冠状动脉旁路移植术后患者持续吸烟的高危因素研究

Risk factors related to persistent smoking in patients after coronary artery bypass grafting

目的探讨冠状动脉旁路移植术(CABG)后患者持续吸烟的高危因素。方法回顾性分析阜外心血管病医院2015年7月至2015年9月期间随访的CABG术后的患者临床资料。将术前吸烟的391例患者作为研究对象,中位随访时间为2.6年,按照随访时是否吸烟分为持续吸烟组和戒烟组。采用logistic多因素回归分析CABG术后患者持续吸烟的高危因素。结果391例患者中,124例(31.7%)患者仍持续吸烟(持续吸烟组),而267例(68.3%)患者术后戒烟成功(戒烟组)。和戒烟组相比,持续吸烟组年龄<60岁比例(71.0%比56.2%)、男性比例(99.2%比94.0%)、脑血管病史比例(16.1%比8.6%)、体重指数≥28 kg/㎡比例(39.5%比23.2%)和肌酐清除率(100.3比94.2 mL/min/1.73 ㎡)均显著增高(P均<0.05)。多因素回归分析表明:年龄<60岁的患者持续吸烟风险为1.92倍(OR=1.92,95%CI 1.13~3.26),脑血管病史的患者持续吸烟风险为2.05倍(OR=2.05,95%CI 1.04~4.04),体重指数≥28 kg/㎡的患者持续吸烟风险为1.92倍(OR=1.92,95%CI 1.14~3.26)。结论近三分之一CABG术后患者仍持续吸烟。针对年龄<60岁、有脑血管病史和肥胖的CABG术后患者,临床医师应加强其戒烟咨询的管理。

Objective To evaluate the persistent smoking status and related risk factors in adult patients after coronary artery bypass grafting(CABG).Methods The clinical data of patients,who underwent CABG and were followed up at Fuwai Hospital(Beijing,China)from July to September in 2015,were retrospectively analyzed.391 patients smoking before CABG were,grouped as the persistent smoking group and smoking cessation group according to self-reported smoking status at a median follow-up period of 2.6 years.Logistic regression analysis was used to evaluate the risk factors related with persistent smoking during follow-up.Results Among 391 patients,124 patients(31.7%)were persistent smoking,and 267 patients(68.3%)stopped smoking at follow-up.Compared with patients in the smoking cessation group,those in the persistent smoking group were more age less than 60 years(71.0%vs.56.2%),more male(99.2%vs.94.0%),higher prevalence of a history of stroke(16.1%vs.8.6%),more body mass index(BMI)higher than 28 kg/㎡(39.5%vs.23.2%)and higher creatinine clearance rate(100.3 vs.94.2 mL/min/1.73 ㎡)(All P<0.05).In the multivariable logistic regression analysis,age<60 years(OR=1.92,95%CI:1.13~3.26),history of stroke(OR=2.05,95%CI:1.04~4.04)and BMI≥28 kg/㎡(OR=1.92,95%CI:1.14~3.26)were positively associated with persistent smoking.Conclusions Almost one third of the patients are persistent smoking after CABG.Those patients with age<60 years,history of stroke and high BMI level should be recommended strengthening smoking cessation counseling.