikely.Step5.IfStep4indicatesthatthereisdisesethenyouneedtogotothe%predictedforFEV1/FVC.Ifthe%predictedforFEV1/FVCis88%-90%orhigher,thenthepatienthasarestrictedlungdisease.Ifthe%predictedforFEV1/FVCis69%orlower,thenthepatienthasanobstructedlungdisease.32PPT学习交流Decision : This person is obstructedDecision:ThispersonisobstructedDecision : This person is obstructedDecision : This person is obstructed33PPT学习交流实实 例例男，59岁。身高151cm。体重46kg。34PPT学习交流谢谢谢！谢！35PPT学习交流
