尼古丁替代治疗用于妊娠期戒烟
2018/01/19
摘要
参照当前澳洲临床指南，尼古丁替代治疗（NRT）被推荐用于无辅助且无法戒断的妊娠期妇女。临床医生指出在妊娠期极少处方NRT，因考虑其安全性以及对本人处方NRT的信心不足。动物研究提示尼古丁对胎儿具有毒性，尤其是对大脑和肺部发育，但人体研究尚未发现对胎儿和妊娠的影响。针对疗效和效率的真实世界研究提示妊娠期NRT可以提高戒断率。然而这一结果可能会受到当前研究NRT剂量并未不足以增加妊娠期尼古丁代谢这一事实的影响。因此，NRT治疗不足以解决戒断症状。需要进一步研究评估妊娠期高剂量NRT的安全性和有效性，尤其是应用两种形式的NRT。鉴于NRT安全性高于吸烟，临床医生应该建议所有妊娠期吸烟妇女接受NRT治疗。应就妊娠期NRT治疗制订相应的个体化治疗指南。
Nicotine replacement therapy for smoking cessation during pregnancy.
Med J Aust. 2018 Jan 15;208(1):46-51.
Bar-Zeev Y et al.
Abstract
Nicotine replacement therapy (NRT) is recommended in current Australian clinical guidelines for pregnant women who are unable to quit smoking unassisted. Clinicians report low levels of prescribing NRT during pregnancy, due to safety concerns and low levels of confidence in their ability to prescribe NRT. Animal models show that nicotine is harmful to the fetus, especially for brain and lung development, but human studies have not found any harmful effects on fetal and pregnancy outcomes. Studies of efficacy and effectiveness in the real world suggest that NRT use during pregnancy increases smoking cessation rates. These rates may be hampered by the fact that studies so far have used an NRT dose that does not adequately account for the higher nicotine metabolism during pregnancy and, therefore, does not adequately treat withdrawal symptoms. Further research is needed to assess the safety and efficacy of higher dosages of NRT in pregnancy, specifically of combination treatment using dual forms of NRT. As NRT is safer than smoking, clinicians need to offer this option to all pregnant women who smoke. A practical guide for initiating and tailoring the dose of NRT in pregnancy is suggested.
参照当前澳洲临床指南，尼古丁替代治疗（NRT）被推荐用于无辅助且无法戒断的妊娠期妇女。临床医生指出在妊娠期极少处方NRT，因考虑其安全性以及对本人处方NRT的信心不足。动物研究提示尼古丁对胎儿具有毒性，尤其是对大脑和肺部发育，但人体研究尚未发现对胎儿和妊娠的影响。针对疗效和效率的真实世界研究提示妊娠期NRT可以提高戒断率。然而这一结果可能会受到当前研究NRT剂量并未不足以增加妊娠期尼古丁代谢这一事实的影响。因此，NRT治疗不足以解决戒断症状。需要进一步研究评估妊娠期高剂量NRT的安全性和有效性，尤其是应用两种形式的NRT。鉴于NRT安全性高于吸烟，临床医生应该建议所有妊娠期吸烟妇女接受NRT治疗。应就妊娠期NRT治疗制订相应的个体化治疗指南。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Med J Aust. 2018 Jan 15;208(1):46-51.）
（Med J Aust. 2018 Jan 15;208(1):46-51.）
Nicotine replacement therapy for smoking cessation during pregnancy.
Med J Aust. 2018 Jan 15;208(1):46-51.
Bar-Zeev Y et al.
Abstract
Nicotine replacement therapy (NRT) is recommended in current Australian clinical guidelines for pregnant women who are unable to quit smoking unassisted. Clinicians report low levels of prescribing NRT during pregnancy, due to safety concerns and low levels of confidence in their ability to prescribe NRT. Animal models show that nicotine is harmful to the fetus, especially for brain and lung development, but human studies have not found any harmful effects on fetal and pregnancy outcomes. Studies of efficacy and effectiveness in the real world suggest that NRT use during pregnancy increases smoking cessation rates. These rates may be hampered by the fact that studies so far have used an NRT dose that does not adequately account for the higher nicotine metabolism during pregnancy and, therefore, does not adequately treat withdrawal symptoms. Further research is needed to assess the safety and efficacy of higher dosages of NRT in pregnancy, specifically of combination treatment using dual forms of NRT. As NRT is safer than smoking, clinicians need to offer this option to all pregnant women who smoke. A practical guide for initiating and tailoring the dose of NRT in pregnancy is suggested.
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