临床肺功能检查PFT-MEDppt.ppt

Pulmonary Function Tests临床肺功能检查What Pulmonary Function Tests Do You Need?SpirometryLung VolumesBody PlethysmographyDiffusing Capacity(DLCO)Arterial Blood Gas AnalysisWater-seal spirometer:水鼓式 Pneumotach流速仪Portable spirometer便携式Portable spirometer动态肺量计Body box体描箱DiffusionWhat Information Does PFT Provide?The function of the airwaysThe function of pulmonary parenchymaPulmonary vasculatureRespiratory muscleSpirometryDetect lung disease(screening)Quantify extent of known diseaseDetermine benefits/risks of therapyAssess surgical riskIndicationsLung Volumes Diagnose/assess restrictive lung diseaseAssess hyperinflation in obstructive diseaseAssess response to treatmentLung transplantationLung volume reductionRadiation,chemotherapyIndicationsDiffusion CapacityFollow progress of interstitial lung diseaseAssess pulmonary involvement in systemic diseaseEvaluate gas exchange in obstructive diseaseAssess pulmonary vascular diseases IndicationsTesting GuidelinesForceful expiration,no hesitation,at least 6 secondsAt least 3 acceptable maneuvers obtainedTwo largest FVC and FEV1 values within 150 mlBest test=largest FVC+FEV1SpirometryInterpretation of Pulmonary Function Testing Step 1.Examine flow-volume loop Is it a good PFTs?Is it normal?Characteristic pattern of obstruction?Pattern of restriction?Pattern of upper airway obstruction?Normal Flow-Volume LoopCoughVariable Effort Severe ObstructionRestrictionUpper Airway Obstruction Step 2.Are the data consistent with flow-volume loop?FVC(VC):an expression of lung sizeFEV1:influenced by lung size and the dimensions of airwayFEV1/FVC:a measure of airway obstructionReduced FVC with normal FEV1/FVC only suggests restriction.TLC is indicated to confirm the restrictionCriteria for RestrictionReduced TLC is a Golden standardReduced FVC with normal FEV1/FVC ratio is sensitive but lacks of specificityNonspecific Ventilation LimitationReduced FVC and FEV1Normal FEV1/FVC Normal TLCRestrictive?Obstructive?Step 3.Examine the response to bronchodilation FEV1:12%or more increase and 200ml increasesGaw*:30-40%or more increase*Chest 1992;101:1572-1581Step 4.Lung volume,diffusion and othersCase 1A 60 year old female was evaluated for dyspnea on exertion.Case 1Case 1RefMeas%FVC3.413.0288 FEV12.531.2349FEV1%7441PEF6.103.9565How to interpret the test?Case 2A 55 year old male was evaluated preoperatively f o r c a t a r a c t s u r g e r y.Case 2Case 2RefMeas%FVC4.601.8540 FEV13.330.9228FEV1%7250PEF8.553.8245How to interpret the test?Case 330 y/o male,186 cm,68 kg,severe interstitial fibrosis.Case 3Case 3RefMeas%FVC6.011.1219 FEV14.891.0421FEV1%8193TLC7.452.0928DLCO 359 26How to interpret the test?Case 4BKM 25 y/o male,non-smoker,cough for 1 month,deniedshortness of breath or wheezing.Normal physical exam.Order a chest x-rayCase 4Case 4RefMeas%FVC5.254.4384 FEV14.443.6181FEV1%8674How to interpret the test?Case 4How to interpret bronchodilator test?Bronchodilator TestPrePost%ChangeFVC4.435.08 15%FEV13.614.10 14%FEV1%74 79Can you make a statement as to the patients underlyinglung disease?Case 5ZXM 39 y/o female,non-smoker,cough and wheezing 10 days,worsening at night,asthma s u s p e c t e d.N o r m a l p h y s i c a l e x a m.Case 5RefMeas%FVC3.324.20127 FEV12.862.2679FEV1%86 66How to interpret the test?Portable spirometry for 14 daysTulobuterol patch 2mg QD for 14 daysCase 5Portable spirometry动态肺量测定Three times daily recordings of spirometryFEV1Case 5 Obstruction based on a reduced FEV1%Recurrent morning falls in FEV1 and PEFPEF variability 68%Substantial improvement with treatmentFinal diagnosis of asthmaCase 6SW58 y/o female,160 cm,84 kgreferred for dyspnea on exertionCase 61)Difficulty to perform spirometry2)Audible stridor during expirationCase 6Case 6Ref Pre%Post%ChangeFVC3.00 2.39 80 2.38 79 0FEV12.22 1.18 53 0.51 23 -57FEV1%74 49 21 -57TLC4.73 4.03 85RV1.72 1.64 95RV/TLC%37 41DLCOCould not be performedCase 7RS50 y/o male,170 cm,64 kghistory of COPD,referred for LVRSCase 7Case 7PredPRE%Pred POST%Pred%ChgFVC4.43 1.79 40 2.74 62 53 FEV13.30 0.63 19 0.92 28 46FEV1%74 35 34 -3TLC6.45 6.79 105RV2.02 3.75 185DLCO27.8 8.9 32Case 7 The patient has severe obstruction based on a markedly decreased FEV1/FVC ratio.Significant hyperinflation is present with an increased RV.The reduced DLCO suggests the presence of anatomic emphysemaThere is a significant response to bronchodilatorHow would you interpret the test?What therapy do you suggest based on the results of PFT?Case 7SummaryPulmonary function tests are valuable for the assessment of lung diseases.By ensuring proper calibration of equipment and performance of test maneuvers,one can differentiate among several different diseases.Thank you for your attention!