急性冠脉综合征患者采用安非他酮戒烟的效果
2011/05/10
摘要
背景：因急性冠脉综合征(ACS)住院的患者，随后出现缺血性事件的风险明显增加。然而，有超过2/3的患者在急性心肌梗死后仍然继续吸烟。盐酸安非他酮被证实可有效帮助戒烟，但有关盐酸安非他酮在ACS患者中的安全性和疗效资料有限。
方法：在一项随机对照、双盲试验中，我们比较了作为护士指导的、以医院和电话随访为基础的支持治疗中的辅助治疗，8周安非他酮缓释剂(SR)和安慰剂在ACS住院的吸烟患者中帮助戒烟的安全性和疗效。主要疗效结果是1年时的戒烟。主要安全性结果是1年时的临床事件。
结果：共计151名患者入选，除2名患者外其他患者均完成随访。安非他酮和安慰剂组在3个月时的戒断率分别为45%和44% (P =0.99)，6个月时分别为37%和42%(P = .61)，1年时分别为31%和33% (P =0.86)。多变量分析显示，住院期间的有创性操作是1年时戒断的独立预测因子（OR：4.2; 95%CI：1.22-14.19）。治疗导致的副作用是戒烟的阴性预测因子(OR, 0.23; 95% CI, 0.07-0.78)。安非他酮缓释剂治疗与临床事件增加、血压和体重指数变化无关，但与安慰剂组相比，安非他酮治疗组的眩晕发生率较高(14% vs 1.4%; P =0.005)。
结论：ACS住院患者，在接受持续、集中的护士戒烟咨询中，采用安非他酮戒烟不会增加戒断率。
（刘国梁 审校）
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome.
Planer D, Lev I, Elitzur Y, Sharon N, Ouzan E, Pugatsch T, Chasid M, Rom M, Lotan C.
Ouzan, Pugatsch, and Lotan), Department of Family Medicine (Dr Lev), and Braun School of Public Health (Mr Sharon), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Internal Medicine, Hadassah-Hebrew University Medical Centre, Mount Scopus Jerusalem, Israel (Dr Elitzur); and Hebrew University-Hadassah School of Nursing, Jerusalem (Ms Chasid and Dr Rom).
Abstract
BACKGROUND: Smokers hospitalized with acute coronary syndrome (ACS) are at high risk for subsequent ischemic events. Nevertheless, over two-thirds of patients continue to smoke after an acute myocardial infarction. Bupropion hydrochloride has proven efficacy as a smoking cessation aid, but data regarding its safety and efficacy in ACS patients are limited.
METHODS: In a double-blind, randomized controlled trial, we compared the safety and efficacy of 8 weeks of treatment with bupropion slow-release (SR) or placebo for smokers hospitalized with ACS as an adjunct to nurse-led hospital- and telephone-based support. Primary efficacy outcome was smoking abstinence at 1 year. Primary safety outcome was clinical events at 1 year.
RESULTS: A total of 151 patients were enrolled; all but 2 completed follow-up. Abstinence rates at 3 months were 45% and 44% in the bupropion SR and placebo groups, respectively (P = .99); 37% vs 42% (P = .61) at 6 months; and 31% vs 33% (P = .86) at 1 year. On multivariate analysis, an invasive procedure performed during index hospitalization was an independent predictor for smoking abstinence at 1 year (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.22-14.19). Presence of adverse effects attributed to treatment was a negative predictor for smoking cessation (OR, 0.23; 95% CI, 0.07-0.78). Treatment with bupropion SR was not associated with an increase in clinical events or change in blood pressure or body mass index, but dizziness was more common compared with placebo (14% vs 1.4%; P = .005).
CONCLUSION: In hospitalized patients with ACS who received continuous, intensive nurse counseling about smoking cessation, bupropion did not increase the rates of smoking abstinence.
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
背景：因急性冠脉综合征(ACS)住院的患者，随后出现缺血性事件的风险明显增加。然而，有超过2/3的患者在急性心肌梗死后仍然继续吸烟。盐酸安非他酮被证实可有效帮助戒烟，但有关盐酸安非他酮在ACS患者中的安全性和疗效资料有限。
方法：在一项随机对照、双盲试验中，我们比较了作为护士指导的、以医院和电话随访为基础的支持治疗中的辅助治疗，8周安非他酮缓释剂(SR)和安慰剂在ACS住院的吸烟患者中帮助戒烟的安全性和疗效。主要疗效结果是1年时的戒烟。主要安全性结果是1年时的临床事件。
结果：共计151名患者入选，除2名患者外其他患者均完成随访。安非他酮和安慰剂组在3个月时的戒断率分别为45%和44% (P =0.99)，6个月时分别为37%和42%(P = .61)，1年时分别为31%和33% (P =0.86)。多变量分析显示，住院期间的有创性操作是1年时戒断的独立预测因子（OR：4.2; 95%CI：1.22-14.19）。治疗导致的副作用是戒烟的阴性预测因子(OR, 0.23; 95% CI, 0.07-0.78)。安非他酮缓释剂治疗与临床事件增加、血压和体重指数变化无关，但与安慰剂组相比，安非他酮治疗组的眩晕发生率较高(14% vs 1.4%; P =0.005)。
结论：ACS住院患者，在接受持续、集中的护士戒烟咨询中，采用安非他酮戒烟不会增加戒断率。
（刘国梁 审校）
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome.
Planer D, Lev I, Elitzur Y, Sharon N, Ouzan E, Pugatsch T, Chasid M, Rom M, Lotan C.
Ouzan, Pugatsch, and Lotan), Department of Family Medicine (Dr Lev), and Braun School of Public Health (Mr Sharon), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Internal Medicine, Hadassah-Hebrew University Medical Centre, Mount Scopus Jerusalem, Israel (Dr Elitzur); and Hebrew University-Hadassah School of Nursing, Jerusalem (Ms Chasid and Dr Rom).
Abstract
BACKGROUND: Smokers hospitalized with acute coronary syndrome (ACS) are at high risk for subsequent ischemic events. Nevertheless, over two-thirds of patients continue to smoke after an acute myocardial infarction. Bupropion hydrochloride has proven efficacy as a smoking cessation aid, but data regarding its safety and efficacy in ACS patients are limited.
METHODS: In a double-blind, randomized controlled trial, we compared the safety and efficacy of 8 weeks of treatment with bupropion slow-release (SR) or placebo for smokers hospitalized with ACS as an adjunct to nurse-led hospital- and telephone-based support. Primary efficacy outcome was smoking abstinence at 1 year. Primary safety outcome was clinical events at 1 year.
RESULTS: A total of 151 patients were enrolled; all but 2 completed follow-up. Abstinence rates at 3 months were 45% and 44% in the bupropion SR and placebo groups, respectively (P = .99); 37% vs 42% (P = .61) at 6 months; and 31% vs 33% (P = .86) at 1 year. On multivariate analysis, an invasive procedure performed during index hospitalization was an independent predictor for smoking abstinence at 1 year (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.22-14.19). Presence of adverse effects attributed to treatment was a negative predictor for smoking cessation (OR, 0.23; 95% CI, 0.07-0.78). Treatment with bupropion SR was not associated with an increase in clinical events or change in blood pressure or body mass index, but dizziness was more common compared with placebo (14% vs 1.4%; P = .005).
CONCLUSION: In hospitalized patients with ACS who received continuous, intensive nurse counseling about smoking cessation, bupropion did not increase the rates of smoking abstinence.
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
