Davies A M, Koenig J S, Thach B T
Edward Mallinckrodt Department of Pediatrics, Washington University, St. Louis, Missouri.
Am Rev Respir Dis. 1989 Mar;139(3):668-73. doi: 10.1164/ajrccm/139.3.668.
Water instilled into the pharynx of sleeping human infants elicits a range of chemoreflex responses that, occasionally, includes prolonged apnea (defined as absence of ventilation for at least 20 s, or for a shorter period if accompanied by bradycardia of less than or equal to 100 b.p.m. or cyanosis). To learn more about airway receptors mediating this prolonged apneic response and factors determining its occurrence, we examined the importance of stimulus location and associations between prolonged apnea, bradycardia, and upper airway responses. A total of 29 episodes of prolonged apnea were recorded after water stimulation in 12 infants. Bradycardia (HR less than 100) followed stimulus delivery but was always preceded by apnea and did not appear as an independent chemoreflex response. Behavioral arousal and prolonged apnea were not mutually exclusive responses and recovery from prolonged apnea was not always closely linked with arousal. Occurrence of prolonged apnea was greater after pharyngeal than nasal stimulation, and was frequently associated with coughing, but not with sneezing, suggesting that prolonged apnea is elicited from a sensory site close to, or the same as, one mediating cough. We conclude, using this water stimulus method, that the predominant receptors for chemoreflex-prolonged apnea are located in the pharynx or larynx rather than in the nose.
向睡眠中的人类婴儿咽部滴入水会引发一系列化学反射反应，偶尔会出现长时间呼吸暂停（定义为至少20秒无通气，或在伴有心率小于或等于100次/分钟的心动过缓或发绀时，通气时间较短）。为了更多地了解介导这种长时间呼吸暂停反应的气道感受器以及决定其发生的因素，我们研究了刺激部位的重要性以及长时间呼吸暂停、心动过缓和上呼吸道反应之间的关联。在12名婴儿的水刺激后共记录到29次长时间呼吸暂停发作。心动过缓（心率小于100）在刺激后出现，但总是先于呼吸暂停，且并非作为一种独立的化学反射反应出现。行为觉醒和长时间呼吸暂停并非相互排斥的反应，长时间呼吸暂停的恢复并不总是与觉醒密切相关。咽部刺激后长时间呼吸暂停的发生率高于鼻腔刺激，且常与咳嗽相关，但与打喷嚏无关，这表明长时间呼吸暂停是由一个与介导咳嗽的感受器相近或相同的感觉部位引发的。我们使用这种水刺激方法得出结论，化学反射性长时间呼吸暂停的主要感受器位于咽部或喉部而非鼻部。
