病理学与病理生理学总论应激

It is generally agreed by the scientific community that ： Stress is not what happens to someone. Stress is how a person reacts to stressors.
应激原（Stressor）的概念
生理学家，美国 “fight or flight response”
(1907~1982)
内分泌学家，加拿大 stress
saline solution
ovarian extract
on the roof of the research building
in the boiler room were forced to exercise underwent surgical procedures
distress
Severe, protracted, and uncontrolled situations of psychological and physical distress are disruptive of health.
应激的机制
应激的机制
stressor
Neuroendocrine responses
保证儿茶酚胺及胰高血糖素的 脂肪动员作用
生长发育迟缓；行为改变
（心理社会呆小状态）
GC可提高心血管对儿茶酚胺的 性腺轴受抑制、甲状腺轴抑制 敏感性 行为异常 稳定溶酶体膜，减轻组织损伤 蛋白分解过多，负氮平衡 强大抗炎作用，减轻组织损
Locus Coeruleus
LC-NE axis
HPA axis
ACTH
Adrenal gland Glucocoticoids
+ Gluconeogenesis + Lipolysis + Proteolysis + Insulin Resistance - Inflammation
norepinephrine epinephrine
Acute phase response
Cellular response
Functional and Metabolic alterations
Stressor
Hypothalamus Pituitary
CRH
+ Anxiety +/- Psychomotor symptoms - Slow wave sleep - Appetite - Libido + LC + Pyramidal cell
Stress
应 激
Department of Pathophysiology
Shanghai Jiao-Tong University School of Medicine
Baidu Nhomakorabea
概
述
概
述
应激（Stress） 应激原（Stressor）
Walter Cannon
Hans Selye
(1871-1945 )
several months peptic ulcers greatly enlarged adrenal glands shrunken immune tissues
The body has a set of similar responses to a broad array of stressors. Under certain conditions, the stressors will make you sick
+ Blood Pressure + Heart Rate + Blood Sugar - GI Blood Flow
应激时交感-肾上腺髓质系统的外周效应
防御意义
循环系统
不利影响
心输出量增加,血压升高,血流 心肌负荷加重，心律失常,诱发 重分布,心、脑、骨骼肌血供充 原发性高血压,外周小器官缺血 分 缺氧加重 促进糖原分解,脂肪动员，保证 能量过渡消耗，机体消瘦 能量供应
Loss of blood
infectious disease
advanced cancer
appetite
muscular strength
weight
ambition to accomplish anything
facial expression betrays that he is ill
The events or environmental agents responsible for initiating the stress response are called stressors.
the properties of the stressor
the conditioning of the person being stressed
syndrome of just being sick
感染 烧伤 噪音 手术
一定 强度
外伤 缺氧
特异性反应
生 理 反 应 化脓 组织坏死 酸中毒
非特异性适应反应
焦 虑
血 Stress 恐 液 心 率 增 加
惧
重 分 布
与刺激因素性质无 直接关系
应激（Stress）的概念
机体在受到内外环境因素及社会、心理因素 刺激时所出现的全身性非特异性适应反应，称为 应激或应激反应。 Stress is defined as a state of tension that can lead to disharmony or threaten the homeostasis of body.
the nature of the stress response
eustress
Mild, brief, and controllable periods of stress could be perceived as positive stimuli to emotional and intellectual growth and development.
支气管扩张，通气量增加,机体 摄取氧增多 ACTH、生长激素、EPO、胰 高血糖素等分泌增加 促使血小板增多,红细胞增加， 易引起血栓；脂质过氧化物生成 增加，生物膜受损
物质与 能量代谢
呼吸系统
其它
应激时GC和CRH分泌增多的意义
防御代偿意义
促进蛋白质分解和糖异生
机体不利影响
免疫反应受抑；感染增加