Fisher James P, Zera Tymoteusz, Paton Julian F R
Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
Handb Clin Neurol. 2022;188:279-308. doi: 10.1016/B978-0-323-91534-2.00006-0.
Much of biology is rhythmical and comprises oscillators that can couple. These have optimized energy efficiency and have been preserved during evolution. The respiratory and cardiovascular systems contain numerous oscillators, and importantly, they couple. This coupling is dynamic but essential for an efficient transmission of neural information critical for the precise linking of breathing and oxygen delivery while permitting adaptive responses to changes in state. The respiratory pattern generator and the neural network responsible for sympathetic and cardiovagal (parasympathetic) tone generation interact at many levels ensuring that cardiac output and regional blood flow match oxygen delivery to the lungs and tissues efficiently. The most classic manifestations of these interactions are respiratory sinus arrhythmia and the respiratory modulation of sympathetic nerve activity. These interactions derive from shared somatic and cardiopulmonary afferent inputs, reciprocal interactions between brainstem networks and inputs from supra-pontine regions. Disrupted respiratory-cardiovascular coupling can result in disease, where it may further the pathophysiological sequelae and be a harbinger of poor outcomes. This has been well documented by diminished respiratory sinus arrhythmia and altered respiratory sympathetic coupling in animal models and/or patients with myocardial infarction, heart failure, diabetes mellitus, and neurological disorders as stroke, brain trauma, Parkinson disease, or epilepsy. Future research needs to assess the therapeutic potential for ameliorating respiratory-cardiovascular coupling in disease.
生物学的许多方面都具有节律性，包含可耦合的振荡器。这些振荡器优化了能量效率，并在进化过程中得以保留。呼吸系统和心血管系统包含众多振荡器，重要的是，它们相互耦合。这种耦合是动态的，但对于有效传递神经信息至关重要，而这些神经信息对于呼吸与氧气输送的精确关联以及允许对状态变化做出适应性反应至关重要。呼吸模式发生器以及负责产生交感神经和心迷走（副交感神经）张力的神经网络在多个层面相互作用，确保心输出量和局部血流有效地匹配向肺部和组织的氧气输送。这些相互作用最典型的表现是呼吸性窦性心律不齐和交感神经活动的呼吸调节。这些相互作用源于共同的躯体和心肺传入输入、脑干网络之间的相互作用以及脑桥上区域的输入。呼吸 - 心血管耦合中断可导致疾病，在疾病中它可能会加剧病理生理后遗症，并预示不良后果。在动物模型和/或患有心肌梗死、心力衰竭、糖尿病以及中风、脑外伤、帕金森病或癫痫等神经系统疾病的患者中，呼吸性窦性心律不齐减弱和呼吸交感耦合改变已充分证明了这一点。未来的研究需要评估改善疾病中呼吸 - 心血管耦合的治疗潜力。
