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[常规肺功能检查的解读与应用:肺活量测定、静态肺容量、肺弥散、动脉血气分析、乙酰甲胆碱激发试验及6分钟步行试验]

[Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test].

作者信息

Bokov P, Delclaux C

机构信息

Service de physiologie, clinique de la dyspnée, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.

Service de physiologie, clinique de la dyspnée, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.

出版信息

Rev Med Interne. 2016 Feb;37(2):100-10. doi: 10.1016/j.revmed.2015.10.356. Epub 2015 Dec 3.

Abstract

Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint.

摘要

静息肺功能测试(PFT)包括通气功能评估:肺量计检查(用力呼气流量和可动员容积)以及静态容积评估,尤其是使用体容积描记法。肺量计检查可潜在定义阻塞性缺陷,而静态容积评估可潜在定义限制性缺陷(肺总量降低)和胸廓过度充气(静态容积增加)。必须记住,这种评估并不完整,而且通常需要评估通气需求,尤其是在面对呼吸困难时:评估动脉血气(寻找呼吸功能不全)以及测量肺的转运系数,结合肺泡容积测量来计算肺一氧化碳弥散量(DLCO:评估肺泡-毛细血管壁和毛细血管血容量)。所有这些肺功能测试都是2005年发表的美欧工作组(肺功能测试标准化)的主题,并于2007年翻译成法语。已经推荐了肺功能测试的解读策略,即使用预测值的第5和第95百分位数(正常值的下限和上限)来定义异常肺功能测试。因此,所有肺功能测试单位都需要实施这些建议。仅在哮喘的预测试概率为中等(诊断不确定)的情况下才进行乙酰甲胆碱激发试验,这种情况并不常见。最方便的运动测试是6分钟步行试验,它可以评估步行能力、寻找动脉血氧饱和度下降情况以及量化呼吸困难主诉。

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