壓力與健康：生理病理反應

Stress and Health: Pathophysiological Reactivity

施嫈瑜(Ying-Yu Shih) ； 李明濱(Ming-Been Lee) ； 李世代(Shyh-Dye Lee) ； 郭聖達(San-Dar Kuo)

《北市醫學雜誌》 1卷1期 (2004/01) Pp. 17-24

https://doi.org/10.6200/TCMJ.2004.1.1.05

摘要

壓力對健康的影響，已是無庸置疑，但卻仍常被現代醫療人員所忽略。本文旨在整體性地回顧並討論正常壓力的生理反應及不當適應負荷所誘發的病理變化。攻擊或逃逸反應是急性壓力下為求生存的重要生理反應，但長期、過度的激發可能導致病態後果：包括失眠、肌肉僵緊痛、疲倦、頭痛或暈、胸悶或痛、心悸、眼睛乾澀、喉嚨痛或異物感、脹氣或腹瀉、記性差、專注力差、情緒障礙身心症狀；或慢性疲勞、大腸激躁症、纖維肌痛、憂鬱症等症候群；乃至糖尿病或代謝症候群、心血管疾病及免疫紊亂等疾病。因病症無特異性，且其共病現象嚴重，易因專科分工造成醫療的重複與浪費。壓力相關的健康問題相當普遍，為提供病患整體而有效的診療照護，臨床醫師應提升對此致病模式的警覺，並積極介入處理其源發的身心社會壓力因素。

關鍵字

心身醫學 ； 適應負荷 ； 攻擊或逃逸反應 ； 共病 ； 生理心理社會模式

並列摘要

Stress is a phenomenon of undoubted health importance, which is often ignored in the practice of conventional medicine. This article reviews current understanding of the physiological response to normal stress, and the pathological reaction to an excessive allostatic load. Fight or flight response is a defense reaction which is initiated for survival in conditions of acute stress. However, chronic or excessive physiological activation leads to pathological consequences. The most common stress-related somatic symptoms are insomnia, muscle stiffness or pain, malaise, headache, dizziness, chest pain, palpitation, dyspnea, dryness of mouth or eyes, sore throat, abdominal gas or pain etc; as well as psychiatric symptoms including poor memory or concentration, and depression／anxiety disorder. Biological and epidemiological studies have shown that some diseases, such as diabetes, syndrome X, coronary artery disease and immune disorder are strongly associated with allostatic load. There is co-morbidity as well as interaction between stress-related illnesses and other types of disease. The prevalence of stress-related health problems is quite high in medical care. Current strategies to intervene in unexplained medical illness are mostly palliative and often do not address the underlying stresses that play a role in their development. While management of stress-related illnesses or diseases may prevent pathological progression, if stress is a causal or predisposing factor to the illness, then medical control may not enough resolve the problems resulting from accumulating deterioration due to excessive allostatic load. To provide patients with comprehensive and efficient treatment, physicians must incorporate knowledge of stress-realted health problems and the bio-psycho-social underpinnings of disease into daily practice.

並列關鍵字

psychosomatic medicine ； allostatic load ； fight or flight response ； co-morbidity ； bio-psycho-social model