{"id":251,"date":"2012-05-22T12:20:57","date_gmt":"2012-05-22T12:20:57","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=251"},"modified":"2012-05-22T12:20:57","modified_gmt":"2012-05-22T12:20:57","slug":"ucakta-sigara-icmek","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=251","title":{"rendered":"U\u00e7akta sigara i\u00e7mek"},"content":{"rendered":"
\n

\"\"<\/a>T\u00fct\u00fcn; tar, nikotin ve karbonmonoksit (CO) olmak \u00fczere 3 ana toksik madde i\u00e7erir. Tar, bo\u011faz ve akci\u011fer kanserine; Nikotin, damar hastal\u0131klar\u0131na neden olur. CO, u\u00e7u\u015f i\u00e7in en sak\u0131ncal\u0131 olan\u0131d\u0131r; \u00e7\u00fcnk\u00fc kan hemoglobiniyle birle\u015fme kapasitesi oksijenden 210 kat fazlad\u0131r.\u00a0 U\u00e7ak i\u00e7inde kabin irtifa\u0131n\u0131n d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc, oksijen parsiyel bas\u0131nc\u0131n\u0131n da d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc demek oldu\u011fundan, i\u00e7ilen t\u00fct\u00fcn\u00fcn duman\u0131ndaki CO, kan hemoglobinine \u00e7ok daha y\u00fcksek oranda ba\u011flanarak hipoksi potansiyelini artt\u0131r\u0131r. Bu nedenle e\u011fer u\u00e7u\u015ftan \u00f6nce 2-3 sigara i\u00e7ilmi\u015fse, (kandaki karboksihemoglobin\u2019in oksijene olan bask\u0131nl\u0131\u011f\u0131 y\u00fcz\u00fcnden) 5 bin ft kabin irtifa\u0131nda olan bir insan 10 bin ft irtifaya e\u015fde\u011fer fizyolojik duruma girer. Bu, sinsi hipoksi riski kadar, gece u\u00e7u\u015flar\u0131nda karanl\u0131k adaptasyonunu bozmas\u0131 bak\u0131m\u0131ndan da \u00f6nemlidir. Kabin bas\u0131n\u00e7lamas\u0131 (oksijenizasyonu) olsa bile gece g\u00f6r\u00fc\u015f keskinli\u011fi %15-18 azal\u0131r (2,4).<\/p>\n

\u00a0<\/p>\n

T\u00fct\u00fcndeki nikotinin (adrenalin ve noradrenalin salg\u0131s\u0131n\u0131 artt\u0131rarak) fizyolojik kam\u00e7\u0131lanma yaratt\u0131\u011f\u0131 bilinmektedir. Bu \u2018arousal\u2019 durumu, sigara i\u00e7iminden sonra ya\u015fanan relaksasyon hissi ile \u00e7eli\u015fmektedir; buna Nesbit\u2019s Paradox<\/strong> denilmektedir ve yeterince a\u00e7\u0131klanamayan bir durumdur. Nikotin\u2019in sa\u011flad\u0131\u011f\u0131 performans ile baz\u0131 i\u015flerin becerilmesi, sonu\u00e7ta \u00f6zg\u00fcveni artt\u0131rarak anksiyeteyi azaltmakta olabilir \u015feklinde yorumlayanlar vard\u0131r (4).<\/p>\n

Sigara b\u0131rak\u0131ld\u0131\u011f\u0131nda nikotinin v\u00fccuttan \u00e7ekilmesiyle ba\u015flang\u0131\u00e7ta ciddi semptomlar g\u00f6r\u00fcl\u00fcr. Bunlar\u0131n en \u00f6nemlisi performans d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcd\u00fcr; psikomotor beceriler bir hayli etkilenir. Ergenlerde yap\u0131lan bir \u00e7al\u0131\u015fmada, sigaray\u0131 b\u0131rakmay\u0131 takiben s\u00f6zel bellek, i\u015fler bellek ve bili\u015fsel performansta b\u00fcy\u00fck d\u00fc\u015f\u00fc\u015fler tespit edilmi\u015ftir. Di\u011fer bir \u00e7al\u0131\u015fmada, sigaray\u0131 b\u0131rakt\u0131ktan 24 saat sonra bili\u015fsel i\u015flevlerde ve reaksiyon zaman\u0131nda belirgin azalma oldu\u011fu, uyan\u0131kl\u0131l\u0131k gerektiren g\u00f6revlerde ciddi hatalar yap\u0131ld\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. 2003 y\u0131l\u0131nda 20 u\u00e7u\u015f g\u00f6revlisi \u00fczerinde yap\u0131lan bir ba\u015fka ara\u015ft\u0131rmada (12 saat sigara kesilmesinde) saptanan belirtiler; sinirlilik, gerginlik, konsantrasyon ve uyan\u0131kl\u0131k azalmas\u0131 ile t\u00fct\u00fcn \u00f6zlemidir. Ayr\u0131ca reaksiyon zaman\u0131n\u0131n uzamas\u0131, uyuklama, istek azalmas\u0131 ve muhakeme zay\u0131fl\u0131\u011f\u0131 olmu\u015ftur. U\u00e7u\u015f esnas\u0131nda yap\u0131lan kay\u0131tlarda da nikotin yoksunlu\u011fu nedeniyle bili\u015fsel i\u015flevlerde ciddi bozulmalar saptanm\u0131\u015ft\u0131r. Keza, kavgac\u0131l\u0131k, d\u00fcrt\u00fcsellik, konf\u00fczyon ve i\u015ftah art\u0131\u015f\u0131 da g\u00f6r\u00fclebilir. Sigaray\u0131 b\u0131rakman\u0131n yaratt\u0131\u011f\u0131 performans azalmas\u0131 ve g\u00f6rev hatalar\u0131na ba\u011fl\u0131 olarak i\u015ften \u00e7\u0131karmalar\u0131n oldu\u011fundan da bahsedilmektedir. Ama en \u00f6nemlisi, sigaray\u0131 b\u0131rakan u\u00e7ucularda kaza riski art\u0131\u015f\u0131 olas\u0131l\u0131\u011f\u0131d\u0131r. Nikotin vb. gibi kolinerjik ila\u00e7lar\u0131n performans\u0131 artt\u0131rd\u0131\u011f\u0131 bir ger\u00e7ektir. Alzheimer ve Parkinson hastalar\u0131nda dikkat, bellek ve bilgi i\u015fleme s\u00fcre\u00e7lerine nikotinin olumlu etkileri kan\u0131tlanm\u0131\u015ft\u0131r. U\u00e7u\u015f simulat\u00f6r\u00fcnde yap\u0131lan bir \u00e7al\u0131\u015fmada, nikotinin \u00f6zellikle ini\u015f esnas\u0131nda pilotlar\u0131n dikkat devaml\u0131l\u0131\u011f\u0131n\u0131 sa\u011flad\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (5).<\/p>\n

Ba\u015fka bir ara\u015ft\u0131rma, sigaray\u0131 b\u0131rakanlarda ya da u\u00e7u\u015f nedeniyle belirli s\u00fcrelerde i\u00e7meyenlerde depresyon, sinirlilik ve konsantrasyon kayb\u0131 gibi yak\u0131nmalar olmakta ise de, bu s\u00fcre\u00e7te yap\u0131lan psikolojik testlerde belirgin performans azalmas\u0131 bulunmad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir. Yani tiryakilerdeki nikotin yoksunlu\u011funa ba\u011fl\u0131 yak\u0131nmalar\u0131n s\u00fcbjektif bir y\u00f6n\u00fc de vard\u0131r. Nikotin, uzun belle\u011fi artt\u0131rmas\u0131na kar\u015f\u0131n yak\u0131n belle\u011fi azaltmaktad\u0131r. T\u00fct\u00fcn kullananlarda aerobik egzersiz performans\u0131n\u0131n ve maksimum \u00e7al\u0131\u015fma kapasitesinin azald\u0131\u011f\u0131 da bilinmektedir (2,4). B\u00fct\u00fcn bu nedenlerle d\u00fcnyada sigara kullan\u0131m\u0131na kar\u015f\u0131 istikrarl\u0131 bir sava\u015f verilmekte, havac\u0131l\u0131k sekt\u00f6r\u00fc de bunu \u00f6nemli say\u0131p desteklemektedir.<\/p>\n

Sivil havac\u0131l\u0131kta u\u00e7aklarda sigara k\u0131s\u0131tlamas\u0131 1973 y\u0131l\u0131nda ba\u015flad\u0131; United Airlines u\u00e7aklarda sigara i\u00e7ilen\/i\u00e7ilmeyen b\u00f6l\u00fcmleri ay\u0131rd\u0131.<\/p>\n

\u00a0\u00a0\u00a0 1987-1990: Amerika ve Kanada\u2019da \u00f6nce 2, sonra 6 saatten k\u0131sa u\u00e7u\u015flarda sigara i\u00e7imi yasakland\u0131.<\/p>\n

\u00a0\u00a0\u00a0 1995-2000: Amerika\u2019da \u00f6nce i\u00e7 hat, sonra k\u0131talararas\u0131 u\u00e7u\u015flarda sigara i\u00e7imi kesinlikle yasakland\u0131.<\/p>\n

\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Her iki D\u00fcnya Sava\u015f\u0131nda da moral deste\u011fi amac\u0131yla Amerikal\u0131 \u00fcreticiler cephedeki askerlere \u00fccretsiz sigara g\u00f6nderdiler. Sigaran\u0131n kalp-damar hastal\u0131klar\u0131 ve kanser riskini kesinlikle artt\u0131rd\u0131\u011f\u0131n\u0131n belirlenmesinden sonra Amerikan askeri havac\u0131l\u0131\u011f\u0131nda y\u00fcr\u00fct\u00fclen kampanyalar sonucu sigara kullan\u0131m\u0131 1980\u2032lerde %51 iken, 2001\u2032e gelindi\u011finde %29,9\u2032a geriledi. Ama K\u00f6rfez Sava\u015f\u0131nda Amerikan askerlerine gene bedava sigara verildi (2,3). Bug\u00fcn art\u0131k tiryaki pilotlar\u0131n sigara i\u00e7meyince zihinsel i\u015flevlerinin azald\u0131\u011f\u0131 bahanesiyle kokpitte sigara i\u00e7me ayr\u0131cal\u0131\u011f\u0131 talep etmeleri makul g\u00f6r\u00fclmemektedir. Bu ki\u015filerin kurallar\u0131 \u00e7i\u011fnemek, u\u00e7u\u015fu ve ba\u015fkalar\u0131n\u0131n sa\u011fl\u0131\u011f\u0131n\u0131 riske sokmak yerine, irade kullanarak veya tedavi g\u00f6rerek (Zyban, Chantix, Nikotin replasman\u0131, vs<\/em>) bu al\u0131\u015fkanl\u0131klar\u0131ndan kurtulmalar\u0131 \u00f6nerilmektedir. Sigaray\u0131 b\u0131rakt\u0131rma tedavilerinde kullan\u0131lan ila\u00e7lar\u0131n u\u00e7u\u015fta inkapasitasyon olu\u015fturma riski vard\u0131r. Bupropion vb. gibi ila\u00e7lar kullan\u0131l\u0131rken u\u00e7u\u015fun kesilmesi, 1-2 haftal\u0131k bir tedavi s\u00fcrecinden sonra ilac\u0131n kesilerek kokpite d\u00f6n\u00fclmesi en uygun karard\u0131r. Buna kar\u015f\u0131l\u0131k nikotinli uygulamalar s\u0131ras\u0131nda u\u00e7u\u015fu kesme gere\u011fi yoktur ve u\u00e7u\u015fta da kontroll\u00fc bi\u00e7imde verilebilir (5).<\/p>\n

ABD\u2019de yolcular\u0131n u\u00e7akta sigara i\u00e7meleri Federal bir su\u00e7tur. Baz\u0131 ki\u015filerin tuvaletlerdeki duman detekt\u00f6rlerini bozarak sigara i\u00e7meye \u00e7al\u0131\u015ft\u0131klar\u0131 bilinmekte ama tespit edildi\u011finde a\u011f\u0131r cezalar kesilmektedir. Hen\u00fcz duman detekt\u00f6rlerinin konmad\u0131\u011f\u0131 y\u0131llarda tuvalette sigara i\u00e7ip izmaritlerin k\u00e2\u011f\u0131tlar\u0131 tutu\u015fturmas\u0131na ba\u011fl\u0131 yang\u0131n olaylar\u0131 oldu. 1973 y\u0131l\u0131nda bir B-707 u\u00e7a\u011f\u0131n\u0131n tuvaletinde \u00e7\u0131kan yang\u0131n nedeniyle Paris yak\u0131nlar\u0131nda d\u00fc\u015fmesi 124 ki\u015finin \u00f6l\u00fcm\u00fcne yol a\u00e7t\u0131. 1983 y\u0131l\u0131nda ise ABD\u2019de iki DC-9 tuvalet yang\u0131n\u0131 kazas\u0131 oldu; Cincinati\u2019de olanda 23 ki\u015fi \u00f6ld\u00fc (2).<\/p>\n

ABD\u2019de sigara i\u00e7en hamile bayanlar y\u0131lda 400 bin premat\u00fcre bebek d\u00fcnyaya getirmekte; sigara i\u00e7enlerde kalp damar hastal\u0131\u011f\u0131 riski iki kat artmaktad\u0131r (1). ABD\u2019de her y\u0131l 20 milyon tiryaki sigaray\u0131 b\u0131rakmaya \u00e7al\u0131\u015f\u0131r, bunlar\u0131n %6\u2019s\u0131 ba\u015far\u0131l\u0131 olur (5). Sigara kullanmayan insanlar (bebek ve \u00e7ocuklar dahil), bulunduklar\u0131 ortamlarda sigara i\u00e7ildi\u011finde \u2018pasif i\u00e7ici\u2019 durumuna girer ve bu durum b\u00f6yle devam ederse (tiryakiler gibi) uzun vadede bo\u011faz-akci\u011fer kanseri ve kalp-damar hastal\u0131klar\u0131 gibi ya\u015famsal risklere aday haline gelebilirler. K\u0131sa vadede ise g\u00f6z yanmas\u0131, nefes darl\u0131\u011f\u0131, ba\u015f d\u00f6nmesi, konsantrasyon kayb\u0131 gibi sorunlar ya\u015fan\u0131r.<\/p>\n

Bug\u00fcn Avrupa\u2019daki herhangi bir u\u00e7a\u011f\u0131n kabin veya kokpitinde \u201csigara i\u00e7ebilir miyim?\u201d diye soru sormak abestir; bu tart\u0131\u015f\u0131lmaz bir yasakt\u0131r ve istisnas\u0131z olarak herkes uymak zorundad\u0131r. Sigara tiryakisi baz\u0131 pilot ve hostesler uzun u\u00e7u\u015flarda nikotin tableti \u00e7i\u011fnerler ve talep eden yolculara da nikotin tabletleri sunulur.<\/p>\n

\u00a0<\/p>\n

\u00dclkemizdeki durum\u00a0 <\/strong><\/p>\n

\u00dclkemizde 1930\u2032lu y\u0131llarda askerlere \u2018cigara\u2019 da\u011f\u0131t\u0131l\u0131r, gazilere \u2018t\u00fct\u00fcn paras\u0131\u2019 verilir, hastanede yatan tiryaki hastalara sigara re\u00e7ete edilirdi\u2026 Yak\u0131n ge\u00e7mi\u015fte, eski Cumhurba\u015fkanlar\u0131ndan birinin e\u015fi u\u00e7akta sigara i\u00e7me \u0131srar\u0131nda bulunmu\u015f, bunu bir keyif ve \u00f6zg\u00fcrl\u00fck olarak nitelemi\u015fti. 19 May\u0131s 2008 g\u00fcn\u00fc \u00e7\u0131kan yasa gere\u011fi t\u00fcm kapal\u0131 mek\u00e2nlarda t\u00fct\u00fcn i\u00e7imi yasaklanm\u0131\u015f durumdad\u0131r. Art\u0131k sigaran\u0131n rekl\u00e2m\u0131n\u0131n yap\u0131lmas\u0131, otomatik makineler arac\u0131l\u0131\u011f\u0131yla veya \u00e7ocuklara sat\u0131\u015f\u0131 da m\u00fcmk\u00fcn de\u011fildir. Sigara paketlerinin \u00fczerinde t\u00fct\u00fcn\u00fcn \u00f6ld\u00fcr\u00fcc\u00fc oldu\u011funa dair yaz\u0131 ve resimler yer al\u0131yor\u2026 Buna ra\u011fmen bug\u00fcn d\u00fcnyada 1,5 milyar, T\u00fcrkiye\u2019de 17 milyon tiryaki var; t\u00fct\u00fcne y\u0131lda 15 milyar $ harcanmakta; y\u0131lda 100 bin ki\u015fi t\u00fct\u00fcn kullan\u0131m\u0131na ba\u011fl\u0131 hastal\u0131klardan \u00f6lmekte\u2026 T\u00fcrkiye\u2019de insanlara rol modeli olmas\u0131 gereken doktorlar\u0131n %35-45\u2032i sigara i\u00e7mekte\u2026<\/p>\n

\u00dclkemizde kokpit ve kabinlerde t\u00fct\u00fcn kullan\u0131m\u0131 yasak olmas\u0131na ra\u011fmen baz\u0131 pilotlar\u0131n \u00e7ok dar bir hacmi olan kokpitte sigara, pipo ve hatt\u00e2 puro i\u00e7tikleri duyulmakta; baz\u0131 hat\u0131rl\u0131 yolcular da (kokpitler sanki sigara i\u00e7me odas\u0131ym\u0131\u015f gibi) kabinde i\u00e7emedi\u011fi sigaras\u0131n\u0131 burada i\u00e7meyi istemektedirler. Bunun bir yasa\u011f\u0131 \u00e7i\u011fnemek oldu\u011fu ve t\u00fct\u00fcn kullanmayan di\u011fer kokpit ekibi i\u00e7in nas\u0131l bir eziyete yol a\u00e7t\u0131\u011f\u0131 bir yana, u\u00e7u\u015f emniyeti i\u00e7in de ciddi bir risk oldu\u011fu unutulmamal\u0131d\u0131r.<\/p>\n

\u00a0<\/p>\n

Kaynaklar<\/strong>:<\/p>\n

    \n
  1. Davis JR, Johnson R, Stepanek J, Fogarty JA. Fundamentals of Aerospace Medicine. 4th Edit. Lippincott Williams&Wilkins, 2008 p.324<\/li>\n
  2. DeHart DL, Davis JR. Fundamentals of Aerospace Medicine. 3rd Edit. Philadelphia: Lippincott Williams& Wilkins, 2002 p. 299,370<\/li>\n
  3. Forgas LB, Cohen ME. Tobacco use habits of Naval personel during Desert Storm. Military Medicine, Vol. 161, March 1996: 165-68<\/li>\n
  4. Hawkins FH. Human Factors in Flight. Gower Tech.Press, 1987 Aldershot, England. pp.83-87, 290<\/li>\n
  5. Grossman A, Landau DA, Barenboim E, Goldstein L. Smoking cessation therapy and the return of aviators to flying duty. Aviat Space Environ Med. 2005; 76:1064-7<\/li>\n<\/ol>\n

    Haz\u0131rlayan<\/strong>: Do\u00e7. Dr. Muzaffer \u00c7eting\u00fc\u00e7<\/strong><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    T\u00fct\u00fcn; tar, nikotin ve karbonmonoksit (CO) olmak \u00fczere 3 ana toksik madde i\u00e7erir. Tar, bo\u011faz ve akci\u011fer kanserine; Nikotin, damar hastal\u0131klar\u0131na neden olur. CO, u\u00e7u\u015f i\u00e7in en sak\u0131ncal\u0131 olan\u0131d\u0131r; \u00e7\u00fcnk\u00fc kan hemoglobiniyle birle\u015fme kapasitesi oksijenden 210 kat fazlad\u0131r.\u00a0 U\u00e7ak i\u00e7inde kabin irtifa\u0131n\u0131n d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc, oksijen parsiyel bas\u0131nc\u0131n\u0131n da d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc demek oldu\u011fundan, i\u00e7ilen t\u00fct\u00fcn\u00fcn duman\u0131ndaki CO, kan hemoglobinine \u00e7ok daha y\u00fcksek oranda […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-251","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/251","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=251"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/251\/revisions"}],"predecessor-version":[{"id":253,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/251\/revisions\/253"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=251"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=251"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}