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一文轻松搞定肺功能检查

2021-11-08 图图 MedSci原创

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​肺功能检查是呼吸科医生临床诊疗的必备手段之一，不同于X光和CT，肺功能检查更多地反映人体呼吸功能的变化。

​肺功能检查是呼吸科医生临床诊疗的必备手段之一，不同于X光和CT，肺功能检查更多地反映人体呼吸功能的变化。
 
肺功能检查在临床上应用广泛，是呼吸疾病诊治应用和科学研究中必不可少的检查方法之一。在呼吸系统疾病的诊断与鉴别诊断、严重度分级、疾病进展、预后评估以及治疗方案选择和疗效评估等方面都有十分重要的意义。了解和掌握这些肺功能检查的目的和临床意义，可为临床疾病的诊治提供良好的帮助。
 
肺功能检查示意图
 
肺功能检查有哪些临床意义？
 
| 协助疾病诊断和鉴别诊断
 
  • 对肺、气道疾病的早期诊断
人体的呼吸功能有巨大的代偿能力,在疾病早期由于机体的代偿作用,临床不适往往不显著。同时,大多数疾病的发展是缓慢的,人体能够逐渐对此适应,也因而不易引起患者的重视。
 
我国哮喘防治指南中也特别指出对临床症状不典型的哮喘患者，可通过支气管激发试验进行鉴别。
 
  • 对肺功能损害性质的定性诊断
通过肺通气功能检查,可诊断肺功能损害的性质,如做出阻塞性通气功能障碍、限制性通气功能障碍、混合性通气功能障碍等的临床诊断。了解到肺功能损害性质对疾病的正确诊断有很重要的指导意义。
 
  • 诊断病变部位
确切的呼吸道病变部位可通过胸部X线片、胸部CT、纤维支气管镜、鼻咽镜检查等做出诊断,但胸部X线片敏感性差、胸部CT检查费用较高受试者一般不易接受,而纤维支气管镜、鼻咽镜等检查是侵入性检查,有一定的创伤性,也不易为患者所接受。肺功能检查作为筛查项目可弥补这些缺点。
 
| 评估疾病的病情严重程度、进展和预后
 
  • 疾病严重程度评估
肺功能检查除对呼吸系统疾病的功能损害进行定性诊断外，还可以对疾病损害的严重程度进行判断，亦即定量诊断。
 
全球慢性阻塞性肺疾病(COPD)防治创议(GOLD，2011版)将COPD的气流受限严重程度分为轻、中、重和极重度。肺功能的损害程度与疾病的严重程度有明确的相关性。
 
  • 劳动强度及耐受力评估
对重体力劳动者的劳动强度、运动员的运动能力等进行评估,可通过静态的肺功能检查和动态的运动心肺功能检查综合判断。
 
  • 疾病的进展与预后评估
肺功能的追踪能反映疾病的进展速度与预后,对追踪随访疾病的发展或转归有重要的意义。如呼气峰流量(PEF)的监测可实时监控哮喘患者的气道功能状况,了解哮喘的变化规律。当PEF下降且变异率增大时,提示临床有可能出现哮喘的急性加重,需要给予积极的平喘抗炎治疗。
 
肺功能检查如此重要，一起来了解下常用的肺功能检查吧。
 
肺功能检查是采用一系列手段检测肺的通气功能、弥散功能和气体交换功能，检测人体呼吸的生理和病理改变的一种检查方法。
 
肺通气功能测定：是单位时间内肺脏吸入或呼出多少气体，以及以多快速度呼出。其中最重要的有三个参数 (FEV1、FVC 和FEV1/FVC)。
 
FEV1 即第一秒用力呼出气量，代表一秒钟内尽最大努力能呼出的气体量。
 
FVC 即用力呼出气量，是指用力吸气后尽最大力气、最快速度呼气所能呼出的气体量。
 
FEV1/FVC 值非常重要，代表个人用力呼出总量中第一秒用力呼出气体的比例，正常值是 70%~85％，FEV1/FVC 值小于 70％ 可以确定气道阻塞。
 
弥散功能检查：是测定氧气从肺泡进入血液及血液中二氧化碳进入肺的交换能力，反映肺气体交换能力的最常用检查项目。
 
支气管舒张实验：是通过测定患者吸入支气管扩张剂前后 FEV1 的变化来判断气道阻塞的可逆性，检查时首先要进行普通肺通气功能测定，一旦常规肺功能检查提示 FEV1/FVC 小于 70％，存在阻塞性通气功能障碍。
 
参考资料：
1.郑劲平.肺功能检查临床意义和诊断思路[J].中国实用内科杂志,2012,32(08):569-574.
2.周明娟,郑劲平.肺功能检查临床实用方法指标及含[J].中国实用内科杂志,2012,32(08):575-577+580.

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    2022-03-13 未来将来

    这个好

    0

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    2022-03-03 未来将来

    学习了

    0

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    2022-01-09 ms9000000416515103

    学习

    0

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    2021-11-10 yykkxiaodou

    #肺功能检查#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1202155, encodeId=7d3e1202155a5, content=这个好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210826/7a6cce5e03844bcf8a6ee8a36dba8188/b15bf50504094d3aa56a8f1a32d3304c.jpg, createdBy=1d8c1533153, createdName=未来将来, createdTime=Sun Mar 13 06:54:59 CST 2022, time=2022-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198923, encodeId=55d91198923d3, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210826/7a6cce5e03844bcf8a6ee8a36dba8188/b15bf50504094d3aa56a8f1a32d3304c.jpg, createdBy=1d8c1533153, createdName=未来将来, createdTime=Thu Mar 03 06:39:08 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1182459, encodeId=69f311824591b, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3fb06454672, createdName=ms9000000416515103, createdTime=Sun Jan 09 10:16:32 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628218, encodeId=72f916282189d, content=<a href='/topic/show?id=85118203ef1' target=_blank style='color:#2F92EE;'>#肺功能检查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82037, encryptionId=85118203ef1, topicName=肺功能检查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d36b21178423, createdName=yykkxiaodou, createdTime=Wed Nov 10 05:24:10 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068315, encodeId=8bd7106831579, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23395652140, createdName=ms3000001114626132, createdTime=Mon Nov 08 22:56:14 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068262, encodeId=e835106826207, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=10b65509612, createdName=小雨闲, createdTime=Mon Nov 08 20:52:22 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068130, encodeId=07161068130f1, content=👍👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a35612197, createdName=ms7000001779514415, createdTime=Mon Nov 08 15:15:22 CST 2021, time=2021-11-08, status=1, ipAttribution=)]
    2021-11-08 ms3000001114626132

    学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1202155, encodeId=7d3e1202155a5, content=这个好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210826/7a6cce5e03844bcf8a6ee8a36dba8188/b15bf50504094d3aa56a8f1a32d3304c.jpg, createdBy=1d8c1533153, createdName=未来将来, createdTime=Sun Mar 13 06:54:59 CST 2022, time=2022-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198923, encodeId=55d91198923d3, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210826/7a6cce5e03844bcf8a6ee8a36dba8188/b15bf50504094d3aa56a8f1a32d3304c.jpg, createdBy=1d8c1533153, createdName=未来将来, createdTime=Thu Mar 03 06:39:08 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1182459, encodeId=69f311824591b, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3fb06454672, createdName=ms9000000416515103, createdTime=Sun Jan 09 10:16:32 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628218, encodeId=72f916282189d, content=<a href='/topic/show?id=85118203ef1' target=_blank style='color:#2F92EE;'>#肺功能检查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82037, encryptionId=85118203ef1, topicName=肺功能检查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d36b21178423, createdName=yykkxiaodou, createdTime=Wed Nov 10 05:24:10 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068315, encodeId=8bd7106831579, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23395652140, createdName=ms3000001114626132, createdTime=Mon Nov 08 22:56:14 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068262, encodeId=e835106826207, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=10b65509612, createdName=小雨闲, createdTime=Mon Nov 08 20:52:22 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068130, encodeId=07161068130f1, content=👍👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a35612197, createdName=ms7000001779514415, createdTime=Mon Nov 08 15:15:22 CST 2021, time=2021-11-08, status=1, ipAttribution=)]
    2021-11-08 小雨闲

    学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1202155, encodeId=7d3e1202155a5, content=这个好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210826/7a6cce5e03844bcf8a6ee8a36dba8188/b15bf50504094d3aa56a8f1a32d3304c.jpg, createdBy=1d8c1533153, createdName=未来将来, createdTime=Sun Mar 13 06:54:59 CST 2022, time=2022-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1198923, encodeId=55d91198923d3, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210826/7a6cce5e03844bcf8a6ee8a36dba8188/b15bf50504094d3aa56a8f1a32d3304c.jpg, createdBy=1d8c1533153, createdName=未来将来, createdTime=Thu Mar 03 06:39:08 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1182459, encodeId=69f311824591b, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3fb06454672, createdName=ms9000000416515103, createdTime=Sun Jan 09 10:16:32 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628218, encodeId=72f916282189d, content=<a href='/topic/show?id=85118203ef1' target=_blank style='color:#2F92EE;'>#肺功能检查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82037, encryptionId=85118203ef1, topicName=肺功能检查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d36b21178423, createdName=yykkxiaodou, createdTime=Wed Nov 10 05:24:10 CST 2021, time=2021-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068315, encodeId=8bd7106831579, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23395652140, createdName=ms3000001114626132, createdTime=Mon Nov 08 22:56:14 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068262, encodeId=e835106826207, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=10b65509612, createdName=小雨闲, createdTime=Mon Nov 08 20:52:22 CST 2021, time=2021-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1068130, encodeId=07161068130f1, content=👍👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a35612197, createdName=ms7000001779514415, createdTime=Mon Nov 08 15:15:22 CST 2021, time=2021-11-08, status=1, ipAttribution=)]
    2021-11-08 ms7000001779514415

    👍👍

    0