| Background:As a special group of college students, the learning burden of medical students usually is hard. A number of clinical psychological researches have found that pre-exam anxiety is one of common psychological disorder of medical students. Exam candidates who at a high anxiety level easily lead to autonomic nervous system disorders, such as insomnia, digestive hypothyroidism, etc. Heart Rate Variability (HRV) refers to small changes in heart rate or instantaneous transient cardiac cycle. It considered one of the better judgments of quantitative indicators of autonomic activity. Auricular points relate to cranial nerves and cervical nerve, therefore, HRV indexes can be changed when auricular points were pressuring.Object:Using Actiheart recorder to record the heart rate (HR) and HRV, and preliminary discuss whether auricular therapy has the post-stimulation effect on HR and HRV of different pre-exam anxiety stage students.Methods:(1) PreparationAll the volunteers were in the same room which quiet and comfortable to received the threapy. Volunteers were asked to lie down with wearing earplugs and eye mask for lOmin before treatment.(2) The auricular acupointsCombining previous research results and clinical experiences, heart (CO15), liver (CO12), kidney (CO10), Shenmen (TF4), endocrine (CO18), adrenal (TG2p) were selected.(3) Application①The intervention group and control group:Those six auricular acupoints were chose to be pressed, by the Cowherb seeds and covered with pieces of surgical tape (0.5 x 0.5 cm). Then the auricular acupoints were pressed respectively and repeatedly by the acupuncturist with his index finger and thumb for 2min30s totally. After the stimulation period was over, the volunteer lay on the bed for a further 60 min, and then the surgical tapes were removed from the ear..②The placebo group:The application was same as the intervention group and control group, but the surgical tape without Cowherb seeds.(4) The data recordingWe used an ECG recorder (Actiheart; Cambridge Neurotechnology Ltd, Papworth, UK) and the accompanying software (Actiheart software, version 2.2) to continuous record the HR and HRV of all groups of students.(5) The observation indexesThe heart rate indicators:HR, BPM;Heart rate variability index:Standard Deviation of Normal- to -Normal Intervals(SDNN; ms), The Root Mean Square of Difference Between Adjacent NN Intervals,(RMSSD; ms); Standard Deviation of The business of NN Intervals in All 5-minutes of The-Recording(SDANN; ms); Very Low Frequency(VLF,0.003- 0.04 Hz, ms2),Low Frequency(LF,0.04-0.15 Hz, ms2), High Frequency(HF,0.15-0.4 Hz, ms2), The Ratio of Low Frequency and High Frequency(LF/HF).(6) Statistical analysisA professional data analyst who did not otherwise participate in this study analyzed the data before stimulation of the auricular therapy and at 40,50, and 60 minutes after stimulation, by using SPSS software (version 19.0; SPSS Inc., Chicago, IL, USA). Because of the raw data value was too large and the levels of dispersion too high, the data were analyzed after logarithmic conversion of VLF, LF, and HF to InVLF, InLF, and InHF. The one-way ANOVA was used to compare between the various indicators of HR and HRV of three groups. For data including TAS score before stimulation, RMSSD and SDNN at 40,50, and 60 min after stimulation.Within-group comparisons for all groups were carried out using single factor repeated measures variance analysis. For data that did not meet the indicators of the sphericity test, we used the Greenhouse-Geisser ε correction coefficient for degrees of freedom correction. To assess the main effect of repeated factors at different times, we used the least squares difference test for multiple comparisons. P=0.05 was considered significant.Results:(1) The post-stimulation effect of HR①Compared between groupsNo matter before stimulation or 40 min,50min,60min after stimulation, there was no significant difference between the three groups on heart rate (P> 0.05).②Compared within groupsIn the control group, HR decreased at 50min (P=0.030) and 60 min (P=0.028) after stimulation compared with the baseline pre-stimulation data; and it also decreased at 60min after stimulation in the placebo group (P=0.030). However, there was no significant difference in the intervention group.(2) The post-stimulation effect of HRV①Compared between groupsCompared with the control group, the intervention group had higher SDNN at before stimulation(P=0.034),40min(P=0.014),50min(P<0.01), and at 60min after stimulation(P=0.018); and had higher RMSSD at both before stimulation(P=0.046) and 50min after stimulation(P=0.024); also had higher InHF(P=0.021) at 40min after stimulation and higher InVLF (P=0.034) at 50min after stimulation.Compared with the control group, the placebo group had higher SDNN before stimulation (P=0.041) but it decreased at 50min after stimulation (P=0.049).Compared with the placebo group, the intervention group had higher RMSSD(P=0.026)、InVLF(P=0.035、InLF(P=0.035) at 40min after stimulation; and also had higher RMSSD(P=0.010)、InLF(P=0.044) at 60min after stimulation.②Compared within groupsA. The intervention groupCompared with before stimulation, SDNN increased at 40min,60min after stimulation(P<0.05); SDANN increased at 40min after stimulation (P=0.031); both of InVLF and lnLF increased at 40 min,50 min and 60 min after stimulation (P< 0.05); and LF/HF also increased at 60min(P=0.002).Compared with 40min after stimulation, SDNN decreased at 50min after stimulation (P= 0.028) while it increased at 60min after stimulation (P= 0.031).B. The control groupCompared with before stimulation, SDNN, LF/HF, lnVLF increased at 40min, 50min and 60min after stimulation(P< 0.05); lnLF increased at 40min stimulation(P=0.010).C. The placebo groupCompared with before stimulation, SDNN decreased at 50min after stimulation (P<0.05) and RMSSD decreased at both of 50min and 60min after stimulation(P< 0.05).Conclusion:1. The prescription of auricular acupuncture on the treatment of mental disease often chooses auricular concha and antitragus as the main area; the most common acupoints are Shenmen, subcortex, heart, kidney; it widely using in insomnia, depression and anxiety.2. No matter before stimulation or at 60min after stimulation, the autonomic nervous function of pre-exam anxiety students (intervention group and placebo group) was more complex than normal students (control group).3. The control group had post-stimulation effect on HR and this effect could last for more than 60min. However, the intervention group did not show significant changed.4. Both of the control group and intervention group had post-stimulation effect on HRV, it could also adjust the excitability of sympathetic nerve and vagus nerve.5. The post-stimulation effects on anxiety students will last longer. |
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