Abstract:

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.

Key words: Neurocritical care, Endocrine regulation, Critical care