急性肺部炎症对呼吸中枢神经 调控的影响
Impact of Acute Pulmonary Inflammation on the Neuroregulatory Function of the Respiratory Centers
摘要: 呼吸运动依赖于呼吸中枢精准调控及多器官系统协同。本文系统阐述呼吸调控通路的组成与功能，涵盖呼吸中枢、效应器及反馈感受器。呼吸驱动作为呼吸中枢的神经输出，受中枢–外周神经环路精准调控，其异常是机械通气患者继发肺损伤的重要机制。现有治疗多聚焦于血气指标对呼吸中枢的反馈调节，但难以解释血气正常者仍存在高驱动的现象。本文综述急性肺部炎症对呼吸中枢、化学感受器及呼吸肌的多层面影响，归纳流速指数、气道闭合压(Airway occlusion pressure, P0.1)、呼气末气道阻断压(Negative pressure deflection during the end-expiratory occlusion, POCC)、食道压变化(Change in esophageal pressure, ΔPES)、膈肌电活动(Electrical activity of diaphragm, EAdi)、膈肌超声等床旁呼吸驱动监测手段，总结急性炎症所致的高呼吸驱动鉴别要点，并强调控制炎症对实现肺–膈肌双重保护的关键作用，以指导临床治疗。
Abstract: Respiration relies on precise regulation by the respiratory centers and the coordinated function of multiple organ systems. This article systematically elucidates the composition and function of the respiratory control pathway, encompassing the respiratory centers, effectors, and feedback receptors. The respiratory drive, defined as the neural output from the respiratory centers, is precisely regulated by central-peripheral neural circuits. Its abnormality serves as a key mechanism for ventilator-induced lung injury in mechanically ventilated patients. Current therapies primarily focus on the feedback modulation of the respiratory centers by blood gas parameters. Yet, they fail to adequately explain the persistence of high respiratory drive in patients with normal blood gases. This review summarizes the multifaceted impact of acute pulmonary inflammation on the respiratory centers, chemoreceptors, and respiratory muscles. It also outlines bedside methods for monitoring respiratory drive, including the flow index, airway occlusion pressure (P0.1), negative pressure deflection during the end‐expiratory occlusion (POCC), change in esophageal pressure (ΔPes), electrical activity of diaphragm (EAdi), and diaphragm ultrasound. The review summarizes the key points for differentiating high respiratory drive caused by acute inflammation, and emphasizes the critical role of inflammation control in achieving dual lung and diaphragm protection to guide clinical management.
文章引用：周宇杰, 黄文祺. 急性肺部炎症对呼吸中枢神经 调控的影响[J]. 临床医学进展, 2026, 16(3): 809-817. https://doi.org/10.12677/acm.2026.163851

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