促进戒烟
2012/07/05
摘要
在美国，吸烟者具有较高的患病率和死亡率。临床医生常常采用5A框架（询问、建议、评价、帮助、安排）以促进戒烟。在每次临床就诊时，每位患者需被问及烟草使用，并评价其戒烟动机。医生应该强烈建议患者戒烟，对于愿意戒烟的患者可采用动机访谈法促进戒烟。对于无戒烟动机的患者，临床接触时需强调戒烟的好处及相关知识，介绍吸烟的风险以及戒烟存在的障碍。这些信息需在每次就诊时反复强调。对于合适的患者，应该给予药物辅助戒烟，如尼古丁替代治疗、安非他酮和瓦伦尼克林。戒烟过程中的药物支持能使戒烟的成功性倍增。采用一种以上的尼古丁替代治疗和联合安非他酮可增加戒烟的有效率。然而，对于特殊人群的戒烟来说是一大挑战。尼古丁替代治疗增加了出生缺陷的风险，在妊娠期应避免使用。除不稳定性心绞痛患者或2周内有冠脉事件的患者，对于其他有心血管疾病的患者该治疗是安全的。伐尼克兰可能增加冠脉事件的风险。尼古丁替代治疗对于青少年是安全的，然而，对成人戒烟的有效性一般。在戒烟期，医生应该安排与吸烟者反复接触，以强化戒烟信息。
（陈欣 审校）
Am Fam Physician. 2012 Mar 15;85(6):591-8.
Promoting smoking cessation.
Larzelere MM, Williams DE.
Source
Louisiana State University School of Medicine, New Orleans, LA, USA.
Abstract
Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A’s framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.
Am Fam Physician. 2012 Mar 15;85(6):591-8.
在美国，吸烟者具有较高的患病率和死亡率。临床医生常常采用5A框架（询问、建议、评价、帮助、安排）以促进戒烟。在每次临床就诊时，每位患者需被问及烟草使用，并评价其戒烟动机。医生应该强烈建议患者戒烟，对于愿意戒烟的患者可采用动机访谈法促进戒烟。对于无戒烟动机的患者，临床接触时需强调戒烟的好处及相关知识，介绍吸烟的风险以及戒烟存在的障碍。这些信息需在每次就诊时反复强调。对于合适的患者，应该给予药物辅助戒烟，如尼古丁替代治疗、安非他酮和瓦伦尼克林。戒烟过程中的药物支持能使戒烟的成功性倍增。采用一种以上的尼古丁替代治疗和联合安非他酮可增加戒烟的有效率。然而，对于特殊人群的戒烟来说是一大挑战。尼古丁替代治疗增加了出生缺陷的风险，在妊娠期应避免使用。除不稳定性心绞痛患者或2周内有冠脉事件的患者，对于其他有心血管疾病的患者该治疗是安全的。伐尼克兰可能增加冠脉事件的风险。尼古丁替代治疗对于青少年是安全的，然而，对成人戒烟的有效性一般。在戒烟期，医生应该安排与吸烟者反复接触，以强化戒烟信息。
（陈欣 审校）
Am Fam Physician. 2012 Mar 15;85(6):591-8.
Promoting smoking cessation.
Larzelere MM, Williams DE.
Source
Louisiana State University School of Medicine, New Orleans, LA, USA.
Abstract
Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A’s framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.
Am Fam Physician. 2012 Mar 15;85(6):591-8.
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戒烟药物对α4β2尼古丁受体的分子作用机制：同源结合蛋白的晶体结构
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轻度吸烟的非洲裔美国人中采用安非他酮戒烟：随机对照试验
