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Pulmonary function test ´ëÀå°æ Á¤¸®

1. Æó±â´É °Ë»çÀÇ ÃßÁ¤ Á¤»óÄ¡(predictive value)¸¦ °áÁ¤ÇÏ´Â °¡Àå Áß¿äÇÑ ¿ä¼Ò?

³ªÀÌ, ¼ºº°, Ű, Á¾Á·

2. ³ëÈ­¿¡ µû¸¥ È£Èí±âÀÇ º¯È­ - ¹æ¾î±â´ÉÀÇ º¯È­

»ó±âµµ ÈíÀÎÀÇ Áõ°¡, ±âµµ ¹× ÆóÆ÷ ¹æ¾î±â´ÉÀÇ ÀúÇÏ, ÀÚ°¡Ç×üÀÇ Áõ°¡

3. Æó±â´É °Ë»ç

- TLCÀÇ ÁÖ¿ä °áÁ¤ÀÎÀÚ´Â "Èí½Ä±ÙÀÇ °­µµ"¿Í "ÆóÀÇ °æÁ÷¼º(stiffness) = inward recoil of lung"

ÀÌ´Ù.

- flow-volume curve¿¡¼­ ¼Ò±âµµ Æó¼â¼º ÁúȯÀº "scooped out"¾ç»óÀ» ³ªÅ¸³»°í

´ë±âµµ Æó¼â¼º ÁúȯÀº "squared off"ÀÇ ¾ç»óÀ» ³ªÅ¸³½´Ù.

- FRCÀ̻󿡼­ È£Èí½Ã °¡Àå È¿°úÀûÀÎ °ø±âÀÇ ÃâÀÔÀÌ »ý±ä´Ù.

4. forced expiratory flow rate¸¦ Áõ°¡½ÃŰ´Â Áß¿äÇÑ ÀÎÀÚ: muscle power, elastic recoil

cf. ±âµµÀúÇ×Àº È£±â·ù ¼Óµµ¸¦ °¨¼Ò½ÃŲ´Ù.

5. flow volume curveÀÌ»ó: ¿ÞÂʺÎÅÍ O-> E -> P

1) obstructive lung disease: TLC, RV¡è

2) extraparenchymal restrictive disease:

¿¹> inspiratory muscle weakness or chest wall stiffness, obesity

TLC¡é, RV À¯Áö, MIP, MEP¡é

3) parenchymal restrictive disease: TLC, RV¡é, VC¡é, FEV1À¯Áö

6. flow volume curve·Î´Â TLC, RVÀ» ±¸ÇÒ¼ö ¾ø´Ù.

7. flow volume curve¿¡¼­

1) fixed obstruction

2) extrathoracic obstruction: Èí±â½Ã ¾ÇÈ­, inspiratory stridor ¿¹>tracheal tumor, vocal

cord tumor

3) intrathoracic obstruction: È£±â½Ã ¾ÇÈ­

8. emphysema¿¡¼­´Â static lung compliance´Â Áõ°¡Çϰí, dynamic lung compliance´Â °¨¼Ò

ÇÑ´Ù.

9. obstructive lung disease: asthma, COPD, bronchiectasis, cystic fibrosis, bronchiolitis

10. parenchymal restrictive pattern: ILD, IPF, sarcoidosis

11. extraparenchymal restrictive pattern: neuromuscular(myasthemia, Gullain-Barre

syndrome), chest wallÀÌ»ó(kyphosis, obesity)

12. ÆóȰ·® °Ë»ç ÁöÇ¥

1) ±â·ùÆó¼â¸¦ ¿¹¹ÎÇÏ°Ô ¹Ý¿µ = FEV1

2) Á¦ÇѼº ÆóÁúȯ¿¡¼­ °¨¼Ò = FVC

3) °¡½º°¡ ÆóÆ÷¿¡¼­ capillary·Î ¾ó¸¶³ª ¿ëÀÌÇÏ°Ô À̵¿Çϴ°¡¸¦ ÃøÁ¤ÇÏ´Â ÁöÇ¥ = DLco

4) ȯÀÚ°¡ ÀÚ¹ßÀû ³ë·ÂÀ¸·Î 1ºÐ°£ ÃÖ´ë·Î È£ÈíÇÒ¼ö ÀÖ´Â ±â·®, ±ÙÀ°ÀÌ»ó, Èä°ûÀÌ»ó¿¡ ÀÇÇÑ

È£ÈíÀÌ»óÀÇ Áø´Ü¿¡ µµ¿òÀÌ µÇ´Â ÁöÇ¥: MVV(maximal voluntary volume)

5) ȯÀÚÀÇ ³ë·Â¿¡ °ü°è¾øÀÌ ¼Ò±âµµ Á¶±âº´º¯ÀÇ Áø´Ü¿¡ µµ¿òÀÌ µÇ´Â ÁöÇ¥

: MMEFR(maximal midexpiratory flow rate) or FEF25-75%

13. ºñ¸¸È¯ÀÚÀÇ Æó±â´É: extraparenchymal restrictive pattern

FRC, ERV¡é, RVÀº À¯Áö

V/Q mismatch¡è, DLco¡è(d/t RBC mass¡è)

14. FRC ÃøÁ¤¹ý

1) Inert gas : helium dilution method, nitrogen washout test

2) body plethysmography

3) planimetry

15. ȯ±â°¡ Àß µÇÁö ¾Ê´Â bullae³ª pneumothoraxÀÇ ¿ëÀûÀ» ÃøÁ¤Çϱâ À§ÇÑ °Ë»ç

: body plethysmography

16. lung°ú chest wallÀÇ elastic recoilÀÌ °°¾ÆÁö´Â lung volume: FRC

17. small airway disease¸¦ Áø´ÜÇÒ¼ö ÀÖ´Â ¹æ¹ý

1) FEF25-75% : maximal-effort expiratory spirogram

2) dynamic compliance:

3) closing volume: single breath nitrogen washout test

4) volume of isoflow: helium oxygen flow-volume curve

5) Vmax50

18. ¼Ò±âµµ ÁúȯÀÇ °¡Àå Ãʱ⿡ ³ªÅ¸³ª´Â Æó±â´É º¯È­? FEF25-75%

19. single breath nitrogen washout test

phase I : anatomic dead space

phase II : mixed alveolar and dead space

phase III: alveolar plateau

phase IV : closing volume

20. phase IIIÀÇ slopeÀÌ ÀǹÌÇÏ´Â °Í? ventilatory homogeneityÀÇ index

21. diffusion¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ÀÎÀÚ

i) alveolar-capillary surface area

ii) pulmonary capillary blood volume

iii) alveolar-capillmary membrane thickness

iv) V/Q mismatchÁ¤µµ

v) ȯÀÚ Hgb level

22. DLcoÃøÁ¤¿¡ ¿µÇâÀ» ¹ÌÄ¡´Â ÀÎÀÚµé

Hb, PAO2, lung volume, C.O, smoking, CO pressure µî

23. DLco¡é : DILD, emphysema, pulmonary vascular disease

DLco¡è: CHF, Goodpasture's syndrome, asthma, supine position

24. hysteresisÀÇ Á¤ÀÇ

µ¿ÀÏÇÑ ¾Ð·Â¿¡¼­ È£±â½ÃÀÇ Æó¿ëÀûÀÌ Èí±â½ÃÀÇ Æó¿ëÀûº¸´Ù Å©°Ô ³ªÅ¸³ª´Â Çö»ó

25. Cstat = tidal volume/(plateau pressure - end expiratory pressure)

Cdyn = tidal volume/(peak airway pressure - end expiratory pressure)