Neurocardiology: Structure-Based Function
Neurocardiology: Structure-Based Function
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DOI：
10.1002/cphy.c150046
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发表时间：
2016-10-01
影响因子：
5.8
通讯作者：
Armour, John Andrew
中科院分区：
文献类型：
--
作者：
Ardell, Jeffrey L.;Armour, John Andrew
心脏控制是通过一系列反射控制网络介导的，这些反射控制网络涉及（i）心内神经节（心脏）、（ii）胸内心外神经节（星状，中颈）、（iii）上级颈神经节、（iv）脊髓、（v）脑干和（vi）高级中枢中的胞体。这些处理中心中的每一个都包含传入、传出和局部回路神经元，这些神经元在局部以相互依赖的方式与其他水平相互作用，以在逐搏的基础上协调区域心脏电和机械指数。该控制系统被优化以响应正常的生理应激（站立、运动和温度）;然而，它可能被病理事件（如心肌缺血）灾难性地破坏。事实上，现在认识到自主神经失调是心力衰竭和心律失常演变的核心。自主神经调节治疗是一种新兴的方式在急性和慢性心脏病的管理。针对心脏控制的该层级的选择连结点的基于神经调节的方法提供了通过改善心血管反射控制的功效来积极影响治疗结果的独特机会。因此，理解这种控制的解剖学和生理学基础对于有效地实施新型神经调节疗法是必要的。(C)2016美国生理学会。
Cardiac control is mediated via a series of reflex control networks involving somata in the (i) intrinsic cardiac ganglia (heart), (ii) intrathoracic extracardiac ganglia (stellate, middle cervical), (iii) superior cervical ganglia, (iv) spinal cord, (v) brainstem, and (vi) higher centers. Each of these processing centers contains afferent, efferent, and local circuit neurons, which interact locally and in an interdependent fashion with the other levels to coordinate regional cardiac electrical and mechanical indices on a beat-to-beat basis. This control system is optimized to respond to normal physiological stressors (standing, exercise, and temperature); however, it can be catastrophically disrupted by pathological events such as myocardial ischemia. In fact, it is now recognized that autonomic dysregulation is central to the evolution of heart failure and arrhythmias. Autonomic regulation therapy is an emerging modality in the management of acute and chronic cardiac pathologies. Neuromodulation-based approaches that target select nexus points of this hierarchy for cardiac control offer unique opportunities to positively affect therapeutic outcomes via improved efficacy of cardiovascular reflex control. As such, understanding the anatomical and physiological basis for such control is necessary to implement effectively novel neuromodulation therapies. (C) 2016 American Physiological Society.