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Pulmonary Function Tests

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1 Pulmonary Function Tests
Department of Respiratory medicine Zhongshan Hospital Fudan University Zhu Lei

2 The Indication for PFTs
Dyspnea, chronic cough Suspectable bronchus, lung, heart, or vertebrae diseases Descending motor ability Judgment of airway hyperresponsiveness

3 The Indication for PFTs
The evaluation of therapeutic efficacy in bronchial danrespiratory diseases (No therapy without check!) The investigation of community medicine and epidemiology The evaluation of risk of surgery and anaesthesia The research of occupational disease

4 Some Important Name 肺功能测定 肺功能参数 静态肺功能参数 动态肺功能参数 动脉血气
Pulmonry function test -PFT 肺功能参数 Pulmonry function parameters -PFPs 静态肺功能参数 Static lung parameters 动态肺功能参数 Dynamic lung parameters 动脉血气 Artery blood gases-ABGs

5 The Content of Pulmonary Function Testing
lung volume Ventilation Function Gas Exchange Funtion Gas distrubusion Gas diffusion Ventilation perfusion ratio Lung shunt Dynamic mechanism Arterial blood gases analysis

6 Lung Capacity

7 Basal Lung Volume tidal volume(VT) Inspiratory Reserve Volume(IRV)
VT×RR=VE Inspiratory Reserve Volume(IRV) Expiratory Reserve Volume(ERV) Residal Volume(RV)

8 Basal Lung Capacity Inspiratory Capacity(IC) Vital Capacity(VC)
Functional Residual Capacity(FRC) Total Lung Capacity(TLC)

9 Normal Pulmonary Function
Capacity directly measured lung capacity indirectly measured lung capacity (the parameters including RV) Ventilation function forced expiratory volume and forced expiratory volume in certain second maximal voluntary ventilation flow-volume curve direct measurement CO diffusion indirect measurement

10 The measurement of directly measured lung capacity and ventilation
肺活量和静息通气功能 Slow Spirometry 流速容量环 Flow-Volume Loop 时间肺活量检查 Forced Spirometry 每分钟最大通气量检查 MVV

11 Spirometer 1846 J. Hutchinson “VC” 1950 Tiffeneau “V (t), FVC, FEV1”
1956 Du Bois “Raw, Zosc” residual volume determinating apparatus diffusion capacity test apparatus

12 Flowmeter

13 Pneumotachygraph Lilly Type Flow Transducer

14 Static lung parameter

15 Pulmonary Ventilation Function
Expiratory Minute Ventilation(VE) Alveolar Ventilation(VA) Maximal Ventilatory Volume(MVV) Forced Vital Capacity(FVC) Flow-Volume Curve(Loop)

16 Alveolar Ventilation Gas volume from exhalerespiratory bronchiole and alveoli Ventilation efficacy anatomical dead space alveolar dead space physiological dead space(VD)

17 VA-calculation • VD PACO2-PECO2 VT PACO2-PICO2 • VD PaCO2 -PECO2
· PACO2= PaCO2,PICO2=0 • VD PaCO2 -PECO2 VT PaCO2 • VA=VT(1-VD/VT)×RR

18 The clinical importance of VA
• VA: effective ventilation • consequence of VA • PaO2↓ PaCO2↑ •influencing factor •VE ↓ •alteration of respiraion pattern

19 Forced Spirometry FEV1 FVC a b MMEF = bc / ab c 0 1 2 3 4 5 Volume(L)
TLC FEV FVC a b MMEF = bc / ab c RV Time(s)

20 Dynamic lung parameter
FVC FEV1 绝对值占预计值的比例,反应减退的程度 FEV1/FVC 反映阻塞的存在 COPD与阻塞的区别

21 Dynamic lung parameter

22 Combination Flow Volume - Spirometry

23 MVV Measurement time 12s or 15s MVV=measured value*5(or 4)

24 Operating Requirements

25 Environmental Calibration
Measurement of Environmental Parameters BTPS autocorrection

26 Volume Calibration Automatic volume (flow) calibration
Manual volume calibration

27 Gas calibration CO 原理:电化学法 范围:0 - 0.4 % 分辨率:0.0002 % 精度: 0.003%
He 原理:惠斯通电桥热导式 范围: % 分辨率:0.005 % 精度: 0.05% 稳定性:< 0.02% CO 原理:电化学法 范围: % 分辨率: % 精度: 0.003% 稳定性:< %

28 Prerequisites for best function measurements to obtain reliable and reproducible parameters
subjects : - sitting position- static lung parameters - erect position - dynamic lung parameters - maximal motivation operator : routine in operating the equipment detailed and comprehensible instruction of the patient before measurement reliable and motivating instruction of the patient during the measurement

29 影响肺功能的相关因素 身高、体重、年龄、种族 生长,老年改变 体位 昼夜变化:早晨FEV1下降0.2升
取预计值的80% FEV1/FVC和RV/TLC例外 体位 昼夜变化:早晨FEV1下降0.2升 妊娠:TLC /(-);RV、FRC、VC(-) 其它:环境因素、吸烟

30 间接测定肺功能指标的测定方法 肺总量 残气量 弥散 体容积描记法 间接测量的参数 功能残气量 测量方法 氮稀释法-密闭式重复描记法
间接测量的参数 功能残气量 肺总量 弥散 密封式氦稀释法- 重复呼吸法 - 一口气法 测量方法 氮稀释法-密闭式重复描记法 体容积描记法

31 Lung Volume by SB with Helium DLCO by SB
Single Breath Method Lung Volume by SB with Helium DLCO by SB

32 3 Steps of a diffusion 1. Distribution 2. Diffusion 3. Perfusion
Diffusion physiology 3 Steps of a diffusion 1. Distribution 2. Diffusion 3. Perfusion

33 DLCO = Inspired gas volume/mmHg/min diffuded gas amount
Diffusion physiology DLCO = Inspired gas volume/mmHg/min diffuded gas amount PACO×breath hold time

34 Diffusion SB

35 Diffusion by RB

36 弥散功能的影响因素 体表面积 年龄 体位 运动 肺容量 屏气时间 吸氧浓度 吸烟 血红蛋白

37 气体弥散的决定因素 呼吸膜两侧气体分压差: * 正常的通气功能 气体溶解度 * 气相:CO2<O2 气体分布 弥散面积、距离 血流量
* 正常的通气功能 * 正常的气体分布 * 时间常数 气体溶解度 * 气相:CO2<O2 * 液相:CO2>O2 正常肺 CO2弥散率/O2 弥散率=20.6/1 气体分布 弥散面积、距离 血流量

38 Abnormal Pulmonary Function

39 Obstructive disease .

40 obstructive ventilation disorder
Normal Mild Severe

41 Impertant Concept Airway Obstrucion Airflow Obstructin
Airflow Limitation

42 Airflow Obstruction of perapheral airway
FEV1 FVC VC >FVC RV、FRC、FRC/TLC

43 Middle- perapheral airway Obstruction
FEV1 FVC 0 RV、FRC、FRC/TLC

44 Fixed Obstruction of Large Airway
Flow FEV1 Volume VC、RV、FRC、FRC/TLC-

45 intrathoracic nonfixed obstruction of large airway
Flow Vlume

46 Extrathoracic Nonfixed Obstruction of Large Airway
Flow Volume

47 Restrictive Ventilation Disorder

48 Restrictive Ventilation Disorder
FEV1 0 FVC FVC =VC RV、FRC FRC/TLC

49 Grade of Pulmonary Funcion
mild middle severe VC (FVC) <40 FEV <40 MVV <40

50 Small Airway Dysfunction
•FVC、FEV1、FEV1/FVC: Normal •FEF25~75%(MMEF)、FEF50%(V50)、 FEF25(V25) : two of three <lower limit of normal(LLN)

51

52 Dynamic Lung Compliance at Certain Respiratory Rrequency (CdynRR)

53 Normal Small Airway Function

54 Small Airway Dysfunction

55 通气功能障碍基本判断标准 阻塞性通气功能障碍 限制性通气功能障碍 FVC<95%正常预计值可信限 小气道病变
FEV1/FVC比值<95%正常预计值可信限 限制性通气功能障碍 FVC<95%正常预计值可信限 小气道病变 FVC、FEV1、FEV1/FVC三者在正常范围 FEF25~75%、FEF50%、FEF25三者中有二个低于 95%正常预计值可信限

56 激发试验 药物激发试验 运动激发试验 冷激发试验

57 The PFP change of COPD

58 High risk factors Small airway disease

59 Mild obstructive Obstructive ventilation Normal pulmonary volume
Normal DLco

60 Mild to middle obstructive
Obstructive ventilation Normal pulmonary volume Decreased DLco Deep and slow breath

61 Middle obstructive Obstructive ventilation Lung volume Decreased DLco
Normal VC Increased RV FRC RV/TLC FRC/TLC Decreased DLco Deep and slow breath

62 Middle to severe obstructive
Obstructive ventilation Lung volume Decreased VC Increased RV FRC RV/TLC FRC/TLC Decreased DLco Deep and slow breath Increased VE

63 Severe obstructive Obstructive ventilation Lung volume Decreased DLco
Decreased VC Increased RV FRC RV/TLC FRC/TLC(>67%) Decreased DLco Shallow and quick breath Respiratory failure Increased PaCO2

64 Arterial Blood Gases Analysis

65 Arterial Oxygen Partial Pressure(PaO2)
P total =PN2+PO2+PCO2+••• 氧分压为氧气所占的部分压力,即溶解状态的氧所占的压力 平原 正常值95~100mmHg(年轻人) 高原 大气压 PaO2 PAO2与VA 、每分钟氧耗量及FiO2有关

66 PaO2 PaO2与PiO2 、通气功能、换气功能及机体氧耗量有关 空气 肺泡 动脉血 混合静脉血 PO2 150 104 100 40
空气、肺泡、动脉血和混合静脉血氧和CO2分压的比较(mmHg) 空气 肺泡 动脉血 混合静脉血 PO PCO

67 Arterial Partial Pressure of CO2(PaCO2)
CO2分压是血液中溶解状态的CO2所占的压力 CO2排出途径 体内产生的CO2 经静脉血 右心 肺血管 肺泡 经呼气 排出体外 VCO2恒定时,PACO2与VA成反比 PaCO2的正常值、临床意义

68 Arterial Saturation of Hb with O2(SaO2)
SaO2= HbO2/(HbO2+Hb)×100% Normal value 95~98%

69 Oxygen Dissociation Curve
SaO2 PaO2

70 Oxygen Dissociation Curve
Influencing Factor right shift left shift PaCO ↑ ↓ pH ↓ ↑ temperature ↑ ↓ 2,3-DPG ↑ ↓

71 Arterial Content of O2 (CaO2)
CaO2指每100ml血液中所携带氧的ml数 包括 物理溶解的氧 与Hb结合的氧 CaO2=0.003×PaO × SaO2 × Hb 氧的溶解系数是指100ml血液中每1mmHg氧分压有 ml物理溶解状态的氧 氧的溶解系数为

72 CaO2 ▲在SaO2为95%,Hb为15.5g%状态下 ◆正常人动脉血红蛋白结合氧量为
1.34(ml/g) ×95%×15.5g%=19.7ml/100ml ◇血氧含量为19.7ml/100ml+0.3ml/100ml =20ml/100ml

73 CaO2 ◆在正常大气压下呼吸空气时物理溶解氧量(0.3ml)明显低于血红蛋白结合氧量(19.7ml) ◇物理溶解氧量与PO2成正比
(可满足机体对氧需求)

74 Total Plasma CO2 content(T-CO2)
H2CO CO32- carbamido-CO HCO3- Dissolved CO

75 Carbon Dioxide Dissociation Curve
CO2 content PCO2

76 Actual Bicarbonate(AB)
AB-在实际PCO2及血氧饱和度情况下,血浆所含的HCO3-含量 受呼吸、代谢因素的双重影响 正常值 22~27mmol/L 平均 24mmol/L

77 Standard Bicarbonate(SB)
SB-血液在37℃、Hb充分氧合及PCO2 40mmHg条件下,血浆的HCO3-含量 去除呼吸因素影响,能反映代谢性酸碱平衡情况 正常值 22~27mmol/L 平均 24mmol/L

78 pH pH值是血液酸碱度的指标 pH=-lg[H+] 正常值 7.35~7.45 pH变化的临床意义

79 Buffer Base(BB) BB——是血液中具有缓冲能力的负离子的总和 正常值 45~55mmol/L(平均50mmol/L)
全血缓冲碱的组成 血浆HCO3- % 红细胞HCO3- % 氧合和还原血红蛋白 % 血浆蛋白 7% 有机、无机碳酸盐 5% SBB-与SB含义相似

80 Buffer Excess(BE) ABE、SBE(BE)与AB、SB,及BB、SBB含义相似
BE 37℃、Hb充分氧合、PCO240mmHg,将1升全血的pH滴定到7.40所需的酸或碱量 BE=SBB-BB 正常值:±2~3mmol/L 能反映血液缓冲碱的变化,指导临床补酸或碱量

81 酸碱平衡调节的机制 血液的缓冲系统 细胞内外离子交换 肺脏、肾脏的调节 缓冲能力最差的是脑脊液

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86 酸碱紊乱 急性呼酸 PaCO2>45mmHg,pH<7.35;HCO3->SB,SB正常;BE正常; hypoxemia 。 慢性呼酸 PaCO2>45mmHg;pH正常(一般<7.4),或稍低于7.35;HCO3->SB>正常,BE为正值;存在低氧血症。 呼酸并发代碱 PaCO2>45mmHg;pH>7.45,或接近7.45;SB>正常,BE为正值;存在低氧血症,常有低钾血症或低氯血症。

87                                    谢 谢 !


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