Sınav Stresinde Değişen Otonomik Fonksiyonlar: Kardiyovasküler-Pulmoner Etkileşimler

Abstract

Amaç: Tıp eğitimi, öğrencilerin sık sık sınavlarla değerlendirildiği uzun ve kapsamlı bir müfredata sahiptir. Sınav öncesi stres, öğrencilerin sınavlardan önce karşılaştıkları yaygın bir durumdur ve özellikle tıp öğrencilerinin en müzdarip olduğu sorunlardan biridir. Çalışmanın amacı, sınav stresinin öğrencilerin otonom sinir sistemi aktivitelerine etkisini kardiyovasküler parametreler ve solunum testleri ile değerlendirmektir. Materyal ve Metod: Çalışmaya ikinci sınıf tıp öğrencilerinden 29 kişi dahil edildi. Bu kesitsel çalışma, Şubat-Mart 2020 tarihleri arasında Harran Üniversitesi, Türkiye'de gerçekleştirildi. Kullanılan parametreler; oksijen satürasyonu, nabız hızı, sistolik ve diyastolik kan basıncı ve solunum fonksiyon testleri idi. Veriler öğrencilerin sınav döneminde dört farklı zamanda toplandı. Bulgular: Sınav döneminde farklı zamanlarda ölçülen PR, SBP ve DBP arasında istatistiksel olarak anlamlı fark vardır (sırasıyla p˂0.001; p=0.001; p=0.003). Sınav stresinin akciğer fonksiyonunda artışa neden olduğu bulundu. Yapılan korelasyon analizinin sonuçları, PR ile Zorlu vital kapasite (FVC), birinci saniyedeki zorlu ekspiratuvar volüm (FEV1), vital kapasite (VC) arasında negatif bir ilişki olduğunu gösterdi. Sonuç: Sempatik sinir sistemi indüksiyonu sonucunda sınav anına kadar hemodinamik parametreler ve solunum testleri kademeli olarak arttı. PR ile FEV1, FVC ve VC arasında negatif bir korelasyonun varlığı, fizyolojik kompanzasyonun solunum döngüsü ve PR arasındaki dinamik denge yoluyla gerçekleştiğini gösterir. Solunumsal sinüs aritmisinin bu fizyolojik kompanzasyon mekanizmasına katkıda bulunduğu düşünülmektedir.

Keywords

• stres
• hemodinamik
• solunum fonksiyon testi
• tıp öğrencisi
• sınav

Altered Autonomic Functions in Exam Stress: Cardiovascular-Pulmonary Interactions

Abstract

Background: Medical training involves a long and exhaustive curriculum in which students are frequently evaluated by examinations. Pre-examination stress is a common condition faced by students prior to exams and is one of the most widely experienced problems for medical students. The aim of the study was to assess the effects of exam stress on autonomic nervous system functions of students through cardiovascular parameters and respiratory tests. Materials and Methods: The study group consisted of 29 second-year medical students. This cross-sectional study was carried out from February to March 2020 at Harran University, Turkey. The parameters used were oxygen saturation, pulse rate (PR), systolic (SBP) and diastolic blood pressure (DBP), and pulmonary function tests. Data were collected four times during an exam period. Results: There is a statistically significant difference between the measurements of PR, SBP, and DBP at different times (p˂0.001; p=0.001; p=0.003, respectively). It was found that exam stress caused an increase in lung function. The results of correlation analysis showed a negative relationship between PR, and Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), vital capacity (VC). Conclusion: As a result of the sympathetic nervous system induction, hemodynamic and respiratory tests increased gradually until the examination. The presence of a negative correlation between PR and FEV1, FVC, and VC indicates that physiological compensation occurs through the dynamic balance between the respiratory cycle and PR. It is thought that respiratory sinus arrhythmia contributes to this physiological compensation mechanism.

Keywords

• Stress
• Hemodynamics
• Pulmonary function test
• Medical student
• Exam

Thanks

The author would like to thank Assoc. Prof. Hakim ÇELİK and Dr. Abdullah TAŞKIN for their suggestions and comments on the manuscript.

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