參數簡易判讀- FEF25~75%

Report
CareFusion
Masterscreen Pneumo
Wuerzburg, Germany
Masterscreen Pneumo
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Pneumotachograph
• Jaeger
pneumotachograph
• The world’s most
validated flow meter
CONFIDENTIAL – for internal use only
© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Pneumotachograph
The accuracy of the spirometric measurements depends on different technical factors. The most
substantial one is the quality of the spirometric transducer (usually called pneumotachometer):
its accuracy, linearity, repeatability, long term stability, response time or dynamic answer and
flow resistance. Typical converting accuracy given in catalogues is about 3% (Table 1).
Nonlinearity error is usually substantially lower then 1%. Pneumotachometer should add only
minimal resistance to the airflow. It is recommended in that it should be less than 150 Pas/dm3
at 12 dm3/s flow.
B. Juroszek / Measurement 39 (2006) 458–465
CONFIDENTIAL – for internal use only
© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
肺功能
◦ 藉呼吸時進出呼吸道的空氣量來計算
肺容積及肺容量,以評估肺臟的通氣
功能
•評估一個人的呼吸功能或肺功能,其實
有許多不同的檢查,但是最常使用的指
標是『肺活量, FVC』和『一秒量,
FEV1』
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© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
檢查前準備
• 檢查前不可抽煙。
• 檢查前4~6小時停服支氣管擴張劑。
• 檢查過程中是以口呼吸,會用一夾子
夾住鼻子以防空氣漏出,做不同的呼
吸方式。
◦ 肺功能檢查的品質主要決定於病人是否盡
力及配合
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© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
做法
ERS
CONFIDENTIAL – for internal use only
ATS
做法
CONFIDENTIAL INFORMATION –
Not for reproduction or distribution
© 2010 CareFusion Corporation or one of its subsidiaries. All rights
reserved.
CONFIDENTIAL INFORMATION –
Not for reproduction or distribution
© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
好的肺功能報告條件
1.良好的吐氣:
吐氣時間 6 sec (小孩至少3 sec) 或者 (肺容量改變< 0,025 L
for  1 sec)
2.至少三次的試驗
3.FVC 重複性
(兩次試驗之間差異:  0,150 L)
( if FVC  0,150 L   0,100 L)
4.FEV1 重複性
(兩次試驗之間差異:  0,150 L)
( if FEV1  1,0 L   0,100 L
5.若使用者配合度不佳, 重複試驗直到符合要求, 但不超過八
次
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reserved.
參數解釋
• 用力呼氣容積(FEV):最大呼吸後做快而用力的吐氣,第1、2
、3秒所吐出的氣體量,分別為FEV1、FEV2、FEV3。
• 用力肺活量(FVC):在最大吸氣後,再做快而用力的吐氣,所
吐出的氣體量。
• 用力呼氣流速(FEF 25, 50, 75):指測量用力肺活量時,最大呼
氣流速的25%、50%、75%的流速。
• 用力呼氣之25~75%平均流速(maximal midexpiratory flow, FEF
25%~75%):指測量用力肺活量時,介於25~75%間的平均流速
,通常寫成FEF25~75%。
• 尖峰呼氣流速(PEF):指測量用力肺活量時,最大呼氣流速。
• 用力肺活量之200~1200ml 平均流速(maximal expiratory flow,
FEF200–1200):指測量用力肺活量時,介於200ml~1200ml間
的平均流速,通常寫成FEF200-1200。
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© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
參數簡易判讀-FVC
• 肺活量(forced vital capacity, FVC),一般成年人肺活量約有
3.5到4.5升,它和性別、年齡以及個子的大小有關。要把
這些肺活量從肺裡猛吹出來,通常要花三、四秒鐘的時間
。顯示呼吸肌肉的強度及通氣儲備能力。降低時表示氣體
滯留(如慢性阻塞性肺部疾病)。
• Obstructive:
• 呼氣時間變長
◦ FVC ↓
因air trapping
• Restrictive:
◦ FVC < 80% of predicted value
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reserved.
參數簡易判讀-FEV1 & FEV1%FVC
• 第一秒內能夠吹出來的部份,稱之為『用力呼氣一秒量』
(forced expiratory volume in one second, FEV1),簡稱『一
秒量』。成年人的一秒量大約3至4升,它反映了肺臟的整
體能力。FEV1降低:可能為限制型疾病。
• 有時我們也會估算一秒量佔肺活量的百分率(即一秒量除以
肺活量),稱之為一秒率(FEV1/ FVC),當一秒率小於80%
時,就代表呼吸道有阻塞的現象。
• Obstructive:
◦ FEV1 ↓ & FEV1% ↓, FVC不一定
◦ FEV1% < 80%
• Restrictive:
◦ FEV1 ↓ & FVC ↓, FEV1%不變
• Senile change:
◦ FEV1% 隨著年齡增加而些微下降
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參數簡易判讀- FEF25~75%
• FEF25~75%:對於較小呼吸道阻塞較具敏
感性,降低時表示有阻塞。
• Young man: 4.5L/s; young woman: 3.5L/s; or
> 65% of predicted value
• 隨著年齡增加而些微下降
• In restrictive disease, small airway的直徑可能
因lung volume loss而變小,造成FEF25-75%下
降
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reserved.
參數簡易判讀
• 綜合以上判斷
◦ FEV1%FVC: <80%則為阻塞型肺疾病
◦ 若FEV1%FVC>80%, 但FEF25-75% 降低,
仍有可能為早期阻塞型換氣障礙
◦ 若FEV1%FVC>80%, FEF25-75% 正常, 但
FEV1, FVC 變小, 則可能是限制性肺疾病
CONFIDENTIAL INFORMATION –
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© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
CONFIDENTIAL INFORMATION –
Not for reproduction or distribution
© 2010 CareFusion Corporation or one of its subsidiaries. All rights
reserved.
其他注意事項
• 肺功能預測值範圍是依據病人的身高,
體重, 年紀, 性別, 及種族而定
• 做肺功能時, 姿勢也會影響肺功能值的
呈現
◦ 譬如FVC的值, 坐著會比躺著高7~8%以上,
站著會比躺著高2%
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MasterScreen
MS Pneumo
MS IOS
MS Body
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MS Diffusion
MS paed
MS PFT
MasterScreen® CPX
Oxycon Mobile
© 2010 CareFusion Corporation or one of its subsidiaries. All rights
reserved.
MS Babybody
Oxycon Pro™
– for
internal use 26:
only
Eur CONFIDENTIAL
Respir J
2005;
948–968
© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
Volume Calibration
•
•
•
•
•
CorrEX
◦ Correction factor for expiration
CorrIN
◦ Correction factor for inspiration
Q EX
◦ Quality of EX strokes
Q IN
◦ Quality of IN strokes = Variation coefficient
Plausibility criteria:
◦ Corr. = <±5% Calibration ok.
◦ Corr. = > ±15% Warning: Acceptable calibration?
◦ Corr. = > ±25% Repeat calibration!
◦ Q = < 1 Calibration ok.
◦ Q = < 2 Warning: Acceptable calibration?
◦ Q = > 2 Repeat calibration!
CONFIDENTIAL INFORMATION –
Not for reproduction or distribution
© 2010 CareFusion Corporation or one of its subsidiaries. All rights
reserved.
Jaeger pneumotachograph
Proven accuracy
Range
0 - ±20 l/s
Accuracy
0.2 - 12 l/s ±2 %
Resistance
<0.05kPa/(L/s) at 10 l/s
Volume measurement
digital integration
Range
0 - ±20 l
Accuracy
5 ml
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© 2010 CareFusion Corporation or one of its subsidiaries. All rights reserved.
jpt 1-2

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