Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States; Faculty of Health Sciences, Virginia Tech, Blacksburg, VA, United States.
Handb Clin Neurol. 2022;188:309-338. doi: 10.1016/B978-0-323-91534-2.00008-4.
The clinical term dyspnea (a.k.a. breathlessness or shortness of breath) encompasses at least three qualitatively distinct sensations that warn of threats to breathing: air hunger, effort to breathe, and chest tightness. Air hunger is a primal homeostatic warning signal of insufficient alveolar ventilation that can produce fear and anxiety and severely impacts the lives of patients with cardiopulmonary, neuromuscular, psychological, and end-stage disease. The sense of effort to breathe informs of increased respiratory muscle activity and warns of potential impediments to breathing. Most frequently associated with bronchoconstriction, chest tightness may warn of airway inflammation and constriction through activation of airway sensory nerves. This chapter reviews human and functional brain imaging studies with comparison to pertinent neurorespiratory studies in animals to propose the interoceptive networks underlying each sensation. The neural origins of their distinct sensory and affective dimensions are discussed, and areas for future research are proposed. Despite dyspnea's clinical prevalence and impact, management of dyspnea languishes decades behind the treatment of pain. The neurophysiological bases of current therapeutic approaches are reviewed; however, a better understanding of the neural mechanisms of dyspnea may lead to development of novel therapies and improved patient care.
呼吸困难（也称为气促或呼吸急促）是一个临床术语，至少包含三种不同的感觉，这些感觉警告呼吸受到威胁：气促感、呼吸困难感和胸闷感。气促感是肺泡通气不足的原始体内平衡警告信号，可引起恐惧和焦虑，并严重影响心肺、神经肌肉、心理和终末期疾病患者的生活。呼吸困难感提示呼吸肌活动增加，并警告呼吸可能受阻。最常与支气管收缩相关的胸闷感可能通过气道感觉神经的激活来警告气道炎症和收缩。本章通过与动物相关的神经呼吸研究进行比较，回顾了人类和功能性大脑成像研究，提出了每种感觉的内脏感觉网络。讨论了它们不同的感觉和情感维度的神经起源，并提出了未来的研究领域。尽管呼吸困难的临床发病率和影响很高，但与疼痛的治疗相比，呼吸困难的管理落后了几十年。本文回顾了当前治疗方法的神经生理学基础；然而，对呼吸困难神经机制的更好理解可能会导致开发新的治疗方法和改善患者护理。
