Gauda Estelle B, McLemore Gabrielle L, Tolosa Jose, Marston-Nelson Jannette, Kwak Daniel
Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD 21287-3200, USA.
Semin Neonatol. 2004 Jun;9(3):181-94. doi: 10.1016/j.siny.2003.11.002.
Apnoea and periodic breathing are the hallmarks of breathing for the infant who is born prematurely. Sustained respiration is obtained through modulation of respiratory-related neurons with inputs from the periphery. The peripheral arterial chemoreceptors, uniquely and reflexly change ventilation in response to changes in oxygen tension. The chemoreflex in response to hypoxia is hyperventilation, bradycardia and vasoconstriction. The fast response time of the peripheral arterial chemoreceptors to changes in oxygen and carbon dioxide tension increases the risk of more periodicity in the breathing pattern. As a result of baseline hypoxaemia, peripheral arterial chemoreceptors contribute more to baseline breathing in premature than in term infants. While premature infants may have an augmented chemoreflex, infants who develop bronchopulmonary dysplasia have a blunted chemoreflex at term gestation. The development of chemosensitivity of the peripheral arterial chemoreceptors and environmental factors that might cause maldevelopment of chemosensitivity with continued maturation are reviewed in an attempt to help explain the physiology of apnoea of prematurity and the increased incidence of sudden infant death syndrome (SIDS) in infants born prematurely and those who are exposed to tobacco smoke.
呼吸暂停和周期性呼吸是早产婴儿呼吸的特征。通过来自外周的输入对呼吸相关神经元进行调节来实现持续呼吸。外周动脉化学感受器会根据氧张力的变化独特地、反射性地改变通气。对缺氧的化学反射是过度通气、心动过缓和血管收缩。外周动脉化学感受器对氧和二氧化碳张力变化的快速反应时间增加了呼吸模式出现更多周期性的风险。由于基线低氧血症，外周动脉化学感受器对早产婴儿基线呼吸的贡献比足月儿更大。虽然早产婴儿可能有增强的化学反射，但患有支气管肺发育不良的婴儿在足月妊娠时化学反射减弱。本文综述了外周动脉化学感受器化学敏感性的发育以及可能随着持续成熟导致化学敏感性发育异常的环境因素，以试图解释早产呼吸暂停的生理学以及早产婴儿和暴露于烟草烟雾的婴儿中婴儿猝死综合征（SIDS）发病率增加的原因。
