314例戒烟门诊患者戒烟效果及影响因素

doi:10.6040/j.issn.1671-7554.0.2023.0202

摘要/Abstract

摘要： 目的比较药物戒烟与心理行为干预戒烟对实际戒烟效果的影响,对比随访真实世界1个月、3个月及6个月后的戒烟效果及影响因素。方法自2022年6月1日至2022年12月31日于山东省千佛山医院戒烟门诊登记的314名戒烟受试患者,根据受试者意愿分为使用戒烟药物辅助戒烟及心理行为干预戒烟两组,178名吸烟者选择使用药物辅助戒烟(包括113名患者选择安非他酮戒烟、38名患者选择使用伐尼克兰戒烟及27名患者选择使用尼古丁贴片戒烟),定义为治疗组;136名患者心理行为干预戒烟,定义为对照组。使用SPSS 26.0软件统计随访两组患者1个月、3个月及6个月后的戒烟率,分析使用不同药物干预戒烟及心理行为干预戒烟对戒烟效果的差异,分析影响戒烟成功率的因素。结果药物辅助戒烟者成功率为48.3%,心理行为干预辅助戒烟者成功率为13.2%,两组差异有统计学意义(χ2=51.714,P<0.05)。教育程度在大学本科及以上以及每日吸烟量控制在1盒(20支)以内的吸烟者更容易实现戒烟,为戒烟成功的保护性因素。结论使用药物辅助戒烟与心理行为干预戒烟都是辅助戒烟的良好方式;相较于心理行为干预,药物辅助戒烟更有助于提高戒烟成功率,尤其在降低复吸率方面很有价值。

关键词: 烟草依赖, 戒烟, 安非他酮, 伐尼克兰, 尼古丁贴片, 心理行为干预, 戒烟成功率

Abstract: Objective To compare the effects of drug quitting and psychological behavior intervention on smoking cessation, and to compare the success rate of smoking cessation after 1, 3 and 6 months of follow-up in the real world. Methods During Jun. 1, 2022 and Dec. 31, 2022, 314 smoking cessation patients registered in the Smoking Cessation Clinic of Shandong Provincial Qianfoshan Hospital were divided into two groups according to different ways of intervention. The medication-assisted group included 178 smokers who chose to use drugs(113 used Bupropion, 38 used Varenicline and 27 used Nicotine patches), while the control group included 136 patients who accepted the psychological behavioral intervention. The smoking cessation rate of the two groups after 1 month, 3 months and 6 months were analyzed with SPSS 26.0 software to identify the differences in the effects of interventions and the influencing factors. Results The success rate of drug-assisted quitters was 48.3%, the success rate of psychological behavioral quitters was 13.2%, with statistically significant difference between the two groups(χ2=51.714, P<0.05). Smokers with a bachelors degree or above and a daily smoking limit of less than 1 box(20 cigarettes)were more likely to quit smoking, which were protective factors for smoking cessation success. Conclusion Drug-assisted smoking cessation and psychological behavior intervention are both good ways to assist smoking cessation. The former is more helpful, especially in reducing the rate of relapse.

Key words: Tobacco dependence, Smoking cessation, Bupropion, Varenicline, Nicotine patches, Psychological behavior intervention, Success rate of smoking cessation

中图分类号:

R193

仇一帆,王子涵,高婷婷,王西艳,孙燕,刘粉,亓倩,董亮. 314例戒烟门诊患者戒烟效果及影响因素[J]. 山东大学学报 (医学版), 2023, 61(10): 88-94.

QIU Yifan, WANG Zihan, GAO Tingting, WANG Xiyan, SUN Yan, LIU Fen, QI Qian, DONG Liang. Outcome and influencing factors of 314 outpatient smoking cessation cases[J]. Journal of Shandong University (Health Sciences), 2023, 61(10): 88-94.

参考文献

[1] Picciotto MR, Kenny PJ. Mechanisms of nicotine addiction[J]. Cold Spring Harb Perspect Med, 2021, 11(5): a039610. doi: 10.1101/cshperspect.a039610.
[2] Wang M, Luo X, Xu S, et al. Trends in smoking prevalence and implication for chronic diseases in China: serial national cross-sectional surveys from 2003 to 2013[J]. Lancet Respir Med, 2019, 7(1): 35-45.
[3] Liu Z, Li YH, Cui ZY, et al. Prevalence of tobacco dependence and associated factors in China: findings from nationwide China Health Literacy Survey during 2018-19[J]. Lancet Reg Health West Pac, 2022, 24: 100464. doi: 10.1016/j.lanwpc.2022.100464.
[4] DiFranza JR. Can tobacco dependence provide insights into other drug addictions? [J] BMC Psychiatry, 2016, 16(1): 365. doi: 10.1186/s12888-016-1074-4.
[5] GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019[J]. Lancet, 2021, 397(10292): 2337-2360.
[6] Xie L, Yan Y, Yang Y, et al. Evaluation of smoking cessation intervention effectiveness in smoking cessation clinics-China, 2019-2021[J]. China CDC Wkly, 2023, 5(21): 469-474.
[7] Lin B, Xie L, Xie X, et al. Predictors for quitting smoking in smoking cessation clinics among female smokers in China[J]. Tob Induc Dis, 2023, 21: 26. doi: 10.18332/tid/159132.
[8] Chan KH, Wright N, Xiao D, et al. Tobacco smoking and risks of more than 470 diseases in China: a prospective cohort study[J]. Lancet Public Health, 2022, 7(12): e1014-e1026.
[9] GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2018, 392(10159): 1789-1858.
[10] Fallahzadeh A, Sharifnejad Tehrani Y, Sheikhy A, et al. The burden of chronic respiratory disease and attributable risk factors in North Africa and Middle East: findings from global burden of disease study(GBD)2019[J]. Respir Res, 2022, 23(1): 268. doi: 10.1186/s12931-022-02187-3.
[11] Sun J, Bao J, Shi Y, et al. Effect of simvastatin on MMPs and TIMPs in cigarette smoke-induced rat COPD model[J]. Int J Chron Obstruct Pulmon Dis, 2017, 12: 717-724. doi: 10.2147/COPD.S110520.
[12] Arreola-Ramírez JL, Vargas MH, Carbajal V, et al. Mesenchymal stem cells attenuate the proinflammatory cytokine pattern in a guinea pig model of chronic cigarette smoke exposure[J]. Cytokine, 2023, 162: 156104. doi: 10.1016/j.cyto.2022.156104.
[13] Serré J, Mathyssen C, Ajime TT, et al. Airway infection with nontypeable haemophilus influenzae is more rapidly eradicated in vitamin D deficient mice[J]. J Steroid Biochem Mol Biol, 2019, 187: 42-51. doi: 10.1016/j.jsbmb.2018.10.021.
[14] Pournaras N, Andersson A, Kovach MA, et al. Glucose homeostasis in relation to neutrophil mobilization in smokers with COPD[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17: 1179-1194. doi: 10.2147/COPD.S353753.
[15] Martinez FJ, Han MK, Allinson JP, et al. At the root: defining and halting progression of early chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2018, 197(12): 1540-1551.
[16] Chang JT, Anic GM, Rostron BL, et al. Cigarette smoking reduction and health risks: a systematic review and meta-analysis[J]. Nicotine Tob Res, 2021, 23(4): 635-642.
[17] 李文扬,康健.235例戒烟志愿者戒烟成功及失败因素分析[J].贵阳医学院学报, 2015, 40(5): 479-481. LI Wenyang, KANG Jian. Analysis of the failure factors of smoke quitting[J]. Journal of Guiyang Medical College, 2015, 40(5): 479-481.
[18] 葛福婷,张秀,王家豪,等.基于层次分析法的吸烟者戒烟影响因素研究[J].商丘师范学院学报, 2017, 33(6): 5-12. GE Futing, ZHANG Xiu, WANG Jiahao, et al. Research on the influencing factors for smokers to quit smoking from the perspective of analytic hierarchy process[J]. Journal of Shangqiu Normal University, 2017, 33(6): 5-12.
[19] Sharma MK, Suman LN, Srivastava K, et al. Psychometric properties of fagerstrom test of nicotine dependence: a systematic review[J]. Ind Psychiatry J, 2021, 30(2): 207-216.
[20] Cinciripini PM, Minnix JA, Robinson JD, et al. The effects of scheduled smoking reduction and precessation nicotine replacement therapy on smoking cessation: Randomized Controlled Trial With Compliance[J]. JMIR Form Res, 2023, 7: e39487. doi: 10.2196/39487.
[21] Hartmann-Boyce J, Aveyard P. Drugs for smoking cessation[J]. BMJ, 2016, 352: i571. doi: 10.1136/bmj.i571.
[22] 李荣,解世林,张励,等.盐酸安非他酮缓释片联合行为干预真实世界戒烟效果研究[J].中国实用内科杂志, 2019, 39(10): 873-878. LI Rong, XIE Shilin, ZHANG Li, et al. A study on the real world effect of the combination of bupropion hydrochloride sustained release tablets with behavior intervention on smoking cessation[J]. Chinese Journal of Practical Internal Medicine, 2019, 39(10): 873-878.
[23] Jordan CJ, Xi ZX. Discovery and development of varenicline for smoking cessation[J]. Expert Opin Drug Discov, 2018, 13(7): 671-683.
[24] Lopes LC, Zhang Y, Ross S, et al. Varenicline for tobacco-dependent adults who are not ready to discontinue use: a systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2022, 19(12): 2077-2086.
[25] Hernández Zenteno RJ, Lara DF, Venegas AR, et al. Varenicline for long term smoking cessation in patients with COPD[J]. Pulm Pharmacol Ther, 2018, 53: 116-120. doi: 10.1016/j.pupt.2018.11.001.
[26] Tavares Xda S, Blum AP, Nakamura DT, et al. Variations in binding among several agonists at two stoichiometries of the neuronal, α4β2 nicotinic receptor[J]. J Am Chem Soc, 2012, 134(28): 11474-11480.
[27] Tonstad S, Arons C, Rollema H, et al. Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations[J]. Curr Med Res Opin, 2020, 36(5): 713-730.
[28] Kim JS, Jang JY, Park EH, et al. Seven-day continuous abstinence rate from smoking at 1, 2, or 3 years after the use of varenicline[J]. Tuberc Respir Dis(Seoul), 2015, 78(2): 92-98.
[29] Mao RL, Cécile Tromeur, Paleiron N, et al. Effect of early initiation of varenicline on smoking cessation in COPD patients admitted for exacerbation: the save randomized clinical trial[J]. COPD, 2020, 17(1): 7-14.
[30] 商雪,鄂芬芬,郭康乐,等.伐尼克兰戒烟有效性及安全性的Meta分析和试验序贯分析[J]. 中国医院药学杂志, 2023, 43(2): 190-200. SHANG Xue, E Fenfen, GUO Kangle, et al. Effectiveness and safety of varenicline on smoking cessation: a Meta-analysis with trial sequential analysis[J]. Chinese Jounal of Hospital Pharmacy, 2023, 43(2): 190-200.
[31] Wang Q, Dai R, Zhang H, et al. The efficacy and safety of acupuncture and nicotine replacement therapy for smoking cessation: study protocol for a randomized controlled trial[J]. Trials, 2022, 23(1): 465. doi: 10.1186/s13063-022-06384-9.
[32] Zhang B, Cohen JE, Bondy SJ, et al. Duration of nicotine replacement therapy use and smoking cessation: a population-based longitudinal study[J]. Am J Epidemiol, 2015, 181(7): 513-520.
[33] Prochaska JO, Goldstein MG. Process of smoking cessation. Implications for clinicians[J]. Clin Chest Med, 1991, 12(4): 727-735.
[34] 徐鸣丽,金媛. 5A+5R干预联合伐尼克兰对COPD患者戒烟效果及肺功能的影响[J]. 临床肺科杂志, 2020, 25(6): 843-846. XU Mingli, JIN Yuan. Effect of 5A + 5R intervention combined with varenicline on smoking cessation and pulmonary function in patients with COPD[J]. Journal of Clinical Pulmonary Medicine, 2020, 25(6): 843-846.

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