All India Institute of Medical Sciences Rishikesh, India.
Cardiff University School of Medicine, UK.
Int J Low Extrem Wounds. 2024 Sep;23(3):365-371. doi: 10.1177/15347346221077571. Epub 2022 Feb 1.
Stress is hard to define and is further complicated by varied perceptions in the population and differing responses in different situations. Psychological stress brings about certain physiological changes through manipulation of the neural, humoral and immunological systems. Observational studies have showed that fear and anxiety before surgery can complicate normal wound healing. Two different pathways appear to be involved: one directly through hypothalamic-pituitary-adrenal axis and sympathetic-adrenomedullary axis, and another indirectly through negative psychological stressors such as anxiety, depression and social isolation. The pathogenesis includes decreased expression of pro-inflammatory cytokines, resulting in poor angiogenesis, matrix regeneration and delayed healing. Prolonged immunological activation in itself is a stressor and can precipitate a manifested by disturbed sleep, anorexia, reduction in activity, increased responsiveness to pain and addiction to alcohol and tobacco. It has been observed that cortisol release suppresses pro-inflammatory cytokine release, while down-regulation of cortisol causes unabated inflammatory response. In individuals with chronic wounds, on the other hand, it is thought that physical stress has different effects such as foul odor, pain, exudate and social and familial isolation, which may act independently as psychological stressors. This article attempts to appraise the influence of psychological stress on the immunological system and its effect on wound healing.
压力难以定义，并且由于人群中的不同看法和不同情况下的不同反应而变得更加复杂。心理压力通过对神经、体液和免疫系统的操纵带来某些生理变化。观察性研究表明，手术前的恐惧和焦虑会使正常的伤口愈合复杂化。似乎涉及两种不同的途径：一种是通过下丘脑-垂体-肾上腺轴和交感-肾上腺髓质轴直接进行，另一种是通过焦虑、抑郁和社会隔离等负面心理压力源间接进行。发病机制包括促炎细胞因子表达减少，导致血管生成不良、基质再生和愈合延迟。免疫激活持续存在本身就是一种压力源，会导致明显的表现，如睡眠紊乱、食欲不振、活动减少、对疼痛的反应性增加以及对酒精和烟草的依赖。有人观察到，皮质醇释放抑制促炎细胞因子的释放，而皮质醇的下调导致炎症反应持续存在。另一方面，在慢性伤口患者中，人们认为身体压力会产生不同的影响，例如恶臭、疼痛、渗出物以及社会和家庭隔离，这些影响可能会独立作为心理压力源。本文试图评估心理压力对免疫系统的影响及其对伤口愈合的影响。
