冠心病患者介入治疗后吸烟控制情况分析

Smoking control after percutaneous coronary intervention in coronary heart disease patients

目的了解冠心病患者接受经皮冠状动脉介入治疗术后吸烟的控制情况,分析其与循证医学指南的差距。方法选择在北京华信医院急诊科接受介入治疗并且出院后随访时间在180d的所有冠心病患者,分析其入院时与随访期吸烟情况的变化。结果在总共337例患者中,299例接受了6个月的随访(随访率为88.7%)。入院时与随访时的吸烟比率分别为47.5%(142/299)和23.1%(69/299,P=0.003);入院时吸烟的患者在随访时仍吸烟者为35.9%(51/142),入院时无吸烟的患者随访时吸烟率为11.5%(18/157);在随访期间将患者按年龄分组分析,结果显示:非老年组(≤65岁)患者的再吸烟率为52.8%(47/89),老年组(>65岁)患者为41.5%(22/53),非老年组患者高于老年组(P=0.023);老年组在随访期内戒烟率为49.1%(26/53),高于非老年组患者32.6%(29/89,P=0.012);老年组随访期新发吸烟率为5.4%(5/93),低于非老年组20.3%(13/64,P=0.001)。结论冠心病患者在介入治疗后的吸烟控制情况不理想。应加强对冠心病患者的戒烟宣传教育,努力缩小临床实践与循证指南的差距。

Objective To elucidate the situation of giving up smoking after percutaneous coronary intervention （PCI） in patients with coronary artery disease in order to analyze the gap between the real situation and evidencebased medicine. Methods 299 patients with coronary artery disease who had undergone PCI and followed up for 6 months were studied. Results The rates of smoking on admission and follow up period were 47.5% （142/299） and 23.1% （69/299）, respectively. During followup, 35.9% （51/142） of the in hospital smokers continued smoking, whereas 11.5 % （18/157） of the non-smokers during hospitalization became cigarette addict despite a marked reduction in the general rate of smoking （P =0. 003）. All the patients were divided into elderly group （〉65years） and nonelderly group （≤65years）. Compared with the elderly group, the non-elderly group had a higher rate of recurrent smoking （52.8% vs41.5%, P=0.023）, alower rate of giving up smoking （32.6% vs49.1%, P =0.012） anda higher rate of new smokers （20.3% vs 5.4%, P=0. 001） during follow up period. Conclusion The situation of giving up smoking after PCI is far beyond optimal, with a high rate of continued smoking and poor control of smoking. Prompt and effective measures should be taken to enhance the education to the people, especially young patients to minimize the gap between clinical practice and evidence-based guidelines.