术前短时间内戒烟和术后并发症：系统综述和荟萃分析
2011/05/10
摘要
目的：对有关近期戒烟和未戒烟的手术患者进行分析，为临床一线工作人员提供循证证据。有研究认为术前8周内戒烟可能不利于术后的转归。这在医疗系统中产生了很大的不确定性，因为院内患者治疗首要考虑的是就是建议患者戒烟。术前短期戒烟的吸烟者比更早期的戒烟者其术后转归差，但这主要是说近期戒烟的得益不如早期戒烟，而不是说对转归产生不良作用。
设计：采用荟萃分析，进行系统综述。
数据来源：检索2010年5月之前的英国护理指数(BNI)、Cochrane图书馆数据库、护理学和有关卫生学文献累积索引(CINAHL)、Embase、Medline和PsycINFO，对入选的文献的参考文献进行分析、检索。
研究选择：比较接受任何手术前8周内戒烟患者和持续吸烟患者术后并发症。
数据提取：两名作者单独对研究进行筛选，评价研究方法学的质量。数据输入3个单独的荟萃分析，这些荟萃分析考虑所有可获得的研究、对自我主诉的有效戒断风险偏倚较低的研究（评价可能得益）以及仅有肺部并发症的研究（评价可能风险）。结果采用随机效应模型合并，采用I2统计分析评价异质性。
结果：9项研究满足入选标准。一项研究显示，与持续吸烟相比，近期戒烟能使患者获益，未有研究显示戒烟对患者的不利影响。荟萃分析显示，对于所有研究（RR：0.78; 95%CI：0.57-1.07）、一组3项高质量评分的研究(RR, 0.57; 95% CI, 0.16-2.01)和一组4项对肺部并发症特异性评价的研究(RR, 1.18; 95% CI, 0.95-1.46)，术前8周戒烟与术后总体并发症的增加和降低无关。
结论：已有的数据显示，对术前数周戒烟可能造成临床转归恶化的担心是没有根据的。未来需要大样本的研究来进一步证实这些结果。应该告知患者尽可能早的进行戒烟，但没有证据表明，医务人员在术前任何时候不建议患者戒烟。
（刘国梁 审校）
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
Stopping Smoking Shortly Before Surgery and Postoperative Complications: A Systematic Review and Meta-analysis.
Myers K, Hajek P, Hinds C, McRobbie H.
Barts and The London School of Medicine and Dentistry, London, England.
Abstract
OBJECTIVE: To examine existing smoking studies that compare surgical patients who have recently quit smoking with those who continue to smoke to provide an evidence-based recommendation for front-line staff. Concerns have been expressed that stopping smoking within 8 weeks before surgery may be detrimental to postoperative outcomes. This has generated considerable uncertainty even in health care systems that consider smoking cessation advice in the hospital setting an important priority. Smokers who stop smoking shortly before surgery (recent quitters) have been reported to have worse surgical outcomes than early quitters, but this may indicate only that recent quitting is less beneficial than early quitting, not that it is risky.
DESIGN: Systematic review with meta-analysis.
DATA SOURCES: British Nursing Index (BNI), The Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PsycINFO to May 2010, and reference lists of included studies.
STUDY SELECTION: Studies were included that allow a comparison of postoperative complications in patients undergoing any type of surgery who stopped smoking within 8 weeks prior to surgery and those who continued to smoke.
DATA EXTRACTION: Two reviewers independently screened potential studies and assessed their methodologic quality. Data were entered into 3 separate meta-analyses that considered all available studies, studies with a low risk of bias that validated self-reported abstinence (to assess possible benefits), and studies of pulmonary complications only (to assess possible risks). Results were combined by using a random-effects model, and heterogeneity was evaluated by using the I(2) statistic.
RESULTS: Nine studies met the inclusion criteria. One found a beneficial effect of recent quitting compared with continuing smoking, and none identified any detrimental effects. In meta-analyses, quitting smoking within 8 weeks before surgery was not associated with an increase or decrease in overall postoperative complications for all available studies (relative risk [RR], 0.78; 95% confidence interval [CI], 0.57-1.07), for a group of 3 studies with high-quality scores (RR, 0.57; 95% CI, 0.16-2.01), or for a group of 4 studies that specifically evaluated pulmonary complications (RR, 1.18; 95% CI, 0.95-1.46).
CONCLUSIONS: Existing data indicate that the concern that stopping smoking only a few weeks prior to surgery might worsen clinical outcomes is unfounded. Further larger studies would be useful to arrive at a more robust conclusion. Patients should be advised to stop smoking as early as possible, but there is no evidence to suggest that health professionals should not be advising smokers to quit at any time prior to surgery.
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
目的：对有关近期戒烟和未戒烟的手术患者进行分析，为临床一线工作人员提供循证证据。有研究认为术前8周内戒烟可能不利于术后的转归。这在医疗系统中产生了很大的不确定性，因为院内患者治疗首要考虑的是就是建议患者戒烟。术前短期戒烟的吸烟者比更早期的戒烟者其术后转归差，但这主要是说近期戒烟的得益不如早期戒烟，而不是说对转归产生不良作用。
设计：采用荟萃分析，进行系统综述。
数据来源：检索2010年5月之前的英国护理指数(BNI)、Cochrane图书馆数据库、护理学和有关卫生学文献累积索引(CINAHL)、Embase、Medline和PsycINFO，对入选的文献的参考文献进行分析、检索。
研究选择：比较接受任何手术前8周内戒烟患者和持续吸烟患者术后并发症。
数据提取：两名作者单独对研究进行筛选，评价研究方法学的质量。数据输入3个单独的荟萃分析，这些荟萃分析考虑所有可获得的研究、对自我主诉的有效戒断风险偏倚较低的研究（评价可能得益）以及仅有肺部并发症的研究（评价可能风险）。结果采用随机效应模型合并，采用I2统计分析评价异质性。
结果：9项研究满足入选标准。一项研究显示，与持续吸烟相比，近期戒烟能使患者获益，未有研究显示戒烟对患者的不利影响。荟萃分析显示，对于所有研究（RR：0.78; 95%CI：0.57-1.07）、一组3项高质量评分的研究(RR, 0.57; 95% CI, 0.16-2.01)和一组4项对肺部并发症特异性评价的研究(RR, 1.18; 95% CI, 0.95-1.46)，术前8周戒烟与术后总体并发症的增加和降低无关。
结论：已有的数据显示，对术前数周戒烟可能造成临床转归恶化的担心是没有根据的。未来需要大样本的研究来进一步证实这些结果。应该告知患者尽可能早的进行戒烟，但没有证据表明，医务人员在术前任何时候不建议患者戒烟。
（刘国梁 审校）
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
Stopping Smoking Shortly Before Surgery and Postoperative Complications: A Systematic Review and Meta-analysis.
Myers K, Hajek P, Hinds C, McRobbie H.
Barts and The London School of Medicine and Dentistry, London, England.
Abstract
OBJECTIVE: To examine existing smoking studies that compare surgical patients who have recently quit smoking with those who continue to smoke to provide an evidence-based recommendation for front-line staff. Concerns have been expressed that stopping smoking within 8 weeks before surgery may be detrimental to postoperative outcomes. This has generated considerable uncertainty even in health care systems that consider smoking cessation advice in the hospital setting an important priority. Smokers who stop smoking shortly before surgery (recent quitters) have been reported to have worse surgical outcomes than early quitters, but this may indicate only that recent quitting is less beneficial than early quitting, not that it is risky.
DESIGN: Systematic review with meta-analysis.
DATA SOURCES: British Nursing Index (BNI), The Cochrane Library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PsycINFO to May 2010, and reference lists of included studies.
STUDY SELECTION: Studies were included that allow a comparison of postoperative complications in patients undergoing any type of surgery who stopped smoking within 8 weeks prior to surgery and those who continued to smoke.
DATA EXTRACTION: Two reviewers independently screened potential studies and assessed their methodologic quality. Data were entered into 3 separate meta-analyses that considered all available studies, studies with a low risk of bias that validated self-reported abstinence (to assess possible benefits), and studies of pulmonary complications only (to assess possible risks). Results were combined by using a random-effects model, and heterogeneity was evaluated by using the I(2) statistic.
RESULTS: Nine studies met the inclusion criteria. One found a beneficial effect of recent quitting compared with continuing smoking, and none identified any detrimental effects. In meta-analyses, quitting smoking within 8 weeks before surgery was not associated with an increase or decrease in overall postoperative complications for all available studies (relative risk [RR], 0.78; 95% confidence interval [CI], 0.57-1.07), for a group of 3 studies with high-quality scores (RR, 0.57; 95% CI, 0.16-2.01), or for a group of 4 studies that specifically evaluated pulmonary complications (RR, 1.18; 95% CI, 0.95-1.46).
CONCLUSIONS: Existing data indicate that the concern that stopping smoking only a few weeks prior to surgery might worsen clinical outcomes is unfounded. Further larger studies would be useful to arrive at a more robust conclusion. Patients should be advised to stop smoking as early as possible, but there is no evidence to suggest that health professionals should not be advising smokers to quit at any time prior to surgery.
Arch Intern Med. 2011 Mar 14. [Epub ahead of print]
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