关键词: 重症卒中; 呼吸康复; 机械通气; 呼吸道管理; 神经调控

Abstract: Respiratory dysfunction in severe stroke, stemming from its unique and complex central-peripheral pathophysiological mechanisms, poses significant challenges to conventional respiratory support and rehabilitation strategies. In clinical practice, the need to maintain consciousness and intracranial homeostasis restricts conventional assessment of respiratory function and mechanical ventilation weaning potential, which restricts the implementation of early rehabilitation. To overcome these challenges, precision assessment techniques such as diaphragm ultrasound and esophagus pressure measurement, combined with ultra-early neurocritical care bundles and intelligent ventilation modes like neurally adjusted ventilatory assist, are driving a therapeutic paradigm shift in the management of severe stroke-related respiratory dysfunction from passive life support to active functional rehabilitation. This paper systematically reviews the core challenges and key technological breakthroughs in respiratory rehabilitation for severe stroke, aiming to provide a theoretical reference for the optimization of clinical practice and the identification of innovative research directions in this field.

Key words: Severe stroke; Respiratory rehabilitation; Mechanical ventilation; Airway management; Neuromodulation