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[慢性阻塞性肺疾病:普通医学中的肺功能测定]

[COPD: spirometry in general medicine].

作者信息

Legrand A

机构信息

Service de Pneumologie, Hôpital Erasme, U.L.B.

出版信息

Rev Med Brux. 2003 Sep;24(4):A345-9.

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. COPD typically develops for a number of years before seeking medical help. Early detection by primary care physicians is a unique opportunity to intervene when the disease is not yet a health problem. COPD is characterized by airflow limitation that is not fully reversible. Pulmonary function test is thus the cornerstone for the early diagnosis of this disease. Determination of two lung volumes is enough to detect airway obstruction by spirometry: the Force Expiratory Volume during the first second (FEV1) of expiration and the Vital Capacity. Unlike electrocardiography, the procedure is a key stage in the performance of a spirometry. However, with some precautions described in the present paper, the manoeuvre is easy to perform properly. Technical considerations and limitations are also described. The interpretation of the results obtained needs a good understanding of the "normal value" and of the definition of an obstructive defect. When an obstruction is demonstrated with this simple test, it must be completed by more advanced tests to confirm the nature of the obstruction. Among these tests, the bronchodilators challenge testing, the evaluation of hyperinflation by plethysmography and the diffusing capacity of the lungs are the most currently realised tests in pulmonary function laboratories. Early detection and accurate diagnosis are necessary steps to improve the management and prevention of COPD.

摘要

慢性阻塞性肺疾病(COPD)是全球慢性发病和死亡的主要原因。COPD通常在寻求医疗帮助前已发展数年。基层医疗医生的早期检测是在疾病尚未成为健康问题时进行干预的独特机会。COPD的特征是气流受限且不完全可逆。因此,肺功能测试是该疾病早期诊断的基石。通过肺活量测定法测定两个肺容量足以检测气道阻塞:呼气第一秒用力呼气量(FEV1)和肺活量。与心电图不同,该操作是肺活量测定的关键阶段。然而,按照本文所述的一些预防措施,该操作很容易正确执行。还描述了技术考量和局限性。对所得结果的解释需要很好地理解“正常值”和阻塞性缺陷的定义。当通过这个简单测试证明存在阻塞时,必须通过更先进的测试来完成,以确认阻塞的性质。在这些测试中,支气管扩张剂激发试验、体积描记法评估肺过度充气以及肺弥散功能是目前肺功能实验室最常开展的测试。早期检测和准确诊断是改善COPD管理和预防的必要步骤。

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