在诊断和评价慢性阻塞性肺疾病(COPD)临床严重度分级中,反复出现的有用力肺活量(FVC)与一秒用力呼气容积(FEV1)这两个指标,如何理解和判断呢?本期读懂检查单就几个肺功能检查指标进行分析。
判断通气功能障碍类型除了要依据临床表现之外,主要依据是肺功能检查。
阻塞性通气功能障碍以流速 (FEV1/FVC)降低为主。COPD正是一种具有气流受限导致通气功能障碍的疾病,且气流受限呈进行性发展,因此在诊断和评价疾病进展程度过程中,常用到FVC、FEV1和FEV1/FVC。
几个基本的肺容量指标
肺容量是呼吸道与肺泡的总容量,反映外呼吸的空间,虽仅具有静态解剖意义,但其他检查指标都是在此基础计算或比较。
•潮气量(VT):平静呼吸时每次吸入或呼出的气量。正常参考值为500 ml。
•补吸气量(IRV):平静吸气末再用力吸气所能吸入的最大气量,反应胸肺的弹性和吸气肌的力量。正常参考值为男性约2.16 L,女性约1.5 L。
•深吸气量(IC):平静呼气末尽力吸气所能吸入的最大气量,由潮气量与补吸气量组成,即IC= VT+ IRV。正常参考值为男性约2.6 L,女性约1.9 L。当存在呼吸肌功能不全、胸廓或肺活动度减弱、气道阻塞等因素时,IC可减低。
•肺活量(VC):深吸气末尽力呼出的最大气量,正常参考值为男性约3.47 L,女性约2.44 L。各种肺实质病变、肺气肿、胸膜病变、胸廓畸形、呼吸肌无力或麻痹等均可导致VC减低。需要注意的是肺活量受年龄、性别、身长、体表面积等的影响,应以预计值百分率作为指标来判断。正常人群为(100±20)%,<80%为减少。
•肺总量(TLC):深吸气后肺内所含的气体总量,即等于肺活量加残气量。正常范围为男性(5.09±0.87)L,女性(4.00±0.83)L。肺气肿患者的TLC增加,限制性通气障碍的各种情况均可使肺总量明显降低。需要注意的是,肺总量正常不一定代表肺功能正常,因肺活量和残气量的增减可互相弥补。
几个用于COPD诊断的肺通气量指标
肺通气量是指单位时间进出肺的气量和流速,显示时间与容量的关系,并与呼吸幅度、呼吸频率和用力大小有关,是一个较好反映肺通气功能的动态指标。
•用力肺活量(FVC):指最大吸气至TLC位后以最大用力、最快速度呼出的气量,正常情况下与VC一致,可以反映较大气道的呼气期阻力,可用作慢性支气管炎﹑COPD、哮喘和肺气肿的辅助诊断手段﹐也可考核支气管扩张剂的疗效。
•一秒用力呼气容积(FEV1):指最大吸气至TLC位后第1秒内的呼气量,既是容量测定,也是一秒内的平均流速测定,是肺功能受损的主要指标。正常范围为男性(3.18±0.12)L,女性(2.31±0.05)L。正常者FEV1=FVC,在有气道阻塞时,FEV1<FVC,阻塞性通气障碍时FEV1下降、呼出时间延长。
•FEV1/FVC:指FEV1占FVC之比,是判断气道阻塞的常用指标,可反映通气障碍的类型和程度。FEV1/FVC是COPD的一项敏感指标,可检出轻度气流受限;FEV1占预计值的百分比是中、重度气流受限的良好指标,这均为COPD肺功能检查的基本项目。吸入支气管舒张剂后FEV1<80%预计值且FEV1/FVC<70%者,可确定为不能完全可逆的气流受限。
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