Yates Bill J, Catanzaro Michael F, Miller Daniel J, McCall Andrew A
Department of Otolaryngology, Eye and Ear Institute, University of Pittsburgh, Room 519, Pittsburgh, PA, 15213, USA,
Exp Brain Res. 2014 Aug;232(8):2455-69. doi: 10.1007/s00221-014-3937-6. Epub 2014 Apr 16.
Vomiting and nausea can be elicited by a variety of stimuli, although there is considerable evidence that the same brainstem areas mediate these responses despite the triggering mechanism. A variety of experimental approaches showed that nucleus tractus solitarius, the dorsolateral reticular formation of the caudal medulla (lateral tegmental field), and the parabrachial nucleus play key roles in integrating signals that trigger nausea and vomiting. These brainstem areas presumably coordinate the contractions of the diaphragm and abdominal muscles that result in vomiting. However, it is unclear whether these regions also mediate the autonomic responses that precede and accompany vomiting, including alterations in gastrointestinal activity, sweating, and changes in blood flow to the skin. Recent studies showed that delivery of an emetic compound to the gastrointestinal system affects the processing of vestibular inputs in the lateral tegmental field and parabrachial nucleus, potentially altering susceptibility for vestibular-elicited vomiting. Findings from these studies suggested that multiple emetic inputs converge on the same brainstem neurons, such that delivery of one emetic stimulus affects the processing of another emetic signal. Despite the advances in understanding the neurobiology of nausea and vomiting, much is left to be learned. Additional neurophysiologic studies, particularly those conducted in conscious animals, will be crucial to discern the integrative processes in the brain stem that result in emesis.
呕吐和恶心可由多种刺激引发，尽管有大量证据表明，无论触发机制如何，相同的脑干区域介导这些反应。多种实验方法表明，孤束核、延髓尾部的背外侧网状结构（外侧被盖区）和臂旁核在整合触发恶心和呕吐的信号中起关键作用。这些脑干区域可能协调导致呕吐的膈肌和腹部肌肉的收缩。然而，尚不清楚这些区域是否也介导呕吐之前和伴随呕吐的自主反应，包括胃肠活动改变、出汗以及皮肤血流变化。最近的研究表明，向胃肠系统输送催吐化合物会影响外侧被盖区和臂旁核对前庭输入的处理，可能改变前庭诱发呕吐的易感性。这些研究结果表明，多种催吐输入汇聚于相同的脑干神经元，因此一种催吐刺激的传递会影响另一种催吐信号的处理。尽管在理解恶心和呕吐的神经生物学方面取得了进展，但仍有许多有待了解。额外的神经生理学研究，尤其是在清醒动物身上进行的研究，对于识别脑干中导致呕吐的整合过程至关重要。
