Lefman Sara H, Prittie Jennifer E
Emergency and Critical Care, The Animal Medical Center, New York, NY.
J Vet Emerg Crit Care (San Antonio). 2019 Mar;29(2):107-120. doi: 10.1111/vec.12821. Epub 2019 Mar 12.
To review the sources, adverse effects, diagnosis, treatment, and prevention of psychogenic stress in hospitalized human and veterinary patients.
Data were collected by searching PubMed for veterinary and human literature from the past 10 years.
Psychogenic stress has been linked to immune suppression; gastrointestinal, cardiovascular, and cutaneous diseases; delayed wound healing; alterations in pain perception; and neurologic impairment. Sources of psychogenic stress include environmental alterations such as excessive noise and light, social and physical factors, sleep disruption, drugs, and underlying disease. Nonpharmacologic options for stress reduction include environmental and treatment modifications, music therapy, and early mobilization. Pharmacologic options include sedation with benzodiazepines and dexmedetomidine. Trazodone and melatonin have been examined for use in sleep promotion but are not currently recommended as standard treatments in ICU.
Activation of the stress response in veterinary patients is largely the same as in people, as are the affected body systems. Possible sources of stress can include social, physical, and environmental factors. No gold standard currently exists for the identification and quantification of stress. A combination of physical examination findings and the results of serum biochemistry, CBC, and biomarker testing can be used to support the diagnosis. Stress scales can be implemented to identify stressed patients and assess severity. Nonpharmacologic treatment options include low-stress handling, pheromones, environmental modifications, and sleep promotion. Pharmacologic options include trazodone, benzodiazepines, dexmedetomidine, and melatonin.
The prevalence and clinical significance of psychogenic stress in hospitalized veterinary patients is unknown. Future studies are needed to specifically examine the causative factors of psychogenic stress and the effects of various therapies on stress reduction. The recognition and reduction of psychogenic stress in veterinary patients can lead to improvements in patient care and welfare.
综述住院的人类和兽医患者精神性应激的来源、不良反应、诊断、治疗及预防。
通过检索PubMed收集过去10年的兽医和人类文献数据。
精神性应激与免疫抑制、胃肠道疾病、心血管疾病、皮肤疾病、伤口愈合延迟、疼痛感知改变及神经功能损害有关。精神性应激的来源包括环境改变，如过度噪音和光线、社会和身体因素、睡眠中断、药物及基础疾病。减轻应激的非药物选择包括环境和治疗调整、音乐疗法及早期活动。药物选择包括使用苯二氮䓬类药物和右美托咪定镇静。曲唑酮和褪黑素已被研究用于促进睡眠，但目前不推荐作为重症监护病房的标准治疗药物。
兽医患者应激反应的激活在很大程度上与人类相同，受影响的身体系统也一样。应激的可能来源包括社会、身体和环境因素。目前尚无识别和量化应激的金标准。体格检查结果、血清生化、全血细胞计数及生物标志物检测结果相结合可用于支持诊断。可采用应激量表识别应激患者并评估严重程度。非药物治疗选择包括低应激处理、信息素、环境调整及促进睡眠。药物选择包括曲唑酮、苯二氮䓬类药物、右美托咪定和褪黑素。
住院兽医患者精神性应激的患病率及临床意义尚不清楚。未来需要开展研究，专门探讨精神性应激的致病因素以及各种疗法对应激减轻的影响。识别并减轻兽医患者的精神性应激可改善患者护理及福利。
