Norman Debbie
St Helens and Knowsley NHS Trust, Whiston Hospital, Merseyside.
Br J Nurs. 2003;12(21):1256-63. doi: 10.12968/bjon.2003.12.21.11883.
Stress is a universal phenomenon, which has been the focus of much investigation over the past five decades. Much has been discovered about the physiological responses to stress. This review examines the concept of stress in relation to its effect on wound healing. An online literature search was carried out using the databases Medline, Cinahl and Pubmed and the key words stress and wound healing, and stress and leg ulceration. The rationale for specifically examining leg ulceration resulted from the author's interest in this wound type and also the volume of associated literature on the topic published to date. Stress has been demonstrated to have an adverse effect on a variety of natural resistance responses and specific immunological modifications in animal and man alike, causing, for example, reduced inflammatory response, susceptibility to infection and decreased cytokine production (Cohen et al, 1988; Sheridan et al, 1991). Stress and its effects on growth factor regulation have led theorists to examine whether stress adversely affects wound healing (Glaser et al, 1999). Much of the research as examined acute wounds, although causal inferences may be drawn from the wealth of qualitative research examining the effects of venous ulceration. To date, very little has been conducted in the relatively new area of stress and wound healing. Further investigations are required to prove that stress elicits an immunological response affecting the biological markers of wound healing and thus validates the theory that stress may have a negative impact on healing itself. Causal relationships may be postulated between stress and healing in leg ulceration.
压力是一种普遍现象，在过去五十年里一直是大量研究的焦点。关于压力的生理反应已经有了很多发现。这篇综述探讨了压力这一概念及其对伤口愈合的影响。通过使用医学文献数据库（Medline）、护理及健康领域数据库（Cinahl）和医学期刊数据库（Pubmed）进行在线文献检索，检索关键词为“压力与伤口愈合”以及“压力与腿部溃疡”。专门研究腿部溃疡的基本原理源于作者对这种伤口类型的兴趣，以及迄今为止已发表的关于该主题的相关文献数量。压力已被证明对动物和人类的多种天然抵抗反应和特定免疫调节有不利影响，例如导致炎症反应减弱、易感染以及细胞因子产生减少（科恩等人，1988年；谢里丹等人，1991年）。压力及其对生长因子调节的影响促使理论家们研究压力是否会对伤口愈合产生不利影响（格拉泽等人，1999年）。大部分研究关注的是急性伤口，尽管可以从大量关于静脉溃疡影响的定性研究中得出因果推断。迄今为止，在压力与伤口愈合这个相对较新的领域开展的研究非常少。需要进一步的研究来证明压力会引发影响伤口愈合生物学标志物的免疫反应，从而验证压力可能对愈合本身产生负面影响这一理论。在腿部溃疡中，压力与愈合之间可能存在因果关系。
