H hp k

v ng dng lm sng

Ths Phm Hong Khnh

BM Sinh l-HYDCT

CC GIAI ON QU TRNH H HP

Thm d chc nng h hp

THM D CHC NNG H HP

C bn:

Chuyn su:

H hp k

Kho st ng dn kh nh

Kh cn Tng dung lng

Test phn ng ph qun

phi

Kho st c h hp

Kh nng khuch tn

Test vn ng

Kh trong mu

iu khin h hp

THNG KH PHI
Thng kh phi
Kh
tri

Ph
nang

Trao i kh
Ph
nang

Kh
tri

Thm
Thm d
d chc
chc nng
nng thng
thng kh
kh phi:
phi:
-- H
H hp
hp k
k
-- Ph
Ph ng
ng k,
k,
-- Thm
Thm d
d tnh
tnh n
n hi
hi ca
ca phi
phi ngc
ngc
-- o
o sc
sc cn
cn ng
ng h
h hp...
hp...

thng
thng dng
dng nht
nht l
l h
h hp
hp k
k

Ni dung
1. Tng quan v h hp k
2. Vai tr ca thm d chc nng h hp ti cc khoa phng,
bnh vin.

H HP K (Spirometry)

NGUYEN TAC

P (mmHg)

F (L/S) =
-5
R (dynes.cm )

V(L) = F dt

o h hp k

Nhn vin y t

Bnh nhn


PULMONARYFUNCTIONTESTREPORT

Ver2.0
TESTEDBY:

DATE
: Apr/9/2

NAME
:

0
PT.No
: 4730
TEMP.
:
23
C
AGE
: 31yrs
BAROPRES : 760 mmHg
HEIGHT : 159cm
RACEADJ
: 100 %
WEIGHT : 58kg
RACE
: ORIENTAL
SEX
: MALE
Pred.
: ITS

PREBRONCPOSTBRONC%

PRED

ACT

%PRED

ACT

%PRED

CHG

VC(L)

4.23

3.54

84

3.41

81

ERV(L)

1.37

1.41

IRV(L)

1.53

0.97

36

TV(L)

0.64

1.03

61

FVC(L)
FEV.5(L)

4.23
2.81

3.57
1.52

84
54

3.73
2.35

88
83

FEV1(L)

3.64

2.63

72

3.12

86

4
54
19

FEV3(L)

4.15

3.48

84

3.69

89

FEV1/FVC(%)

74.3

91.5

23

FEV3/FVC(%)

98.3

108.2

10

FEF.21.2(L/S)

2.56

4.35

70

FEF2575%(L/S)

4.20

2.34

56

3.51

84

50

FEF7585%(L/S)
BESTFVC(L)

4.23

0.99
3.59

85

1.04
3.73

88

4
4

BESTFEV1(L)

3.64

2.63

72

3.12

86

19

EXTIME(SEC)

4.32

4.41

Vext(L)

0.20

0.19

FIVC(L)

3.02

2.59

13

FIV.5(L)

0.20

0.50

152

FEV.5/FIV.5

7.70

4.70

38

PEF(L/S)

7.61

3.02

40

5.28

69

75

FEF25%(L/S)

7.00

2.76

39

5.21

73

85

FEF50%(L/S)

5.32

2.76

52

4.29

81

55

FEF75%(L/S)
PIF(L/S)
FIF50%(L/S)

1.84

1.34
1.64
0.89

73

1.58
1.62
1.35

86

18
0
52

FEF50%/FIF50%

3.11

3.18

NOTE:

LITERSEXPRESSEDBTPS

PREBDVC:
PREBDFVC:

#2test,
#2test,

2accepted.
2accepted.

POSTBDVC:

#1test,

1accepted.

POSTBDFVC:

#3test,

5accepted.

INTERPRETATIONITS

MILDAIRWAYOBSTRUCTION
ObstructionmaybeunderestimatedExpirationtimeless
than_5second
Upperairwayobstructionsuggested
Spirometrymarkedlyimprovedpostbronchodilator.
LowFEV.5suggestspoorinitialeffort.

REVIEWEDBY:DATE:

20

30

4050S

h
hp

10

6
4

10

12

10

L/S

12

Mu

UNCONFIRMEDREPORTMUSTBEREVIEWEDBYPHYSICIAN.

8L

Cc ch s chnh trong H Hp
K

Vit tt

Tn

Tr s

VC

Vital capacity (L): Dung tch sng

> 80%

FVC

Forced vital capacity (L): Dung tch sng gng sc

> 80%

FEV1

Forced Expiratory Volume during 1st second: Th

tch th ra gng sc trong giy u

> 80%

FEV1/VC

Ch s Tiffeneau

> 70%

FEV1/FVC

Ch s Gaensler

> 70%

FEF25-75

Forced expiratory flow during the middle half of FVC: > 80%
lu lng th ra khong gia ca dung tch sng
gng sc

PEF

Peak expiratory flow: lu lng th ra nh

> 80%

MVV

Maximal voluntary ventilation

> 60%

c mt H Hp K
1. C ng k thut khng ?
2. Kt qu c bnh thng khng ?
X 20%

x 1,64

3. Thuc loi ri lon no ?

T h e t c h ( l t )

Gian o the tch theo thi

gian
5
4
3

K h
l u t h o n g

2
1
0

T he
t c h
d tr
h t v a o

D u n g t c h s o n g

T h e t c h
d tr
t h r a
10

20

30

T h i g i a n ( g i a y )

40

50

Gian o lu lng theo the tch

o thong kh t y toi a
(MVV)
T hra tha
t nhanh, tha
t manh
vahe
t s
c

o tho
ng kh tyto
i a

ng bieu dien dung

tch song
gang sc e o FEV1
va FVC
(ng A).

ng bieu dien thong

kh t y toi a (hnh B)

Phn tch kt qu HHK

1. t chun?
2. Hi chng hn ch? Mc ?
3. Hi chng nghn tc? Mc ?
4. FEF25-75?
5. PEF?
6. MVV?

Phn tch kt qu
Xac nh hoi chng han che:
Gia VC va FVC chon tr so nao ln hn.
VC (FVC) ln hn 80% cua tr so d oan
(% pred) c xem la bnh thng, khong
co hoi chng han che.

Mc o han ch
% VC (FVC) so vi tr
so d oan
80 60 %

Mc o han
ch
Nh

59 40 %

Trung bnh

< 40 %

Nang

Phn tch kt qu
Xac nh hoi chng nghen tac :
FEV1

Neu tren chon VC lap t so Tiffeneau =

x 100
VC

FEV1
Neu tren chon FVC lap t so Gaensler
=
FVC
100

Tiffeneau va Gaensler oc ngay tr so thc te (ACT)

Mc o nghn tc
%FEV1 so vi tr so d Mc o han
oan
ch
80 60 %
Nh
59 40 %

Trung bnh

< 40 %

Nang

Phn tch kt qu
* PEF : Tr so xac nh tnh trang hen suyen
Bnh thng phai ln hn 80% tr so d
oan.
* FEF25 75 : xac nh tnh trang nghen tac sm
ng dan

kh (ng dan kh nho).

Bnh thng phai ln hn 80% tr so d oan

* MVV: anh gia tong quat c hoc ho hap
( >60%)

Test hi phc
ngha:
D hu
Tr liu

Thuc th: MDI

Albuterol : MDI, 2 puffs, 180 mcg 10-20
Ipratropium bromide: MDI, 2 puffs, 40 mcg
30-45

Test hi phc
FEV1, FVC hay VC 12% v 200 ml (ATS)
PEF > 20% (GINA)

PULMONARYFUNCTIONTESTREPORT

Ver2.0
TESTEDBY:

DATE
: Apr/17/2

NAME
:

0
PT.No
: 4835
TEMP.
:
24
C
AGE
: 65yrs
BAROPRES : 760 mmHg
HEIGHT : 167cm
RACEADJ
: 100 %
WEIGHT : 70kg
RACE
: ORIENTAL
SEX
: MALE
Pred.
: ITS

4
3

PREBRONCPOSTBRONC%

VC(L)
ERV(L)
IRV(L)
TV(L)

FVC(L)
FEV.5(L)
FEV1(L)
FEV3(L)
FEV1/FVC(%)
FEV3/FVC(%)
FEF.21.2(L/S)
FEF2575%(L/S)
FEF7585%(L/S)
BESTFVC(L)
BESTFEV1(L)
EXTIME(SEC)
Vext(L)
FIVC(L)
FIV.5(L)
FEV.5/FIV.5

PEF(L/S)
FEF25%(L/S)

PRED

3.98

3.98
2.56
3.14
3.66

3.07

3.98
3.14

7.19
6.51

ACT

1.78
0.46
0.16
1.16

1.74
0.63
0.91
1.51
51.1
84.8
0.56
0.46
0.28
1.74
0.91
4.70
0.18
1.62
0.49
1.28

1.59
1.29

%PRED

45

44
25
29
41

15

44
29

22
20

ACT

2.15
0.30
0.44
1.41

1.89
0.72
1.01
1.56
47.0
72.6
0.69
0.46
0.20
1.89
1.01
6.00
0.14
1.78
0.44
1.63

2.13
1.27

%PRED

54

48
28
32
43

15

48
32

30
20

CHG

20
33
183
22

FEF50%(L/S)
FEF75%(L/S)
PIF(L/S)
FIF50%(L/S)
FEF50%/FIF50%

4.15
1.14

0.52
0.28
1.57
1.48
0.35

13
24

0.44
0.23
1.57
1.48
0.30

11
20

15
16
0
02
14

9
15
11
3
7
13
23
0
27
9
11
28
18
10
9
28

33
1

10

20

30

4050S

L/S

12

10

6
4

8L

VAI TR
CA THM D CHC NNG H HP
I VI CC KHOA PHNG
TRONG BNH VIN

1. Trong ngnh phi hc

2. Thm d chc nng h hp trong phu thut
3. Trong bnh hen ph qun v BPTNMT
4. Gim nh y khoa
5. Trong tai mi hng v tc nghn ng h hp trn