药物联合微信平台在慢性阻塞性肺病患者戒烟中的疗效评价

Assessment of efficacy of medication combined with We Chat platform for quitting smoking in patients with chronic obstructive pulmonary disease

目的探讨药物联合微信平台在慢性阻塞性肺病（COPD）患者戒烟中的疗效评价。方法选取2014年10月—2015年9月间,通过前瞻性设计以及随机选择参与戒烟干预的COPD患者共146例,最终完成全部随访的患者共120例;根据随访方式分为非药物组（n=38）、单纯药物组（n=40）和药物联合微信组（n=42）,3组患者均进行简短劝诫法干预,药物组给予酒石酸伐尼克兰治疗。分析尼古丁依赖性COPD戒烟者的临床资料,评价药物或非药物治疗的戒断成功率及其影响因素,评价指标包括1、3和6个月的7 d时点戒烟率以及持续戒烟率。结果 7 d时点戒烟率比较,第1个月药物治疗组戒断率低于非药物治疗组（χ^2=7.255 9,P=0.023）,而第3和第6个月选择药物戒烟的COPD患者戒断比例高于非药物治疗组（χ^2=15.283 7,P=0.000;χ^2=28.260 3,P=0.000）;药物联合微信组患者与单纯药物组之间差异无统计学意义（χ^2=2.235 1,P=0.125;χ^2=0.204 6,P=0.892;χ^2=0.244 1,P=0.507）。药物治疗组第3和第6个月的持续戒烟率均高于非药物治疗组（χ^2=11.214 5,P=0.004;χ^2=13.278 9,P=0.001）;药物联合微信组的第3个月持续戒烟率优于单纯药物组（χ^2=5.222 4,P=0.022）,第6个月的持续戒烟率在两组之间差异无统计学意义（χ^2=1.239 7,P=0.237）。结论对于尼古丁依赖性COPD患者药物辅助戒烟可显著提高戒断率,而微信平台随访和宣教可以有效督促戒烟过程,有助于提高药物依从性和戒断反应监测。

Objective To assess the efficacy of medication combined with WeChat platform for quitting smoking in patients with chronic obstructive pulmonary disease（COPD）.Methods A total of 146 COPD patients undergoing quitting smoking intervention were randomly selected between October 2014 and September2015 by prospective design.One hundred and twenty patients were completely followed up and were assigned to non-drug group（n=38）,drug group（n=40） and drug and WeChat group（n= 42） according to follow-up methods.All patients were intervened with brief persuasion method and the drug group was treated with varenicline tartrate.Clinical data of nicotine-dependent COPD smoking quitters were analyzed.Successful withdrawal rate of medication or non-medication and their influencing factors were assessed.Assessment indexes included 7 d point withdrawal rates and sustained withdrawal rates in the first,third and sixth months.Results he 7 d point withdrawal rate in the drug group in the first month was lower than that in the non-drug group（χ^2=7.255 9,P = 0.023）,while those in the drug group in the third and sixth months were higher than those in the non-drug group（χ^2 = 15.283 7,P = 0.000;χ^2= 28.260 3,P = 0.000）.T he differences between the drug and WeChat group and the drug group were not statistically significant（χ^2= 2.235 1,P = 0.125;χ^2= 0.204 6,P = 0.892;χ^2=0.244 1,P = 0.507）.The sustained withdrawal rates in the drug group in the third and sixth months were higher than those in the non-drug group（χ^2=11.214 5,P = 0.004;χ^2=13.278 9,P = 0.001）.The sustained withdrawal rate in the drug and WeChat group in the third month was higher than that in the drug group（χ^2=5.222 4,P = 0.022）.The difference in sustained withdrawal rate in the sixth month between two groups was not statistically significant（χ^2= 1.239 7,P = 0.237）.Conclusion For nicotine-dependent COPD patients,medication-assisted quitting smoking can significantly increase the withdrawal rate.Follow-up,propaganda and education via WeChat platform can efficiently promote the quitting smoking process and is helpful for improving the surveillance of drug adherence and withdrawal reactions.