Department of Intensive Care, North Middlesex University Hospital, London, United Kingdom.
Crit Care Med. 2012 Dec;40(12):3283-9. doi: 10.1097/CCM.0b013e31826567eb.
To describe different paradigms that define the stress response, and to postulate how stress is implicated in the pathophysiology of critical illness.
Articles were identified through a search of PubMed and Google Scholar.
The stress response represents a bundle of adaptive behavioral, physiological, and cellular responses. Although generally beneficial, an important adverse consequence of excessive stress is organ dysfunction. Many interventions currently applied to the critically ill patient are additive and may contribute to organ dysfunction, renewed deterioration, and impaired or delayed recovery. Resilience (ρ) summarizes the interaction among predisposition factors, injury (or stressors), and the body's allostatic responses. Resilience changes over the course of critical illness but is potentially measurable and may be used to identify at-risk patients and to tailor therapy.
Critical illness may represent a stress-related decompensation syndrome mediated by neural, endocrine, bioenergetic, and immune systems. As patients pass through the separate phases of critical illness, consideration should be given to different therapeutic end points. This may be particularly pertinent during the established organ dysfunction phase where targeting of normal values may have deleterious consequences. Improved strategies could thus emerge from an increased knowledge and monitoring of the stress response, and what constitutes an optimal adaptive state as it evolves in the course of critical illness.
描述定义应激反应的不同范式，并推测应激在危重病病理生理学中的作用。
通过对 PubMed 和 Google Scholar 的检索，确定了文章。
应激反应代表了一系列适应性行为、生理和细胞反应的综合。尽管通常是有益的，但过度应激的一个重要不良后果是器官功能障碍。目前应用于危重病患者的许多干预措施是累加的，可能导致器官功能障碍、再次恶化以及受损或延迟恢复。恢复力（ρ）总结了易感性因素、损伤（或应激源）和身体的适应反应之间的相互作用。恢复力在危重病的过程中发生变化，但具有潜在的可测量性，可用于识别高危患者并调整治疗。
危重病可能代表一种由神经、内分泌、生物能量和免疫系统介导的应激相关失代偿综合征。随着患者通过危重病的不同阶段，应考虑不同的治疗终点。在已建立的器官功能障碍阶段，针对正常值可能会产生有害后果，这一点尤其重要。因此，通过增加对应激反应的了解和监测，以及在危重病过程中应激反应的最佳适应状态，可能会出现更好的策略。
