重症的神经内分泌调控范式已出现革命性的变化，从“应激相关的单相激活”到“病程相关的双相反应”模式，从“中枢单向线性调控”到“外周适应性反应”模式，从下丘脑-垂体-肾上腺轴和交感-肾上腺髓质系统“两轴的平行激活”到“两轴的交互反馈作用”模式，从“神经内分泌调控”到“神经免疫内分泌调控”模式。与此相应地，神经内分泌调控策略更倾向于中枢干预。一方面联合下丘脑和垂体激素的替代治疗，避免外周激素对中枢的负反馈作用和对重症免疫系统的抑制作用，另一方面通过中枢或者外周的神经刺激，不仅能改善神经和内分泌代谢功能，还可以增强重症患者的免疫功能。目前需要在新技术辅助下（如人工智能），为临床提供个性化和精准的神经内分泌调控策略。

The neuroendocrine regulatory paradigm of critical medicine has undergone revolutionary changes，from the “stress-related one-phase activation” model to the “ disease course related biphase response”model，from the “central one-way linear regulation” model to the “peripheral adaptive response” model，and from the “two- axes parallel activation” of the hypothalamic-pituitary-adrenal axis and sympathetic-adrenal medullary system to the “interactive feedback effect of the two axes” model，from the “neuroendocrine regulation” model to the “neuroimmune endocrine regulation” model.Correspondingly，the neuroendocrine regulation strategy is more inclined towards central intervention.On the one hand，it combines the replacement therapy of hypothalamic and pituitary hormones to avoid the negative feedback effect of peripheral hormones on the central nervous system and the inhibitory effects on the immune system in critical illness.On the other hand，through central or peripheral neural stimulation，not only the neuroendocrine function is improved，but also the immune function of patients can be enhanced.At present，with the assistance of new technologies （such as artificial intelligence），personalized and precise neuroendocrine regulation strategies need to be provided for clinical practice.