Hayano Junichiro, Yasuma Fumihiko
Department of Internal Medicine and Pathophysiology, Nagoya City University Graduate School of Medical Sciences, Japan.
Cardiovasc Res. 2003 Apr 1;58(1):1-9. doi: 10.1016/s0008-6363(02)00851-9.
A hypothesis is presented that explains the physiological reasons why the magnitude of respiratory sinus arrhythmia (RSA) appears to correlate with cardiac vagal tone. The hypothesis is that RSA is an intrinsic resting function of the cardiopulmonary system. Although RSA is mediated by respiratory modulation of cardiac vagal outflow and its magnitude is used as an index of cardiac vagal activity, RSA itself reflects cardiorespiratory interaction. RSA is universally observed among vertebrates throughout the evolution, suggesting that it may bear an intrinsic physiological role. Recent studies have shown that RSA improves pulmonary gas exchange efficiency by matching alveolar ventilation and capillary perfusion throughout respiration cycle. This suggests that in resting animals and humans, RSA could save cardiac and respiratory energy by suppressing unnecessary heartbeats during expiration and ineffective ventilation during waning phases of perfusion. Furthermore, evidence is accumulating for possible dissociation between the magnitude of RSA and vagal control of heart rate, suggesting separated and independent regulations for respiratory modulation of cardiac vagal outflow from those for cardiac vagal tone. By our hypothesis, the apparent associations between RSA and cardiac vagal tone are explained as indirect consequences; i.e., whenever the cardiac vagal tone changes in response to the resting level of the cardiopulmonary system, RSA appears to change parallel to it. Our hypothesis seems more consistent with both physiological and clinical evidence about RSA than that presuming RSA is an index of cardiac vagal activity.
本文提出了一种假说,用以解释呼吸性窦性心律不齐(RSA)的幅度为何似乎与心脏迷走神经张力相关的生理原因。该假说认为,RSA是心肺系统的一种内在静息功能。尽管RSA由心脏迷走神经传出的呼吸调节介导,其幅度被用作心脏迷走神经活动的指标,但RSA本身反映了心肺相互作用。在整个进化过程中,脊椎动物普遍存在RSA,这表明它可能具有内在的生理作用。最近的研究表明,RSA通过在整个呼吸周期中匹配肺泡通气和毛细血管灌注来提高肺气体交换效率。这表明,在静息状态的动物和人类中,RSA可以通过在呼气时抑制不必要的心跳以及在灌注减弱阶段抑制无效通气来节省心脏和呼吸能量。此外,越来越多的证据表明,RSA的幅度与心率的迷走神经控制之间可能存在分离,这表明心脏迷走神经传出的呼吸调节与心脏迷走神经张力的调节是分开且独立的。根据我们的假说,RSA与心脏迷走神经张力之间的明显关联被解释为间接结果;即,每当心脏迷走神经张力因心肺系统的静息水平而发生变化时,RSA似乎会与之平行变化。与假定RSA是心脏迷走神经活动指标的假说相比,我们的假说似乎与关于RSA的生理和临床证据更为一致。
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