出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/15 15:54:28」(JST)
| Nerve: Vagus nerve | |
|---|---|
| Plan of upper portions of glossopharyngeal, vagus, and accessory nerves. | |
| Course and distribution of the glossopharyngeal, vagus, and accessory nerves. | |
| Latin | nervus vagus |
| Gray's | subject #205 910 |
| Innervates | Levator veli palatini, Salpingopharyngeus, Palatoglossus, Palatopharyngeus, Superior pharyngeal constrictor, Middle pharyngeal constrictor, Inferior pharyngeal constrictor, viscera |
| MeSH | Vagus+Nerve |
| Cranial nerves |
|---|
| CN I – Olfactory |
| CN II – Optic |
| CN III – Oculomotor |
| CN IV – Trochlear |
| CN V – Trigeminal |
| CN VI – Abducens |
| CN VII – Facial |
| CN VIII – Vestibulocochlear |
| CN IX – Glossopharyngeal |
| CN X – Vagus |
| CN XI – Accessory |
| CN XII – Hypoglossal |
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The vagus nerve (/ˈveɪɡəs/ VAY-gəs), also called pneumogastric nerve and cranial nerve X is the tenth of twelve (excluding CN0) paired cranial nerves. Upon leaving the medulla between the medullary pyramid and the inferior cerebellar peduncle, it extends through the jugular foramen, then passes into the carotid sheath between the internal carotid artery and the internal jugular vein down below the head, to the neck, chest and abdomen, where it contributes to the innervation of the viscera. Besides output to the various organs in the body, the vagus nerve conveys sensory information about the state of the body's organs to the central nervous system. 80-90% of the nerve fibers in the vagus nerve are afferent (sensory) nerves communicating the state of the viscera to the brain.[1]
The medieval Latin word vagus means literally "wandering" (the words vagrant, vagabond, and vague come from the same root). Sometimes the branches are spoken of in the plural and are thus called vagi (/ˈveɪdʒaɪ/, US dict: vā′·jī). The vagus is also called the pneumogastric nerve since it innervates both the lungs and the stomach.
The motor division of the vagus nerve is derived from the basal plate of the embryonic medulla oblongata, while the sensory division originates from the cranial neural crest.
The vagus nerve includes axons which emerge from or converge onto four nuclei of the medulla:
The vagus runs posterior to the common carotid artery and internal jugular vein inside the carotid sheath.
Right and left vagus nerves descend from the cranial vault through the jugular foramina, penetrating the carotid sheath between the internal and external carotid arteries, then passing posterolateral to the common carotid artery. The cell bodies of visceral afferent fibers of the vagus nerve are located bilaterally in the inferior ganglion of the vagus nerve (nodose ganglia).
The right vagus nerve gives rise to the right recurrent laryngeal nerve, which hooks around the right subclavian artery and ascends into the neck between the trachea and esophagus. The right vagus then crosses anteriorly to the right subclavian artery and runs posterior to the superior vena cava and descends posterior to the right main bronchus and contributes to cardiac, pulmonary, and esophageal plexuses. It forms the posterior vagal trunk at the lower part of the esophagus and enters the diaphragm through the esophageal hiatus.
The left vagus nerve enters the thorax between left common carotid artery and left subclavian artery and descends on the aortic arch. It gives rise to the left recurrent laryngeal nerve, which hooks around the aortic arch to the left of the ligamentum arteriosum and ascends between the trachea and esophagus. The left vagus further gives off thoracic cardiac branches, breaks up into pulmonary plexus, continues into the esophageal plexus, and enters the abdomen as the anterior vagal trunk in the esophageal hiatus of the diaphragm.
The vagus nerve supplies motor parasympathetic fibers to all the organs except the suprarenal (adrenal) glands, from the neck down to the second segment of the transverse colon. The vagus also controls a few skeletal muscles, notable ones being:
This means that the vagus nerve is responsible for such varied tasks as heart rate, gastrointestinal peristalsis, sweating, and quite a few muscle movements in the mouth, including speech (via the recurrent laryngeal nerve) and keeping the larynx open for breathing (via action of the posterior cricoarytenoid muscle, the only abductor of the vocal folds). It also has some afferent fibers that innervate the inner (canal) portion of the outer ear, via the Auricular branch (also known as Alderman's nerve) and part of the meninges. This explains why a person may cough when tickled on the ear (such as when trying to remove ear wax with a cotton swab).
The vagus nerve carries axons of type GVE, general visceral efferent, which provides parasympathetic innervation to glands of mucous membranes of the pharynx, larynx, organs in the neck, thorax, and abdomen.
The vagus nerve also carries axons of type GVA, general visceral afferent, which carries information from the thoracic and abdominal viscera; aortic body and arch.
The vagus nerve also carries axons of type SVA, special visceral afferent, which carry taste of the epiglottis region of the tongue.
The vagus nerve also carries axons of type GSA, general sensory afferent, which carry sensation from the external auditory meatus and tympanic membrane.
The vagus nerve also carries axons of type SVE, special visceral efferent, which innervate skeletal muscle of the pharynx and larynx.
Parasympathetic innervation of the heart is controlled by the vagus nerve. To be specific, the vagus nerve acts to lower the heart rate. The right vagus innervates the sinoatrial node. Parasympathetic hyperstimulation predisposes those affected to bradyarrhythmias. The left vagus when hyperstimulated predisposes the heart to atrioventricular (AV) blocks.
At this location, neuroscientist Otto Loewi first demonstrated that nerves secrete substances called neurotransmitters, which have effects on receptors in target tissues. In his experiment, Loewi electrically stimulated the vagus nerve of a frog heart, which slowed the heart. Then he took the fluid from the heart and transferred it to a second frog heart without a vagus nerve. The second heart slowed down without an electrical stimulation. Loewi described the substance released by the vagus nerve as vagusstoff, which was later found to be acetylcholine. Drugs that inhibit the muscarinic cholinergic receptor (anticholinergics) such as atropine and scopolamine are called vagolytic because they inhibit the action of the vagus nerve on the heart, gastrointestinal tract, and other organs. Anticholinergic drugs increase heart rate and are used to treat bradycardia (slow heart rate). Atropine is no longer indicated for the treatment of pulseless electrical activity (PEA) or asystole per the 2010 ACLS guidelines, as it has not been shown to improve outcomes in these clinical scenarios.
Vagus nerve stimulation (VNS) therapy using a pacemaker-like device implanted in the chest is a treatment used since 1997 to control seizures in epilepsy patients and has recently been approved for treating drug-resistant cases of clinical depression.[2] A non-invasive VNS device that stimulates an afferent branch of the vagus nerve is also being developed and will soon undergo trials.[citation needed]
Clinical trials are currently underway in Antwerp, Belgium using VNS for the treatment of tonal tinnitus after a breakthrough study published in early 2011 by researchers at the University of Texas - Dallas showed successful tinnitus suppression in rats when tones were paired with brief pulses of stimulation of the vagus nerve.[3]
VNS may also be achieved by one of the vagal maneuvers: holding the breath for a few seconds, dipping the face in cold water, coughing, or tensing the stomach muscles as if to bear down to have a bowel movement.[4] Patients with supraventricular tachycardia,[4] atrial fibrillation, and other illnesses may be trained to perform vagal maneuvers (or find one or more on their own).
Vagus nerve blocking (VBLOC) therapy is similar to VNS but used only during the day. In a six-month open-label trial involving three medical centers in Australia, Mexico, and Norway, vagus nerve blocking has helped 31 obese participants lose an average of nearly 15 percent of their excess weight. A year-long 300-participant double-blind, phase II trial has begun.[5]
Vagotomy (cutting of the vagus nerve) is a now-obsolete therapy that was performed for peptic ulcer disease. Vagotomy is currently being researched as a less invasive alternative weight-loss procedure to gastric bypass surgery.[6] The procedure curbs the feeling of hunger and is sometimes performed in conjunction with putting bands on patients' stomachs, resulting in average weight loss of 43% at six months with diet and exercise.[7]
One serious side-effect of a vagotomy is a vitamin B12 deficiency later in life - i.e., 10 years - that is similar to pernicious anemia. The vagus normally stimulates the stomach's parietal cells to secrete acid and intrinsic factor. Intrinsic factor is needed to absorb vitamin B12 from food. The vagotomy reduces this secretion and ultimately leads to the deficiency, which, if left untreated, causes nerve damage, tiredness, dementia, paranoia, and ultimately death.[8]
Activation of the vagus nerve typically leads to a reduction in heart rate, blood pressure, or both. This occurs commonly in the setting of gastrointestinal illness such as viral gastroenteritis or acute cholecystitis, or in response to other stimuli, including carotid sinus massage, Valsalva maneuver, or pain from any cause, in particular, having blood drawn. When the circulatory changes are great enough, vasovagal syncope results. Relative dehydration tends to amplify these responses. Symptoms of Irritable Bowel Syndrome are thought to cause activation of the vagus nerve with many people reporting fainting, vision disturbances and dizziness, but there has been little research into this area as it is not deemed necessary and/or life threatening.
Excessive activation of the vagal nerve during emotional stress, which is a parasympathetic overcompensation of a strong sympathetic nervous system response associated with stress, can also cause vasovagal syncope because of a sudden drop in blood pressure and heart rate. Vasovagal syncope affects young children and women more than other groups. It can also lead to temporary loss of bladder control under moments of extreme fear.
Research has shown that women having had complete spinal cord injury can experience orgasms through the vagus nerve, which can go from the uterus, cervix, and, it is presumed, the vagina to the brain.[9][10]
Liver - Insulin signaling activates the adenosine triphosphate (ATP)-sensitive potassium (KATP) channels in the Arcuate nucleus, decreases AgRP release, and through the vagus nerve, leads to decreased glucose production by the liver by decreasing gluconeogenic enzymes: Phosphoenolpyruvate carboxykinase, Glucose 6-phosphatase[11][12]
The patient complains of hoarse voice, difficulty in swallowing (dysphagia), and choking when drinking fluid. There is also loss of gag reflex. Uvula deviates away from the side of lesion, and there is failure of palate elevation.
Interior view of the human brain, with the cranial nerves labeled.
Vagus nerve
Section of the neck at about the level of the sixth cervical vertebra
Transverse section of thorax, showing relations of pulmonary artery
The arch of the aorta, and its branches
Dura mater and its processes exposed by removing part of the right half of the skull, and the brain
The tracheobronchial lymph glands
Section of the medulla oblongata at about the middle of the olive
Hind- and mid-brains; postero-lateral view
Upper part of medulla spinalis and hind- and mid-brains; posterior aspect, exposed in situ
The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses
The celiac ganglia with the sympathetic plexuses of the abdominal viscera radiating from the ganglia
The position and relation of the esophagus in the cervical region and in the posterior mediastinum, seen from behind
The thyroid gland and its relations
The thymus of a full-term fetus, exposed in situ
Vagus nerve
Vagus nerve
Vagus nerve
Vagus nerve
Vagus nerve
Muscles, arteries and nerves of neck. Newborn dissection.
Muscles, arteries and nerves of neck. Newborn dissection.
Muscles, nerves and arteries of neck.Deep dissection. Anterior view.
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| リンク元 | 「迷走神経」 |
| 関連記事 | 「nervus」「vagus」 |
| 一般感覚性 | 臓性感覚性 | 特殊感覚性 | 体性運動性 | 臓性運動性 | 鰓弓運動性 | 神経細胞(中枢神経外) | 神経細胞(中脳) | 神経細胞(橋) | 神経細胞(延髄) | 神経細胞(脊髄) | ○-< 節後ニューロン | 頭蓋からの出口 | 分布と機能 |
| ○ | 脳神経Xの上神経節 | 頚静脈孔 | 耳介、外耳道、後頭蓋窩からの感覚 | ||||||||||
| ○ | 脳神経Xの上神経節 | 舌底、咽頭、喉頭、器官、気管支、心臓、食道、胃、腸の臓性感覚 | |||||||||||
| ○ | 脳神経Xの下神経節 | 喉頭蓋と口蓋の味覚 | |||||||||||
| ○ | ○ | 内臓近傍のニューロン | 副交感神経：平滑筋（気管、気管支、消化管）、心筋（心臓） | ||||||||||
| ○ | ○ | 支配筋：咽頭収縮筋、口蓋帆張筋を除く口蓋の筋、食道上2/3の横紋筋 |
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.