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  • This is Dr. Lam and welcome to today's session on the discussion of the

    我是Lam醫師,歡迎各位參加今天的研討議題

  • neuroendocrine basis of Adrenal Fatigue Syndrome.

    由神經內分泌學的角度來看「腎上腺疲勞綜合症」

  • First we need to understand

    首先我們需要了解

  • that stress enters our sphere through a small area of the brain called the locus coeruleus or the LC.

    當人感受到壓力後,訊息會經由腦中的一個小區域稱為藍斑核(或LC)進入大腦

  • Discovered in the eighteenth century,

    藍斑核於十八世紀時被發現

  • this area of the brain stem deals with the physiological responses to stress and panic.

    這個位於腦幹中的小區域專門負責遭受壓力或恐慌時的生理狀態

  • An important homeostatic control center of the body, the LC receives input from a variety of sources

    作為人體的內部生理平衡的調節中心,LC接收來自身體各處的感官訊息

  • from our senses it is then routed through the hypothalamus, the amygdala,

    這些訊息接著被傳遞到下視丘、杏仁核、

  • the cerebellum as well as the prefrontal cortex.

    小腦以及前額葉

  • Emotional pain and stressors from the outside world enters our inner world through these pathways.

    來自外界的情感創傷以及壓力經由上述路徑進入我們的內在

  • Once arrived, excitatory signals trigger production and release of norepinephrine from the LC.

    傳達到腦中後,這些訊息刺激使得LC開始製造並釋放正腎上腺素

  • Now, norepinephrine has two functions. In the brain, it acts as a central neuro-transmitter

    目前已知正腎上腺素具有兩種功能。在腦中,它作為中樞神經傳遞物質

  • and keeps us aroused: we become alert.

    使我們保持警醒

  • Norepinephrine released from the LC also increases the sympathetic

    LC釋放的正腎上腺素也會增加交感神經放電

  • discharge and inhibits parasympathetic tone in the peripheral nervous system,

    並在周邊神經系統中抑制副交感神經的作用

  • which we will go into later. At that point it exerts its excitatory effect directly on

    詳細細節我們接著會提到。當正腎上腺素開始作用時

  • the target organs such as the heart.

    會使一些器官像是心臟等更為活躍

  • So as a result, the heart rate as well as the heartbeat force goes up.

    因此心跳的速率以及心搏的強度都會增加

  • Aside from being the principal production site of the brain norepinephrine,

    除了作為腦內正腎上腺素的主要生產場所

  • the LC is also connected on the output side to many parts of the central nervous system;

    LC還投射到中樞神經系統中許多部位

  • including the spinal cord, brain stem, cerebellum, hypothalamus, amygdala as well as the cerebral cortex.

    包括脊椎、腦幹、小腦、下視丘、杏仁核以及大腦皮質

  • So as you can see, it is a two-way street with many many directions and a

    如你所見,好幾個雙向的路徑

  • collaborative network of information flow, to the LC and out of the LC.

    共同組成了訊息網路進出LC

  • Collectively, the LC and areas of the CNS (or the central nervous system),

    LC與CNS(中樞神經系統)

  • affected by the norepinephrine it produces, are described as the LC-NA system,

    中受正腎上腺素調控的部位,可視為一個整體,統稱為LC-NA 系統

  • which stands for locus coeruleus-noradrenergic system.

    也就是「藍斑核-正腎上腺素」系統

  • Noradrenergic is the same as norepinephrine and that is what it connotates here.

    「Noradrenergic」與「norepinephrine 」在這裡都是指正腎上腺素

  • Now the distribution as we talked about of the LC-NA system is ubiquitous

    「藍斑核-正腎上腺素」系統的影響是無處不在的

  • and is consistent with the prominent role that norepinephrine plays

    並且,在中樞神經系統的許多功能中

  • in a variety of central nervous system functions,

    正腎上腺素都是不可或缺的

  • as well as behavior that includes locomotor functions, cognitive functions, motivation and attention

    在一些涉及運動、認知、動機以及專注等功能的行為中,也同樣不可或缺

  • Now what is important is that once the LC-NA system is activated

    當「藍斑核-正腎上腺素」系統被活化時

  • it is responsible for much of the psychological effects we see in Adrenal Fatigue Syndrome.

    會造成好幾種我們在「腎上腺疲勞綜合症」中觀察到的生理症狀

  • They can include fear, anxiety, alertness, memory changes and REM sleep dysregulation.

    包括了恐懼、焦慮、警覺、記憶異常以及快速動眼睡眠週期失調

  • Psychiatric research has documented that the role the LC plays in cognitive function

    精神病學中的研究紀錄顯示LC會影響受壓力狀態下的認知功能

  • in relation to stress is complex and is multi-modal: there is no one direct link,

    其中的關係十分複雜並涉及多項機制,而非單向直接的因果關係

  • multiple factors are involved.

    許多不同的因素都涉及其中

  • From a neuroendocrinological perspective it is clear

    從神經內分泌學的角度來看,很明顯地

  • that the body's multiple stress response pathways are all for it

    許多案例中,人體內各種受壓力引起的反應都是為了達到同樣的目的

  • in a redundancy pattern to handle stress in many many cases,

    藉由繁複的反應路徑來調節壓力

  • it has ensured the survival of our species for quite some time.

    在某些時刻,這些機制確保我們人類得以存活至今

  • What is confusing clinically is that in Adrenal Fatigue Syndrome,

    但是讓人困惑的是,在「腎上腺疲勞綜合症」的例子當中

  • these pathways can be activated few at a time

    這些反應路徑隨著個體的不同,有時一點一點地啟動

  • all at once, or quickly or slowly as the body sees fit.

    有時一次全部啟動、有時快、有時慢

  • The body's truly in control but the symptoms are so convoluted because

    我們確定是身體在調控這些反應,但這症狀是如此讓人費解

  • it depends on what stage and how the body perceives stress.

    因為它受到「身體是處於壓力下的何種階段」以及「身體是如何察覺壓力」的影響

  • Different parts of different systems are being activated all at the same time as necessary.

    當有需要時,不同系統中的不同路徑可能同時啟動

  • To fully appreciate the body's heroic effort to rescue us from stress,

    為了充分了解身體是經過多少努力才讓我們得以倖免於過度的壓力

  • it is important to first understand that our brain is in control,

    我們首先要知道的是大腦調控著

  • the pathway is through the neuroendocrine system.

    神經內分泌系統中的各種路徑

  • What one person perceives as stress may not be for another person.

    一個人視為壓力的事情,另一個人可能完全無感

  • Based on what is perceived as stress by the mind, the body automatically activates

    端看用怎樣的心態面對壓力。人體會自動的啟動

  • any or all of the anti-stress mechanisms in place.

    任何有必要的抗壓力機制

  • In order for us to fully grasp the big picture,

    為了能掌握整體情形

  • clinicians need to take a step back,

    臨床醫師必須要退一步才能見得全貌

  • because it is easy to be confused when you look too close.

    太拘泥於細節反而適得其反

  • The picture from afar is quite clear.

    抽離一點來看,事情就很清楚了

  • We see a body in trouble, unable to maintain homeostasis

    當身體遇上危機,無法維持生理平衡時

  • and trying to use all its ways and means to recover on its own, using the methods that it knows.

    身體會竭盡所能地用它所知道的方法來努力恢復

  • By activating any or all of the built-in stress response systems

    藉由啟動體內所有內建的系統來抵抗壓力

  • modulated by the neurological and endocrine systems working in tandem.

    這些系統是由一連串的神經以及內分泌系統調控

  • The more severe the stress,the more other systems

    壓力越是沉重

  • such as musculoskeletal, psychiatric, cardiac and immune systems are also affected adversely.

    越是對運動、心理、心臟以及免疫等功能不利

  • Remember, that the body is a closed system.

    記住,人體是一個封閉的系統

  • Severe dysregulation of one system invariably impacts other systems.

    單一系統嚴重失調時,多少會影響其他系統

  • This is inescapable.

    這是無可避免的

  • Despite this clinical chaos,

    儘管臨床症狀看似雜亂無序

  • we can see a controlled collapse that is logical and systematic from the body's perspective.

    從身體的角度來看,我們仍能看出這是合理的、有系統的機制

  • Symptoms are simply the messages

    這些症狀都只是

  • or signs the body sends us warning of such impending danger and

    身體面對眼前的危機所發出的警訊

  • thereby alerting us to take appropriate action.

    使我們知道要採取適當的行動

  • If stress is never really resolved or let go,

    如果壓力一直沒有被解決或者消失

  • then even despite a loosing battle,

    就算是在絕望的境地下

  • The mind continues to be ultimately in charge throughout this ordeal

    身體仍會有意識地直面困境

  • through its various endocrinological stress response pathways

    持續地透過內分泌路徑來調控身體

  • The neuroendocrine basis of Adrenal Fatigue is quite clear and solid.

    神經內分泌學對「腎上腺疲勞綜合症」的研究是十分清晰且堅實的

  • Evidence-based scientific research has proven

    研究上已有充分的證據顯示

  • beyond a doubt that stress can kill.

    「過度的壓力足以致命」是毫無疑問的

This is Dr. Lam and welcome to today's session on the discussion of the

我是Lam醫師,歡迎各位參加今天的研討議題

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B1 中級 中文 美國腔 腎上腺素 神經 壓力 路徑 身體 綜合症

腎上腺疲勞綜合徵的神經內分泌基礎》內容預覽 (Preview of The Neuroendocrine Basis of Adrenal Fatigue Syndrome)

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    鍾佳芳 發佈於 2021 年 01 月 14 日
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