2015-2018年央补项目戒烟门诊患者首诊后1个月随访时戒烟率影响因素分析

目的 评估中央补助地方戒烟门诊项目实施效果,探索影响吸烟者戒烟成功的因素,以指导戒烟服务的提供和戒烟门诊工作的开展。方法 采用人群现场干预研究,由经过项目培训的医务人员,对吸烟者进行面对面访谈,完成调查问卷,并进行心理行为干预。已配备戒烟药物的医院,为患者开具相应药物。首诊1个月后开展随访干预,获得1个月随访7 d时点戒烟率。结果 1个月随访7 d时点戒烟率为34.1%。多元logistic回归结果显示, ≥60岁患病人群戒烟可能性最大;自身患病、首诊非每天吸烟、准备在30 d内戒烟、使用酒石酸伐尼克兰和盐酸安非他酮的患者,戒烟成功的可能性更大;未就业者相对于就业者更不利于戒烟;每日吸烟量越大、吸烟年限越长、晨起后第一支烟越急迫的患者,戒烟的可能性越小;是否有戒烟史对戒烟可能性没有影响。结论 从1个月随访时7 d时点戒烟率看,央补戒烟门诊项目戒烟干预有效。应加大对吸烟者的宣传,戒烟越早越有效。使用酒石酸伐尼克兰和盐酸安非他酮等药物能增加戒烟的可能性,应加强戒烟门诊有效药物的配备率。戒烟门诊医务人员帮助患者在戒烟过程中克服戒断症状很重要。     

不同戒烟模式干预效果的网状Meta分析

目的系统评价不同戒烟干预模式的戒烟效果,综合评价不同干预模式利弊,为我国控烟工作和建立规范有效的戒烟服务体系提供理论依据。方法系统检索中国知网(CNKI)、万方、维普电子数据库,筛选纳入32篇文献,通过网状Meta分析比较各干预措施的6个月戒烟效果,并进行排序。结果共纳入32项戒烟干预的随机对照试验,涉及患者4983例。结果显示,5A+5R联合伐尼克兰干预的6个月戒烟效果最优,与尼古丁替代疗法相比,OR=6.96,SUCRA=96.9%;其次为心理干预联合伐尼克兰干预,与尼古丁替代疗法相比,OR=3.67,SUCRA=88.3%。单一干预措施中伐尼克兰药物干预效果最好(SUCRA=62.3%),干戒法效果最差(SUCRA=7.8%)。效果综合排序为5A+5R联合伐尼克兰心理干预联合伐尼克兰伐尼克兰心理干预尼古丁替代疗法5A+5R干预常规戒烟健康干预空白对照干戒法。结论除常规健康教育、空白对照、干戒法外,6种干预措施均能有效帮助吸烟患者达到戒烟目的,其中5A+5R联合伐尼克兰的综合干预效果可能最好,综合干预模式效果显著优于单一干预模式。     

伐尼克兰联合心理干预戒烟对慢性阻塞性肺疾病的疗效观察

目的评估伐尼克兰联合心理干预措施对轻中度慢性阻塞性肺疾病（COPD）吸烟患者烟草依赖的疗效和安全性。方法选取轻中度COPD烟草依赖的患者108例,随机分为干戒组、伐尼克兰组、伐尼克兰＋心理干预（干预组）三组,对伐尼克兰组及干预组给予口服12周伐尼克兰,干预组并给予戒烟咨询及心理干预,随访至24周,观察戒烟者的戒烟率、肺功能变化、不良反应、戒断症状及复吸率。结果干预组12周和24周持续戒烟率分别为77.8%和75%,伐尼克兰组分别为55.6%和41.7%,干戒组分别为25%和8.3%,三组之间差异有统计学意义（P〈0.05）;不良反应主要为恶心、失眠、头痛等,程度轻微,多为一过性。伐尼克兰组12周戒断症状评分为（1.8±2.3）分,干预组为（1.7±2.1）分,均显著低于干戒组（4.1±1.6）分（P〈0.05）。结论伐尼克兰联合心理干预可大大提高戒烟患者短期和长期的戒烟率,伐尼克兰戒烟安全、有效、耐受性好,对我国COPD烟草依赖的患者具有适用性。     

戒烟有效途径及其防癌意义

吸烟在工业化国家是对发病率和死亡率影响最大的可预防危险因素.世界卫生组织预计到2020年烟草将成为最大的一个健康问题,可导致每年约840万人死亡.烟草在肺癌、头颈部癌、泌尿道癌和胰腺癌的病因学方面尤其重要.减少染上吸烟习惯的青年人数量和帮助那些已经开始吸烟的人戒烟是预防癌症的关键.烟草或尼古丁依赖性是一种常见的慢性复发性病症.双生子研究揭示了吸烟易感生的差异和持续性的不同与一些遗传因素有关.减少使用烟草和治疗尼古丁依赖性的可行干预措施为公共卫生人员和临床医生提供了疾病预防的一个良机.5种药物疗法(尼古丁口胶、尼古丁贴片、尼古丁吸入剂、尼古丁鼻腔喷雾剂和安非他酮)及行为疗法既有效又安全,使戒烟率提提高了一倍,并且与副作用少于5%导致的退出率有关.     

戒烟有效途径及其防癌意义

吸烟在工业化国家是对发病率和死亡率影响最大的可预防危险因素。世界卫生组织预计到2020年烟草成为最大的一个健康问题，可导致每年约840万人死亡。烟草在肺癌、头颈部癌、泌尿道癌和胰腺癌的病因学方面尤其重要。减少染上吸烟习惯的青年人数量和帮助那些已经开始吸烟的人戒烟是预防癌症的关键。烟草或尼古丁依赖性是一种常见的慢性复发性病症。双生子研究揭示了吸烟易感性的差异和持续性的不同与一些遗传因素有关。减少使用烟草和治疗居古丁依赖性的可行干预措施为公共卫生人员和临床医生提供了疾病预防的一个良机。5种药物疗法（尼古丁口胶、尼古丁贴片、尼古丁吸入剂、尼古丁鼻腔喷雾剂和安非他酮）及行为疗法既有效又安全，使戒烟率提高了一倍，并且与副作用少于5%导致的退出率有关。     

盐酸安非他酮的戒烟效果

目的初步评价盐酸安非他酮戒除烟瘾的有效性和安全性。方法 43名受试者口服盐酸安非他酮缓释片150～300mg/d,疗程7周,观察12周。分别于服药前,服药后4周及12周进行问卷调查。结果 4周时的戒烟率为20.9%(9/43),12周时为34.9%(15/43)。随着服药时间延长,日吸烟量逐渐减少。烟草依赖自评量表结果显示12周时,各种戒断症状的发生率较4周时明显下降。观察期间出现的不良反应包括恶心(16.2%)、呕吐(2.3%)、异常梦境(4.7%)和情绪改变(7.0%)。没有受试者因为不良反应而停药。结论盐酸安非他酮对戒除烟瘾有一定的疗效,并且具有良好的安全性和可耐受性。     

戒烟的护理干预

香烟是美国人的杀手。在美国,每年死于因烟草所致疾病的人数超过40万。尽管如此,有25%的美国成年人仍在吸烟,在25～44岁年龄组,吸烟是十分普遍的现象。统计数据表明,新烟民中近90%为十几岁的青少年,每年花费在因使用烟草引起的健康问题上的经费为500亿美元,另有470亿美元间接用于其引起的生产能力丧失等问题。 　　吸烟引起的远期副作用已得到证实。然而,护士们认识到,对于没有症状的吸烟者,要使他们意识到自己正受到一种尚未显现的慢性疾病的威胁是很困难的。因此,讨论烟草对吸烟者的近期影响可能更有用。当一个人吸烟时,可能会发生心率增快、血压上升、口腔粘膜溃烂、气短、组织缺氧、晨间咳嗽、胃酸反流、牙周疾病、紧张和焦虑、阳萎和不育、哮喘加重及皮肤早衰等表现。 　　把焦点放在戒烟的近期益处上可能比强调预防远期慢性疾病更有说服力。戒烟后一些有益的变化包括：血压、脉率、CO水平恢复正常,味觉、嗅觉、肺功能和消化不良症状改善,患心梗、支气管炎、肺气肿和肺癌及其他癌肿的机会减少。 　　采用Fagerstrom量表评价吸烟者对尼古丁的依赖性,得分高意味着依赖性大,据此护士能帮助病人增加对戒烟后反应的了解,以制订戒烟计划。在90年代早期,Fiore提出将病人的吸烟状态作为第五生命体征,对住院病人常规进行烟草使用情况评价。 　　护士要以一种友善、关心、非指责性的方式劝导病人戒烟。病人可能曾经经历过戒烟后尼古丁引起的躯体戒断症状,而且病人的吸烟习惯与许多刺激因素有关,包括咖啡、酒精、饭后、工作间歇、烟友以及所有其他与香烟有关的行为。假如病人知道他(她)的刺激因素,并试图避开和妥善处置它们,戒断症状是容易克服的。 　　戒烟有几种有效的方法,包括直截了当法、尼古丁替代治疗、非尼古丁治疗药物如盐酸安非他酮治疗等。其他如催眠、针灸和厌恶疗法的有效性尚有待证实。病人渴望停止吸烟是戒烟成功最重要的因素之一。 　　实用的劝告4A可纳入日常临床护理工作中,即①询问(Ask),②建议(Advise),③帮助(Assist),④安排随访(Arrange follow-up)。 　　动员病人戒烟是一个具有挑战性的护理干预,评价病人对尼古丁的依赖程度和吸烟的刺激因素,对于推荐合适的戒烟行动计划和制定个体化的治疗方案至关重要。护士在病人贯彻戒烟策略过程中起着关键作用,她们在降低与吸烟相关疾病的发生和死亡方面的作用是非常重要的。 (张　淳　魏聿萍摘　李　柏校)     

学会利用戒烟服务戒烟

正近年来由于广泛宣传,公众对烟草烟雾的危害已耳熟能详,是一种尼古丁依赖。世界卫生组织(WHO)将烟草依赖列为国际疾病分类(ICD-10),F17.2。随着公众认识的提高以及医学界对戒烟研究的不断进展,戒烟的成功率在逐步提高。但烟草依赖是一种慢性高复发性疾病,已被定义为药物成瘾性疾病,只有少数吸烟者第一次戒烟就完全戒掉,大多数吸烟者均有复吸的经历。对已达到烟草依赖程度的吸烟者采取戒烟药物治疗,可减缓戒断症状,提高戒烟率。     

伐尼克兰辅助戒烟治疗有效性观察

目的评价伐尼克兰辅助戒烟治疗的有效性。方法研究对象为2008年12月—2012年12月在该院戒烟门诊就诊的吸烟者,将使用伐尼克兰治疗组56例与对照组68例做对照分析,观察开始治疗后6个月时持续戒烟率。结果 56例治疗组中1例因出现严重恶心、呕吐,1例出现胸闷、心率增快停止治疗,54例接受伐尼克兰治疗2~3个月,6个月随访结束时,29.6%的吸烟者已经持续戒烟;68例对照组6个月随访结束时,吸烟者持续戒烟率为10.3%。治疗组戒烟率为对照组的2.9倍,差异有统计学意义（χ^2=7.36,P〈0.01）。结论伐尼克兰能显著提高戒烟率,且安全性、耐受性好。     

烟瘾实是心瘾

烟草没有成瘾性,戒烟时也没有毒品成瘾者的戒断症状。烟草中的尼古丁对中枢神经系统具有兴奋和抑制双重作用,但烟草并不能造成毒品的病态依赖性。人对吸烟的嗜好,一部分原因是在长期生活中形成的一种习惯或者叫条件反射,比如写     

New drugs; varenicline

Nicotine acts in the brain by releasing dopamine in the mesolimbic pathway which results in a reward effect and in dependence when used chronically. The effect of nicotine is mediated via nicotinergic acetylcholine receptors of the alpha4beta2 subtype ofwhich varenicline is a partial agonist. Varenicline can be used for quitting smoking because of two mechanisms: it acts as a partial agonist and thus reduces the symptoms of craving when quitting smoking, and it has antagonistic actions by binding the receptor instead of nicotine and therefore decreases the reward effect of nicotine. The most important side effects of varenicline are nausea, vomiting and headache. After one year, 22% of the treated group continued to abstain from smoking.     

Nationwide Smoking Cessation Treatment Support Program – Turkey project

BackgroundIn 2011, Turkish Ministry of Health (MoH) initiated a nation-wide “Smoking Cessation Treatment Support Program” (SCTSP), to provide smoking cessation drugs free of charge.MethodsSCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix^®, Pfizer) and Bupropion (Zyban^®, GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program.FindingsQuit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates.InterpretationSCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algoritm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.     

Transgenic over expression of nicotinic receptor alpha 5, alpha 3, and beta 4 subunit genes reduces ethanol intake in mice

Abuse of alcohol and smoking are extensively co-morbid. Some studies suggest partial commonality of action of alcohol and nicotine mediated through nicotinic acetylcholine receptors (nAChRs). We tested mice with transgenic over expression of the alpha 5, alpha 3, beta 4 receptor subunit genes, which lie in a cluster on human chromosome 15, that were previously shown to have increased nicotine self-administration, for several responses to ethanol. Transgenic and wild-type mice did not differ in sensitivity to several acute behavioral responses to ethanol. However, transgenic mice drank less ethanol than wild-type in a two-bottle (ethanol vs. water) preference test. These results suggest a complex role for this receptor subunit gene cluster in the modulation of ethanol's as well as nicotine's effects.     

Adolescents’ perceptions about quitting and nicotine replacement therapy: findings from the California Tobacco Survey

We collected data from 5,857 adolescent (12–17 y) respondents in California to assess their perception about quitting smoking and nicotine replacement therapy use.In multivariate models, never smokers were less likely than established or experimenter smokers to believe that if they were to smoke they could quit anytime but were more likely to believe that nicotine replacement therapy is a sure way to quit.     

Study protocol for a randomised trial of nicotine-free cigarettes as an adjunct to usual NRT-based cessation practice,in people who wish to stop smoking

Background  

Current smoking cessation treatments focus on addressing the pharmacological dependence of smokers on nicotine. However, new strategies are needed that address both nicotine dependence and the psychological dependence on cigarettes as the source of nicotine. Evidence from a number of small smoking cessation studies suggests that the use of cigarettes with reduced nicotine content, in combination with nicotine replacement therapy (NRT), may help reduce withdrawal symptoms and increase quit rates. This paper describes the protocol for a large randomised-controlled trial to test the effect of using nicotine-free cigarettes together with NRT on long-term quit rates.     

Stressful life events, resources, and access: key considerations in quitting smoking at an Aboriginal Medical Service

OBJECTIVE: Aboriginal and Torres Strait Islander people experience adverse health outcomes and have high rates of smoking and related illnesses. This brief report describes stress as a barrier to quitting smoking derived from reflections within an Aboriginal Medical Service and makes recommendations for intervention development. METHODS: A high-intensity smoking cessation program was conducted within a suburban Aboriginal Medical Service in Western Sydney, Australia, over a 10-month period. The intervention included weekly cessation counselling sessions and dispensation of free nicotine replacement therapy (NRT). RESULTS: During the observation period, 32 clients made quit attempts. To date, three clients (9%) have quit smoking. Chronic and intercurrent life stressors were noted to be the main barriers to smoking cessation described by participants. CONCLUSIONS: Achieving smoking cessation among Indigenous people is made significantly more complex because of multiple life stressors experienced. IMPLICATIONS: Future interventions targeting Indigenous Australians should take greater account of stressful life events and their impact on quitting smoking.     

Tobacco and aboriginal people in NSW

Tobacco use is a major cause of morbidity and mortality for Aboriginal people in NSW. Few interventions to reduce the harm resulting from tobacco use have been developed specifically for this population. However, brief interventions for smoking cessation, pharmacotherapies such as nicotine replacement therapy, bupropion and varenicline, quit groups and interventions aimed at reducing smoking by pregnant women and hospital inpatients are likely to be effective. Broader population interventions such as anti-tobacco advertising, price rises for tobacco products and prevention of sales to minors are also likely to be effective in reducing the harm resulting from tobacco use.