妊娠期鼻呼吸：生理学、失调及治疗干预的叙述性综述

文献信息

中文摘要

鼻呼吸是母体生理学中一个未被充分认识且理解不足的组成部分。妊娠几乎重塑了每一个生理系统，但呼吸是通过鼻还是口进行却常被忽视。鼻腔在妊娠早期即开始发生激素驱动的适应性变化。升高的雌激素和孕激素使鼻甲充血，增加黏膜水肿，并逐步提高鼻气流阻力。这些变化常被视为良性而被忽视；然而，它们可能带来超出鼻塞范围的后果。本叙述性综述探讨了妊娠期鼻的生理功能、鼻气流受损的后果，以及旨在保护鼻功能和支持母体健康的基于呼吸的、机械的和行为学的策略。鼻呼吸调节吸入空气，输送鼻窦来源的一氧化氮以支持肺血管舒张和宿主防御，并参与维持母胎扩散梯度的二氧化碳稳态。进行性鼻阻塞可能导致口呼吸、打鼾、睡眠碎片化和睡眠呼吸障碍，这些状况与妊娠期高血压疾病、妊娠期糖尿病及其他不良母体和围产期结局相关。鼻呼吸练习（调息）已被证明在非妊娠人群中提供治疗益处。缓慢鼻呼吸，包括交替鼻孔呼吸，在初步妊娠研究中已显示出对呼吸频率、血压、自主神经调节、睡眠和感知幸福感的有利影响。基于哼鸣的呼吸练习增加鼻一氧化氮，并在练习期间产生与干预后或长期效应不同的急性心血管反应。冷却呼吸技术也影响血流动力学功能，而 energizing 练习和屏气在妊娠期研究仍不充分。机械和行为学方法，包括外部鼻扩张器、盐水冲洗、加湿和体位策略，可改善鼻通畅性和症状，但尚未被证明能预防或治疗妊娠相关睡眠呼吸障碍。口部贴扎仍处于研究阶段，因为缺乏妊娠特异性安全性和有效性数据。未来研究应客观表征鼻功能，区分特定呼吸技术，并评估母体症状、睡眠、自主神经和血压轨迹、胎儿生长及围产期结局。将呼吸路径和模式视为母体呼吸生理学中潜在可改变的维度，可能为导致妊娠并发症的途径提供新见解，并识别非药物干预的机会。

英文摘要

Nasal breathing is an underrecognized and poorly understood component of maternal physiology. Pregnancy remodels nearly every physiologic system, yet whether breathing occurs through the nose or mouth is often overlooked. The nose undergoes hormonally driven adaptations beginning early in gestation. Rising estrogen and progesterone engorge the nasal turbinates, increase mucosal edema, and progressively raise nasal airflow resistance. These changes are frequently dismissed as benign; however, they may carry consequences that extend beyond congestion. This narrative review examines the physiologic functions of the nose in pregnancy, the consequences of impaired nasal airflow, and breathing-based, mechanical, and behavioral strategies intended to preserve nasal function and support maternal health. Nasal breathing conditions inspired air, delivers sinus-derived nitric oxide that supports pulmonary vasodilation and host defense, and participates in the carbon dioxide homeostasis that sustains the maternal-fetal diffusion gradient. Progressive nasal obstruction may contribute to mouth breathing, snoring, sleep fragmentation, and sleep-disordered breathing, conditions associated with hypertensive disorders of pregnancy, gestational diabetes, and other adverse maternal and perinatal outcomes. Nasal breathing practices (pranayama) have been shown to provide therapeutic benefit in the non-pregnant population. Slow nasal breathing, including alternate nostril breathing, has shown favorable effects on respiratory rate, blood pressure, autonomic regulation, sleep, and perceived well-being in preliminary pregnancy studies. Humming-based breathing practices increase nasal nitric oxide and produce acute cardiovascular responses during practice that differ from post-intervention or longer-term effects. Cooling breathing techniques also influence hemodynamic function, whereas energizing practices and breath retention remain insufficiently studied in pregnancy. Mechanical and behavioral approaches, including external nasal dilators, saline irrigation, humidification, and positional strategies, improve nasal patency and symptoms but have not been shown to prevent or treat pregnancy-related sleep-disordered breathing. Mouth taping remains investigational because pregnancy-specific safety and efficacy data are absent. Future studies should objectively characterize nasal function, distinguish among specific breathing techniques, and evaluate maternal symptoms, sleep, autonomic and blood pressure trajectories, fetal growth, and perinatal outcomes. Recognizing the route and pattern of breathing as potentially modifiable dimensions of maternal respiratory physiology may provide new insight into pathways contributing to pregnancy complications and identify opportunities for nonpharmacologic intervention.