Test questions and assignments. Functional tests of the respiratory system Types of functional respiratory tests

The physiological basis for the practical use of these tests are systemic (reflex) and local vascular reactions that occur in response to changes in the chemical (mainly gas) composition of the blood due to forced breathing or changes in the content of oxygen and/or carbon dioxide in the inhaled air. Changes in blood chemistry cause chemoreceptor irritation
ditch of the aortic arch and sinocarotid zone with subsequent reflex changes in the frequency and depth of breathing, heart rate, blood pressure, peripheral resistance and cardiac output. Subsequently, in response to changes in the gas composition of the blood, local vascular reactions develop.
One of the most important factors in the regulation of vascular tone is the level of oxygen. Thus, an increase in oxygen tension in the blood causes contraction of arterioles and precapillary sphincters and restriction of blood flow, sometimes even to its complete cessation, which prevents tissue hyperoxia.
Lack of oxygen causes a decrease in vascular tone and an increase in blood flow, which is aimed at eliminating tissue hypoxia. This effect varies significantly in different organs: it is most pronounced in the heart and brain. It is assumed that adenosine (especially in the coronary bed), as well as carbon dioxide or hydrogen ions, can serve as a metabolic mediator of the hypoxic stimulus. The direct effect of oxygen deficiency on smooth muscle cells can be carried out in three ways: changing the properties of excited membranes, interfering directly with the reactions of the contractile apparatus and influencing the content of energy substrates in the cell.
Carbon dioxide (CO2) has a pronounced vasomotor effect, an increase in which in most organs and tissues causes arterial vasodilation, and a decrease - vasoconstriction. In some organs, this effect is due to a direct effect on the vascular wall, in others (the brain) it is mediated by a change in the concentration of hydrogen ions. The vasomotor effect of CO2 varies significantly in different organs. It is less pronounced in the myocardium, but CO2 has a dramatic effect on brain vessels: cerebral blood flow changes by 6% with a change in CO2 tension in the blood for every mmHg. from normal level.
With severe voluntary hyperventilation, a decrease in the level of CO2 in the blood leads to such pronounced cerebral vasoconstriction that cerebral blood flow can be halved, resulting in loss of consciousness.
The hyperventilation test is based on hypocapnia, hypersympathicotonia, respiratory alkalosis with a change in the concentration of potassium, sodium, magnesium ions, a decrease in hydrogen content and an increase in calcium content in the smooth muscle cells of the coronary arteries, which causes an increase in their tone and can provoke coronary spasm.
The indication for the test is suspicion of spontaneous angina.
Methodology. The test is performed early without medication
in the morning, on an empty stomach, with the patient lying down. The subject performs intense and deep breathing movements at a frequency of 30 breaths per minute for 5 minutes until a feeling of dizziness appears. Before the test, during the study and for 15 minutes after it (possibility of delayed reactions), an ECG in 12 leads is recorded and blood pressure is recorded every 2 minutes.
The test is considered positive when an ST segment shift of the “ischemic” type appears on the ECG.
In healthy people, hemodynamic changes during hyperventilation consist of an increase in heart rate, IOC, a decrease in OPSS and multidirectional changes in blood pressure. It is believed that alkalosis and hypocapnia play a role in increasing heart rate and IOC. The decrease in OPSS during forced breathing depends on the vasodilatory effect of hypocapnia and on the ratio of constrictor and dilating adrenergic effects realized through α- and β2-adrenergic receptors, respectively. Moreover, the severity of these hemodynamic reactions was more pronounced in young men.
In patients with coronary artery disease, hyperventilation contributes to a decrease in coronary blood flow due to vasoconstriction and an increase in the affinity of oxygen for hemoglobin. In this regard, the test can cause an attack of spontaneous angina in patients with severe atherosclerotic stenosis of the coronary arteries. In identifying coronary artery disease, the sensitivity of the test with hyperventilation is 55-95%, and according to this indicator it can be considered an alternative method to the test with ergometrine when examining patients with cardiovascular pain syndrome resembling spontaneous angina.
Hypoxemic (hypoxic) tests simulate situations in which the demand for myocardial blood flow increases without increasing the work of the heart, and myocardial ischemia occurs when there is a sufficient volume of coronary blood flow. This phenomenon occurs in cases where the extraction of oxygen from the blood reaches a limit, for example, when the oxygen content in arterial blood decreases. It is possible to simulate changes in the gas composition of a person’s blood in laboratory conditions using so-called hypoxemic tests. These tests are based on an artificial reduction in the partial fraction of oxygen in the inhaled air. Oxygen deficiency in the presence of coronary pathology contributes to the development of myocardial ischemia and is accompanied by hemodynamic and local vascular reactions, and an increase in heart rate occurs in parallel with a decrease in oxygenation.
Indications. These tests can be used to assess the functional capacity of the coronary vessels, the state of coronary blood flow and to identify hidden coronary insufficiency. However, here
we must recognize the validity of D.M. Aronov’s opinion that at present, due to the advent of more informative methods, hypoxemic tests have lost their importance in identifying ischemic heart disease.
Contraindications. Hypoxemic tests are unsafe and contraindicated in patients who have recently suffered a myocardial infarction, with congenital and acquired heart defects, pregnant women, those suffering from severe pulmonary emphysema or severe anemia.
Methodology. There are many ways to artificially create a hypoxic (hypoxemic) state, but their fundamental difference lies only in the CO2 content, so the samples can be divided into two options: 1) a test with dosed normocapnic hypoxia; 2) tests with dosed hypercapnic hypoxia. When performing these tests, it is necessary to have an oximeter or oxygenograph to record the degree of decrease in arterial blood oxygen saturation. In addition, ECG (12-lead) and blood pressure monitoring is carried out.

1. Breathing a mixture with a reduced oxygen content. According to the method developed by R. Levy, the patient is given a mixture of oxygen and nitrogen to breathe (10% oxygen and 90% nitrogen), while CO2 is removed from the exhaled air with a special absorber. Blood pressure and ECG values ​​are recorded at 2-minute intervals for 20 minutes. At the end of the test, the patient is inhaled pure oxygen. If pain in the heart area occurs during the study, the test is stopped.
2. To conduct a hypoxic test, a serial hypoxicator GP10-04 from Hypoxia Medical (Russia-Switzerland) can be used, which allows one to obtain respiratory gas mixtures with a given oxygen content. The device is equipped with a monitoring system for assessing hemoglobin oxygen saturation. When carrying out this test in our studies, the oxygen content in the inhaled air was reduced by 1% every 5 minutes, reaching a 10% concentration, which was maintained for 3 minutes, after which the test was stopped.
3. Achieving hypoxemia can be achieved by reducing the partial pressure of oxygen in the pressure chamber with a gradual decrease in atmospheric pressure, corresponding to a decrease in oxygen in the inspired air. A controlled decrease in oxygen tension in arterial blood can reach a level of 65%.

1. Rebreathing method. To conduct this study, we developed a 75 L closed circuit in which the patient, reservoir and gas analyzer are connected in series using a system of hoses and valves. To calculate the volume of the tank, we used the formula:

During the test, the partial pressure of oxygen in the alveolar air, indicators of pulmonary ventilation, central hemodynamics and ECG were monitored in monitor mode. In the initial state and at the peak of the sample, samples of arterialized capillary blood were taken, in which the oxygen tension (pO2) and carbon dioxide (pCO2) of arterialized capillary blood were determined using the Astrup micromethod (BMS-3 analyzer, Denmark).
The test was stopped when the oxygen content in the inhaled air decreased to 14%, the minute breathing volume reached 40-45% of its proper maximum value and, in isolated cases, when the subject refused to perform the test. It should be noted that when this test was used in 65 patients with coronary artery disease and 25 healthy individuals, in no case was an attack of angina or ECG changes of the “ischemic” type recorded.

1. Breathing through additional dead space. It is known that in humans the normal volume of dead space (nasopharynx, larynx, trachea, bronchi and bronchioles) is 130-160 ml. An artificial increase in the volume of dead space complicates the aeration of the alveoli, while in the inhaled and alveolar air the partial pressure of CO2 increases, and the partial pressure of oxygen decreases. In our study, to conduct a hypercapnic-hypoxic test, additional dead space was created by breathing using a mouthpiece through an elastic horizontal tube (hose from a gas spiro analyzer) with a diameter of 30 mm and a length of 145 cm (volume about 1000 ml). The test duration was 3 minutes, instrumental control methods and test termination criteria were the same as for the rebreathing test.
2. CO2 inhalation can be used as a stress test to assess vascular reactivity. In our study, a gas mixture with 7% CO2 content was dosed according to the float level in the rotameter of the domestic RO-6R anesthesia apparatus. The test was carried out in a horizontal position of the subject. Inhalation of atmospheric air (containing 20% ​​oxygen) with the addition of 7% CO2 was carried out continuously using a mask. The duration of the test was 3 minutes, the control methods and evaluation criteria were similar to the tests described above. It should be noted that there was quite pronounced reflex hyperventilation, which developed 1-2 minutes from the start of the test. Before the study and after 3 minutes, samples of arterialized capillary blood were taken from the finger.

Functional test- an integral part of a comprehensive methodology for medical supervision of persons involved in physical education and sports. The use of such tests is necessary to fully characterize the functional state of the student’s body and its fitness.

The results of functional tests are assessed in comparison with other medical control data. Often, adverse reactions to load during a functional test are the earliest sign of a deterioration in the functional state associated with illness, fatigue, or overtraining.

We present the most common functional tests used in sports practice, as well as tests that can be used during independent physical education.

Functional tests provide information about the functional state of the respiratory organs. For this purpose, spirometry, ultrasound, determination of minute and stroke volumes and other research methods are used. Spirometry is the measurement of vital capacity and other pulmonary volumes using a spirometer. Spirometry allows you to assess the state of external respiration.

Functional Rosenthal test allows us to judge the functional capabilities of the respiratory muscles. The test is carried out on a spirometer, where the subject is tested 4-5 times in a row with an interval of 10-15 s. determine vital capacity. Normally, they get the same results. A decrease in vital capacity throughout the study indicates fatigue of the respiratory muscles.

The Votchal-Tiffno test is a functional test for assessing tracheobronchial patency by measuring the volume of air exhaled in the first second of forced exhalation after maximum inspiration, and calculating its percentage of the actual vital capacity of the lungs (the norm is 70-80%). The test is carried out for obstructive diseases of the bronchi and lungs. Oxygen utilization coefficient is the percentage ratio of the proportion of oxygen used by tissues to the total content in arterial blood. It is an important indicator characterizing the processes of diffusion through the alveolar-capillary membranes (the norm is 40%). In addition, for special indications, bronchospirography is performed (studying the ventilation of one lung, isolated by bronchial intubation); a test with blockade of the pulmonary artery and measurement of pressure in it (an increase in pressure in the pulmonary artery above 40 mm Hg indicates the impossibility of pneumectomy due to the development of hypertension in the pulmonary artery after surgery).

Functional tests for holding the breath - a functional load with holding the breath after inhalation (Stange test) or after exhalation (Genchi test), the delay time is measured in seconds. The Stange test allows you to assess the resistance of the human body to mixed hypercapnia and hypoxia, reflecting the general state of the body's oxygen supply systems when holding the breath against the background of a deep inhalation, and the Genchi test - against the background of a deep exhalation. They are used to judge the oxygen supply of the body and assess the general level of fitness of a person.

Equipment: stopwatch.

Stange's test. After 2-3 deep inhalations and exhalations, the person is asked to hold his breath while inhaling deeply for as long as possible.

After the first test, a rest of 2-3 minutes is required.

Genchi's test. After 2-3 deep breaths and exhalations, the person is asked to exhale deeply and hold his breath for as long as possible.

Evaluation of test results is carried out on the basis of tables (Table 1, Table 2). Good and excellent scores correspond to high functional reserves of the human oxygen supply system.

Table 1. Approximate indicators of the Stange and Genchi test

Table 2. Assessment of the general condition of the subject according to the Stange test parameter

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With all the variety of functional tests and tests that are currently used in sports medicine, tests with changes in environmental conditions (breath holding), with changes in venous reversion of blood to the heart (changes in body position in space) and tests with various physical loads.

Stange test

Genchi test

Functional breath-hold tests characterize the functional abilities of the respiratory and cardiovascular systems; the Genchi test also reflects the body’s resistance to oxygen deficiency. The ability to hold your breath for a long time depends in a certain way on the functional state and power of the respiratory muscles.

However, when conducting breath-hold tests, it should be borne in mind that they are not always objective, since they largely depend on the volitional qualities of the subject. This in some cases reduces the practical value of these samples.

A modified version of the Genchi test after hyperventilation is more informative. In this case, the maximum deep breathing (hyperventilation) is first performed for 45-60 s, then the duration of breath holding after maximum exhalation is recorded. Normally, the time of holding the breath during exhalation increases by 1.5-2 times. The absence of an increase in the time of holding the breath on exhalation indicates a change in the functional state of the cardiorespiratory system.

Serkin test

In healthy trained individuals, the time of holding the breath on inspiration before the load is 40-60 s, after the load - 50% or more of the first test, and after a minute of rest it increases to 100% or more of the first test.

In healthy untrained individuals, inhalation breath holding rates are 36-45 s (30-50%, 70-100%). If the functional state of the cardiorespiratory system is impaired, this indicator at rest is 20-35 s, after exercise it decreases to 30% or less of the initial value, and after 1 minute of rest practically does not change.

Rosenthal test

Sakrut V.N., Kazakov V.N.

Goal of the work: Assess the functional capabilities of the respiratory system using a number of physiological tests: Rosenthal test, test with dosed physical activity, breath-hold tests (Stange and Genche), combined Saabrase test.

Functional research methods are a group of special methods used to assess the functional state of the body. The use of these methods in various combinations underlies functional diagnostics, the essence of which is to study the body’s response to any dosed effect. The nature of the observed changes in a particular function after a load is compared with its value at rest.

In the physiology of work, sports and in functional diagnostics, the concepts of “functional ability” and “functional ability” are used. The higher the functionality, the potentially greater the functional ability. Functional ability is manifested in the process of physical activity and can be trained.

Task 1. Rosenthal test.

Equipment: dry spirometer, alcohol, cotton wool.

Carrying out the Rosenthal test is reduced to five consecutive measurements of vital capacity at 15-second intervals. In healthy people, the value of vital capacity in tests either does not change or even increases. In cases of disease of the respiratory apparatus or circulatory system, as well as in athletes with overwork, overstrain or overtraining, the results of repeated measurements of vital capacity decrease, which is a reflection of the processes of fatigue in the respiratory muscles and a decrease in the level of functionality of the nervous system.

Task 2. Test with dosed physical activity.

Equipment: Same.

Determining the value of vital capacity after dosed physical activity allows you to indirectly assess the state of pulmonary circulation. Its disruption can occur, for example, with an increase in pressure in the vessels of the pulmonary circulation, as a result of which the capacity of the alveoli decreases and, as a result, vital capacity. Determine the initial value of vital capacity (2-3 measurements, the arithmetic average of the results obtained will characterize the initial vital capacity), then perform 15 squats in 30 seconds. and again determine vital capacity. In healthy people, under the influence of physical activity, vital capacity decreases by no more than 15% from the initial values. A more significant decrease in vital capacity does not indicate pulmonary circulatory failure.

Task 3. Breath-hold tests.

Breathing tests with holding your breath during inhalation and exhalation allow you to judge the body’s sensitivity to arterial hypoxemia (decreased amount of oxygen bound in the blood) and hypercapnia (increased carbon dioxide tension in the blood and tissues of the body).

A person can voluntarily hold his breath, regulate the frequency and depth of breathing. However, holding your breath cannot be too long, since carbon dioxide accumulates in the blood of a person holding his breath, and when its concentration reaches a superthreshold level, the respiratory center is excited and breathing resumes against the will of the person. Since the excitability of the respiratory center is different in different people, the duration of voluntary breath holding is different for them. You can increase the breath-holding time by preliminary hyperventilation of the lungs (several frequent and deep inhalations and exhalations for 20-30 seconds). During ventilation of the lungs with maximum frequency and depth, carbon dioxide is “washed out” from the blood and the time of its accumulation to a level that excites the respiratory center increases. The sensitivity of the respiratory center to hypercapnia also decreases during training.

Equipment: nose clip, stopwatch.

Stange's test. Calculate the initial pulse, hold your breath at maximum inhalation after preliminary three breathing cycles completed at 3/4 of the depth of full inhalation and exhalation. While holding your breath, pinch your nose with a clip or your fingers. Record the time you hold your breath and count your pulse immediately after breathing resumes. Record the breath holding time and reaction rate in the protocol:

Evaluation of the data obtained:

less than 39 seconds – unsatisfactory;

40 - 49 sec - satisfactory;

over 50 seconds – good.

Genche's test.(Hold your breath while exhaling). Calculate the initial pulse, hold your breath as you exhale after preliminary three deep breathing movements. Measure heart rate after the delay, calculate PR.

Evaluation of the data obtained:

less than 34 seconds – unsatisfactory;

35 - 39 sec – satisfactory;

over 43 seconds – good.

The PR reaction rate in healthy people should not exceed 1.2.

Test for the time of maximum breath holding at rest and after dosed exercise (Saabrase test)

Hold your breath while inhaling calmly for as long as possible. Record the delay time and enter it into Table 1.

Indicators of the Saabraze sample

Then do 15 squats in 30 seconds. After this load, you need to sit down and immediately hold your breath again while inhaling, without waiting for it to calm down. Enter the time you hold your breath after exercise into the table. Find the difference and calculate the ratio of the difference to the maximum breath holding at rest in % using the formula:

a – maximum breath holding at rest;

b – maximum breath holding after exercise.

In untrained people, during physical activity, additional muscle groups are activated, and the processes of tissue respiration are not economical; carbon dioxide accumulates faster in their body. Therefore, they can hold their breath for less time. This leads to a significant discrepancy between the first and second results. A reduction in latency of 25% or less is considered good, 25-50% is considered satisfactory, and more than 50% is considered poor.

Formalization of the work result: Enter the results of the examination of the functional state of breathing for all indicators in a table and evaluate them at rest and after physical activity.

Dynamic spirometry - determination of changes in vital capacity under the influence of physical activity ( Shafransky's test). Having determined the initial value of vital capacity at rest, the subject is asked to perform dosed physical activity - 2-minute running in place at a pace of 180 steps/min while lifting the hip at an angle of 70-80°, after which vital capacity is determined again. Depending on the functional state of the external respiratory and circulatory system and their adaptation to the load, vital capacity may decrease (unsatisfactory assessment), remain unchanged (satisfactory assessment) or increase (assessment, i.e. adaptation to load, good). We can talk about reliable changes in vital capacity only if it exceeds 200 ml.

Rosenthal test- five-fold measurement of vital capacity, carried out at 15-second intervals. The results of this test make it possible to assess the presence and degree of fatigue of the respiratory muscles, which, in turn, may indicate the presence of fatigue of other skeletal muscles.

The results of the Rosenthal test are assessed as follows:

• - increase in vital capacity from the 1st to the 5th measurement - excellent rating;
• - vital capacity does not change - good assessment;
• - vital capacity decreases by up to 300 ml - satisfactory assessment;
• - vital capacity decreases by more than 300 ml - unsatisfactory assessment.

Shafransky sample consists of determining vital capacity before and after standard physical activity. The latter involves climbing a step (22.5 cm in height) for 6 minutes at a pace of 16 steps/min. Normally, vital capacity remains virtually unchanged. With a decrease in the functionality of the external respiration system, vital capacity values ​​decrease by more than 300 ml.

Genchi test- registration of breath holding time after maximum exhalation. The subject is asked to take a deep breath, then exhale as much as possible. The subject holds his breath with his nose and mouth pinched. The time you hold your breath between inhalation and exhalation is recorded.

Normally, the value of the Genchi test in healthy men and women is 20-40 s and for athletes - 40-60 s.

Stange test- the time of holding the breath during a deep breath is recorded. The subject is asked to inhale, exhale, and then inhale at a level of 85-95% of the maximum. Close your mouth, pinch your nose. After exhalation, the delay time is recorded.

The average values ​​of the Barbell test for women are 35-45 s, for men - 50-60 s, for athletes - 45-55 s and more, for athletes - 65-75 s and more.

Stange test with hyperventilation

After hyperventilation (for women - 30 s, for men - 45 s), the breath is held while taking a deep breath. The time for voluntary breath holding normally increases by 1.5-2.0 times (on average, values ​​for men are 130-150 s, for women - 90-110 s).

Stange test with physical activity.

After performing the Barbell test at rest, a load is performed - 20 squats in 30 s. After the end of physical activity, a repeat Stange test is immediately performed. The time for repeat testing is reduced by 1.5-2.0 times.

By the value of the Genchi test, one can indirectly judge the level of metabolic processes, the degree of adaptation of the respiratory center to hypoxia and hypoxemia, and the condition of the left ventricle of the heart.

Persons with high levels of hypoxemic tests tolerate physical activity better. During training, especially in mid-mountain conditions, these indicators increase.

In children, hypoxemic test rates are lower than in adults.