Cunningham E T, Ravich W J, Jones B, Donner M W
Johns Hopkins Medical Institutions, Baltimore, Maryland.
Ann Intern Med. 1992 Apr 1;116(7):575-82. doi: 10.7326/0003-4819-116-7-575.
To review the physiologic basis for normal and abnormal vagal reflexes arising from the pharynx, larynx, and esophagus, as well as the relevance of vagal reflexes to the pathogenesis of such clinically common cardiorespiratory responses as bradycardia, tachycardia, dysrhythmia, coronary angiospasm, bronchospasm, laryngospasm, prolonged apnea, and singultus (hiccups).
Pertinent articles and reviews were identified through a MEDLINE search (April 1966 to October 1991). Older studies and others not identified in the MEDLINE search were found through a manual search of the bibliographies of the retrieved articles.
Experimental studies in both humans and animals, as well as case series and single case reports, were selected for evaluation and citation. In instances where a similar phenomenon was described in multiple independent reports, only studies that provided a novel finding or interpretation were cited. More authoritative book chapters and peer-reviewed summaries were also cited in support of commonly accepted principles.
Most of the clinical data are derived from case reports and small case series and are therefore anecdotal; equal weight was given to all such studies. Reports of conflicting observations or interpretations were clearly identified and were cited without exception.
Stimulation of the upper aerodigestive tract can lead to clinically significant cardiorespiratory responses. Although the prevalence of and risk factors for such responses have not been established, we suggest that a pharyngeal, a laryngeal, or an esophageal source for abnormal cardiorespiratory responses be sought whenever a detailed clinical evaluation fails to reveal a cause, particularly when there are concurrent symptoms or signs of upper aerodigestive tract disease, such as dysphagia or gastroesophageal reflux.
回顾源于咽、喉及食管的正常和异常迷走反射的生理基础，以及迷走反射与诸如心动过缓、心动过速、心律失常、冠状动脉痉挛、支气管痉挛、喉痉挛、长时间呼吸暂停和呃逆（打嗝）等临床常见心肺反应发病机制的相关性。
通过MEDLINE检索（1966年4月至1991年10月）确定相关文章和综述。通过手工检索所检索文章的参考文献找到MEDLINE检索中未找到的早期研究及其他研究。
选择人类和动物的实验研究以及病例系列和单病例报告进行评估和引用。在多个独立报告中描述了类似现象的情况下，仅引用提供了新发现或解释的研究。还引用了更具权威性的书籍章节和同行评审的综述来支持普遍接受的原则。
大多数临床资料来自病例报告和小病例系列，因此属于轶事性资料；对所有此类研究给予同等权重。明确识别并毫无例外地引用了相互矛盾的观察结果或解释的报告。
上呼吸道消化道的刺激可导致具有临床意义的心肺反应。尽管此类反应的发生率和危险因素尚未确定，但我们建议，当详细的临床评估未能揭示病因时，尤其是当存在上呼吸道消化道疾病的并发症状或体征，如吞咽困难或胃食管反流时，应寻找异常心肺反应的咽、喉或食管来源。
