呼吸肌訓練的分子機制與跨疾病應用：從呼吸康復到全身系統性干預_Chinese Journal of Respiratory and Critical Care Medicine

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武云肖 ^1,2 , 梁紅英 ¹ , 張麗 ¹ , 李海霞 ¹ , 張天明 ¹ , 武凡祺 ¹ , 柳卓涵 ³ ,  王虹 ¹

1. ;
2. ;
3. ;

Corresponding?author：

王虹, Email: 1311098171@qq.com

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DOI：

10.7507/1671-6205.202508005

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Citation： 武云肖, 梁紅英, 張麗, 李海霞, 張天明, 武凡祺, 柳卓涵, 王虹. 呼吸肌訓練的分子機制與跨疾病應用：從呼吸康復到全身系統性干預. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(5): 371-375. doi: 10.7507/1671-6205.202508005 Copy

1.	Figueiredo RIN, Azambuja AM, Cureau FV, et al. Inspiratory muscle training in COPD. Respir Care, 2020, 65(8): 1189-1201.
2.	Leith DE, Bradley M. Ventilatory muscle strength and endurance training. J Appl Physiol, 1976, 41(4): 508-516.
3.	Belman MJ, Mittman C. Ventilatory muscle training improves exercise capacity in chronic obstructive pulmonary disease patients. Am Rev Respir Dis, 1980, 121(2): 273-280.
4.	Belman MJ, Shadmehr R. A target feedback device for ventilatory muscle training. J Clin Monit, 1991, 7(1): 42-48.
5.	Belman MJ, Botnick WC, Nathan SD, et al. Ventilatory load characteristics during ventilatory muscle training. Am J Respir Crit Care Med, 1994, 149(4 Pt 1): 925-929.
6.	Geddes EL, O’Brien K, Reid WD, et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review. Respir Med, 2008, 102(12): 1715-1729.
7.	Bissett BM, Leditschke IA, Neeman T, et al. Inspiratory muscle training to enhance recovery from mechanical ventilation: A randomised trial. Thorax, 2016, 71(9): 812-819.
8.	Jenkins TO, MacBean V, Poulsen MK, et al. The metabolic cost of inspiratory muscle training in mechanically ventilated patients in critical care. Intensive Care Med Exp, 2023, 11(1): 41.
9.	Craighead DH, Heinbockel TC, Freeberg KA, et al. Time‐efficient inspiratory muscle strength training lowers blood pressure and improves endothelial function, NO bioavailability, and oxidative stress in midlife/older adults with above‐normal blood pressure. J Am Heart Assoc, 2021, 10(13): e020980.
10.	何陽, 王易軒, 胡克. 治療性間歇低氧–高氧研究進展. 中國呼吸與危重監護雜志, 2023, 22(11): 815-820.
11.	Sheel AW, Derchak PA, Pegelow DF, et al. Threshold effects of respiratory muscle work on limb vascular resistance. Am J Physiol-Heart Circ Physiol, 2002, 282(5): H1732-H1738.
12.	St Croix CM, Morgan BJ, Wetter TJ, et al. Fatiguing inspiratory muscle work causes reflex sympathetic activation in humans. J Physiol, 2000, 529(2): 493-504.
13.	Sheel AW, Derchak PA, Morgan BJ, et al. Fatiguing inspiratory muscle work causes reflex reduction in resting leg blood flow in humans. J Physiol, 2001, 537(1): 277-289.
14.	Derchak PA, Sheel AW, Morgan BJ, et al. Effects of expiratory muscle work on muscle sympathetic nerve activity. J Appl Physiol, 2002, 92(4): 1539-1552.
15.	Dempsey JA, Romer L, Rodman J, et al. Consequences of exercise-induced respiratory muscle work. Respir Physiol Neurobiol, 2006, 151(2-3): 242-250.
16.	Hill JM. Discharge of group IV phrenic afferent fibers increases during diaphragmatic fatigue. Brain Res, 2000, 856(1-2): 240-244.
17.	Bisschop A, Gayan-Ramirez G, Rollier H, et al. Intermittent inspiratory muscle training induces fiber hypertrophy in rat diaphragm. Am J Respir Crit Care Med, 1997, 155(5): 1583-1589.
18.	Rollier H, Bisschop A, Gayan-Ramirez G, et al. Low load inspiratory muscle training increases diaphragmatic fiber dimensions in rats. Am J Respir Crit Care Med, 1998, 157(3): 833-839.
19.	Bazzy AR, Kim YJ. Effect of chronic respiratory load on cytochrome oxidase activity in diaphragmatic fibers. J Appl Physiol, 1992, 72(1): 266-271.
20.	Langer D, Ciavaglia C, Faisal A, et al. Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. J Appl Physiol, 2018, 125(2): 381-392.
21.	Wu W, Zhang X, Lin L, et al. Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2017, 12: 773-781.
22.	Shiraishi M, Higashimoto Y, Sugiya R, et al. Enhanced diaphragm excursion and exercise tolerance in COPD patients through inspiratory muscle training after standardised pulmonary rehabilitation: randomised controlled trial. ERJ Open Res, 2024, 10(6): 00035-2024.
23.	Liu F, Jones AYM, Tsang RCC, et al. Recruitment of the diaphragm and sternocleidomastoid muscle during increasing inspiratory pressure loads in healthy young adults. Respir Physiol Neurobiol, 2025, 331: 104365.
24.	Lima TBWE, Silva BBDS, Souza APSD, et al. The effect of inspiratory muscle training on the inspiratory muscle metaboreflex: A systematic review. Can J Respir Ther, 2025, 61: 51-59.
25.	Chiappa GR, Roseguini BT, Vieira PJC, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol, 2008, 51(17): 1663-1671.
26.	Salah HM, Goldberg LR, Molinger J, et al. Diaphragmatic function in cardiovascular disease. J Am Coll Cardiol, 2022, 80(17): 1647-1659.
27.	Moreno AM, Castro RRT, Silva BM, et al. Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: Potential role of a respiratory muscle metaboreflex. Braz J Med Biol Res, 2014, 47(11): 972-976.
28.	Jaenisch RB, Hentschke VS, Quagliotto E, et al. Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure. J Appl Physiol, 2011, 111(6): 1664-1670.
29.	Ferreira JB, Plentz RDM, Stein C, et al. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: a randomized controlled trial. Int J Cardiol, 2013, 166(1): 61-67.
30.	Vranish JR, Bailey EF. Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea. Sleep, 2016, 39(6): 1179-1185.
31.	Lei Y, He J, Hu F, et al. Sequential inspiratory muscle exercise-noninvasive positive pressure ventilation alleviates oxidative stress in COPD by mediating SOCS5/JAK2/STAT3 pathway. BMC Pulm Med, 2023, 23(1): 385.
32.	Wang LY, Yang PY, Chen YJ, et al. Inspiratory muscle training attenuates irradiation-induced diaphragm dysfunction. Am J Transl Res, 2019, 11(9): 5599-5610.
33.	Zhang YS, Zhang K, Huang L, et al. The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: A meta-analysis. Eur Rev Aging Phys Act, 2024, 21(1): 4.
34.	Kim NS, Jung JH. The effects of breathing retraining on asymmetry of diaphragm thickness in stroke patients. J Korean Soc Phys Med, 2013, 8(2): 263-269.
35.	Jung JH, Kim NS. The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. J Phys Ther Sci, 2015, 27(10): 3267-3269.
36.	O’Donnell DE, Bertley JC, Chau LK, et al. Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med, 1997, 155(1): 109-115.
37.	Maltais F, Decramer M, Casaburi R, et al. An Official American Thoracic Society/European Respiratory Society Statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2014, 189(9): e15-e62.
38.	Larson JL, Covey MK, Corbridge S. Inspiratory muscle strength in chronic obstructive pulmonary disease. AACN Clin Issues Adv Pract Acute Crit Care, 2002, 13(2): 320-332.
39.	Charususin N, Gosselink R, McConnell A, et al. Inspiratory muscle training improves breathing pattern during exercise in COPD patients. Eur Respir J, 2016, 47(4): 1261-1264.
40.	Huang Z, Li Z, Yan M, et al. Effect of respiratory muscle training in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis. Heliyon, 2024, 10(7): e28733.
41.	Chen TA, Mao ST, Chen TT, et al. Optimal pulmonary rehabilitation program and timing of program initiation for patients with chronic obstructive pulmonary disease: a systematic review and network meta-analysis. J Cardiopulm Rehabil Prev, 2025, 45(5): 318-326.
42.	羅靜, 唐茜, 胡莉麗, 等. 慢性阻塞性肺疾病患者癥狀群及護理干預的研究進展. 中國呼吸與危重監護雜志, 2025, 24(8): 597-601.
43.	中華醫學會呼吸病學分會呼吸治療學組, 中國康復醫學會呼吸康復專委會呼吸治療學組. 家庭無創通氣技術應用規范專家共識. 中國呼吸與危重監護雜志, 2025, 24(9): 609-627.
44.	Adams V, Bowen TS, Werner S, et al. Small‐molecule‐mediated chemical knock‐down of MuRF1/MuRF2 and attenuation of diaphragm dysfunction in chronic heart failure. J Cachexia Sarcopenia Muscle, 2019, 10(5): 1102-1115.
45.	Hughes PD, Polkey MI, Lou Harris M, et al. Diaphragm strength in chronic heart failure. Am J Respir Crit Care Med, 1999, 160(2): 529-534.
46.	Begrambekova YL. Remodeling of the external respiratory system in chronic heart failure - a factor of pathogenesis and a therapeutic target. Kardiologiia, 2025, 65(1): 41-49.
47.	Wu J, Kuang L, Fu L. Effects of inspiratory muscle training in chronic heart failure patients: a systematic review and meta-analysis. Congenit Heart Dis, 2018, 13(2): 194-202.
48.	Kim M, Lee K, Cho J, et al. Diaphragm thickness and inspiratory muscle functions in chronic stroke patients. Med Sci Monit, 2017, 23: 1247-1253.
49.	Pedreira RBS, Fernandes MH, Brito TA, et al. Are maximum respiratory pressures predictors of sarcopenia in the elderly? J Bras Pneumol, 2022: e20210335.
50.	Zhao Q, Shao C, Wang Y, et al. The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes: a randomized controlled trial. Turk J Phys Med Rehabil, 2024, 70(4): 476-485.
51.	Rodríguez Má, Crespo I, Del Valle M, et al. Should respiratory muscle training be part of the treatment of parkinson’s disease? A systematic review of randomized controlled trials. Clin Rehabil, 2020, 34(4): 429-437.
52.	Navas-Garrido I, Martín-Nú?ez J, Raya-Benítez J, et al. Respiratory muscle strength training in parkinson’s disease-a systematic review and meta-analysis. Healthcare, 2025, 13(10): 1214.
53.	佟赫, 叢舒, 方利文, 等 2019-2020年中國40歲及以上人群肺功能檢查狀況分析. 中華流行病學雜志, 2023, 44(5): 727-734.

1. Figueiredo RIN, Azambuja AM, Cureau FV, et al. Inspiratory muscle training in COPD. Respir Care, 2020, 65(8): 1189-1201.
2. Leith DE, Bradley M. Ventilatory muscle strength and endurance training. J Appl Physiol, 1976, 41(4): 508-516.
3. Belman MJ, Mittman C. Ventilatory muscle training improves exercise capacity in chronic obstructive pulmonary disease patients. Am Rev Respir Dis, 1980, 121(2): 273-280.
4. Belman MJ, Shadmehr R. A target feedback device for ventilatory muscle training. J Clin Monit, 1991, 7(1): 42-48.
5. Belman MJ, Botnick WC, Nathan SD, et al. Ventilatory load characteristics during ventilatory muscle training. Am J Respir Crit Care Med, 1994, 149(4 Pt 1): 925-929.
6. Geddes EL, O’Brien K, Reid WD, et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review. Respir Med, 2008, 102(12): 1715-1729.
7. Bissett BM, Leditschke IA, Neeman T, et al. Inspiratory muscle training to enhance recovery from mechanical ventilation: A randomised trial. Thorax, 2016, 71(9): 812-819.
8. Jenkins TO, MacBean V, Poulsen MK, et al. The metabolic cost of inspiratory muscle training in mechanically ventilated patients in critical care. Intensive Care Med Exp, 2023, 11(1): 41.
9. Craighead DH, Heinbockel TC, Freeberg KA, et al. Time‐efficient inspiratory muscle strength training lowers blood pressure and improves endothelial function, NO bioavailability, and oxidative stress in midlife/older adults with above‐normal blood pressure. J Am Heart Assoc, 2021, 10(13): e020980.
10. 何陽, 王易軒, 胡克. 治療性間歇低氧–高氧研究進展. 中國呼吸與危重監護雜志, 2023, 22(11): 815-820.
11. Sheel AW, Derchak PA, Pegelow DF, et al. Threshold effects of respiratory muscle work on limb vascular resistance. Am J Physiol-Heart Circ Physiol, 2002, 282(5): H1732-H1738.
12. St Croix CM, Morgan BJ, Wetter TJ, et al. Fatiguing inspiratory muscle work causes reflex sympathetic activation in humans. J Physiol, 2000, 529(2): 493-504.
13. Sheel AW, Derchak PA, Morgan BJ, et al. Fatiguing inspiratory muscle work causes reflex reduction in resting leg blood flow in humans. J Physiol, 2001, 537(1): 277-289.
14. Derchak PA, Sheel AW, Morgan BJ, et al. Effects of expiratory muscle work on muscle sympathetic nerve activity. J Appl Physiol, 2002, 92(4): 1539-1552.
15. Dempsey JA, Romer L, Rodman J, et al. Consequences of exercise-induced respiratory muscle work. Respir Physiol Neurobiol, 2006, 151(2-3): 242-250.
16. Hill JM. Discharge of group IV phrenic afferent fibers increases during diaphragmatic fatigue. Brain Res, 2000, 856(1-2): 240-244.
17. Bisschop A, Gayan-Ramirez G, Rollier H, et al. Intermittent inspiratory muscle training induces fiber hypertrophy in rat diaphragm. Am J Respir Crit Care Med, 1997, 155(5): 1583-1589.
18. Rollier H, Bisschop A, Gayan-Ramirez G, et al. Low load inspiratory muscle training increases diaphragmatic fiber dimensions in rats. Am J Respir Crit Care Med, 1998, 157(3): 833-839.
19. Bazzy AR, Kim YJ. Effect of chronic respiratory load on cytochrome oxidase activity in diaphragmatic fibers. J Appl Physiol, 1992, 72(1): 266-271.
20. Langer D, Ciavaglia C, Faisal A, et al. Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. J Appl Physiol, 2018, 125(2): 381-392.
21. Wu W, Zhang X, Lin L, et al. Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2017, 12: 773-781.
22. Shiraishi M, Higashimoto Y, Sugiya R, et al. Enhanced diaphragm excursion and exercise tolerance in COPD patients through inspiratory muscle training after standardised pulmonary rehabilitation: randomised controlled trial. ERJ Open Res, 2024, 10(6): 00035-2024.
23. Liu F, Jones AYM, Tsang RCC, et al. Recruitment of the diaphragm and sternocleidomastoid muscle during increasing inspiratory pressure loads in healthy young adults. Respir Physiol Neurobiol, 2025, 331: 104365.
24. Lima TBWE, Silva BBDS, Souza APSD, et al. The effect of inspiratory muscle training on the inspiratory muscle metaboreflex: A systematic review. Can J Respir Ther, 2025, 61: 51-59.
25. Chiappa GR, Roseguini BT, Vieira PJC, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol, 2008, 51(17): 1663-1671.
26. Salah HM, Goldberg LR, Molinger J, et al. Diaphragmatic function in cardiovascular disease. J Am Coll Cardiol, 2022, 80(17): 1647-1659.
27. Moreno AM, Castro RRT, Silva BM, et al. Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: Potential role of a respiratory muscle metaboreflex. Braz J Med Biol Res, 2014, 47(11): 972-976.
28. Jaenisch RB, Hentschke VS, Quagliotto E, et al. Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure. J Appl Physiol, 2011, 111(6): 1664-1670.
29. Ferreira JB, Plentz RDM, Stein C, et al. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: a randomized controlled trial. Int J Cardiol, 2013, 166(1): 61-67.
30. Vranish JR, Bailey EF. Inspiratory muscle training improves sleep and mitigates cardiovascular dysfunction in obstructive sleep apnea. Sleep, 2016, 39(6): 1179-1185.
31. Lei Y, He J, Hu F, et al. Sequential inspiratory muscle exercise-noninvasive positive pressure ventilation alleviates oxidative stress in COPD by mediating SOCS5/JAK2/STAT3 pathway. BMC Pulm Med, 2023, 23(1): 385.
32. Wang LY, Yang PY, Chen YJ, et al. Inspiratory muscle training attenuates irradiation-induced diaphragm dysfunction. Am J Transl Res, 2019, 11(9): 5599-5610.
33. Zhang YS, Zhang K, Huang L, et al. The effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke: A meta-analysis. Eur Rev Aging Phys Act, 2024, 21(1): 4.
34. Kim NS, Jung JH. The effects of breathing retraining on asymmetry of diaphragm thickness in stroke patients. J Korean Soc Phys Med, 2013, 8(2): 263-269.
35. Jung JH, Kim NS. The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. J Phys Ther Sci, 2015, 27(10): 3267-3269.
36. O’Donnell DE, Bertley JC, Chau LK, et al. Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med, 1997, 155(1): 109-115.
37. Maltais F, Decramer M, Casaburi R, et al. An Official American Thoracic Society/European Respiratory Society Statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2014, 189(9): e15-e62.
38. Larson JL, Covey MK, Corbridge S. Inspiratory muscle strength in chronic obstructive pulmonary disease. AACN Clin Issues Adv Pract Acute Crit Care, 2002, 13(2): 320-332.
39. Charususin N, Gosselink R, McConnell A, et al. Inspiratory muscle training improves breathing pattern during exercise in COPD patients. Eur Respir J, 2016, 47(4): 1261-1264.
40. Huang Z, Li Z, Yan M, et al. Effect of respiratory muscle training in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis. Heliyon, 2024, 10(7): e28733.
41. Chen TA, Mao ST, Chen TT, et al. Optimal pulmonary rehabilitation program and timing of program initiation for patients with chronic obstructive pulmonary disease: a systematic review and network meta-analysis. J Cardiopulm Rehabil Prev, 2025, 45(5): 318-326.
42. 羅靜, 唐茜, 胡莉麗, 等. 慢性阻塞性肺疾病患者癥狀群及護理干預的研究進展. 中國呼吸與危重監護雜志, 2025, 24(8): 597-601.
43. 中華醫學會呼吸病學分會呼吸治療學組, 中國康復醫學會呼吸康復專委會呼吸治療學組. 家庭無創通氣技術應用規范專家共識. 中國呼吸與危重監護雜志, 2025, 24(9): 609-627.
44. Adams V, Bowen TS, Werner S, et al. Small‐molecule‐mediated chemical knock‐down of MuRF1/MuRF2 and attenuation of diaphragm dysfunction in chronic heart failure. J Cachexia Sarcopenia Muscle, 2019, 10(5): 1102-1115.
45. Hughes PD, Polkey MI, Lou Harris M, et al. Diaphragm strength in chronic heart failure. Am J Respir Crit Care Med, 1999, 160(2): 529-534.
46. Begrambekova YL. Remodeling of the external respiratory system in chronic heart failure - a factor of pathogenesis and a therapeutic target. Kardiologiia, 2025, 65(1): 41-49.
47. Wu J, Kuang L, Fu L. Effects of inspiratory muscle training in chronic heart failure patients: a systematic review and meta-analysis. Congenit Heart Dis, 2018, 13(2): 194-202.
48. Kim M, Lee K, Cho J, et al. Diaphragm thickness and inspiratory muscle functions in chronic stroke patients. Med Sci Monit, 2017, 23: 1247-1253.
49. Pedreira RBS, Fernandes MH, Brito TA, et al. Are maximum respiratory pressures predictors of sarcopenia in the elderly? J Bras Pneumol, 2022: e20210335.
50. Zhao Q, Shao C, Wang Y, et al. The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes: a randomized controlled trial. Turk J Phys Med Rehabil, 2024, 70(4): 476-485.
51. Rodríguez Má, Crespo I, Del Valle M, et al. Should respiratory muscle training be part of the treatment of parkinson’s disease? A systematic review of randomized controlled trials. Clin Rehabil, 2020, 34(4): 429-437.
52. Navas-Garrido I, Martín-Nú?ez J, Raya-Benítez J, et al. Respiratory muscle strength training in parkinson’s disease-a systematic review and meta-analysis. Healthcare, 2025, 13(10): 1214.
53. 佟赫, 叢舒, 方利文, 等 2019-2020年中國40歲及以上人群肺功能檢查狀況分析. 中華流行病學雜志, 2023, 44(5): 727-734.

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呼吸肌訓練的分子機制與跨疾病應用：從呼吸康復到全身系統性干預

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