吸烟和冠心病：风险和管理
2009/07/30
背景：吸烟是第一位的可以预防的致死原因，也是冠心病的重要病因。吸烟对心血管系统和冠心病危险因素的影响是广泛的。吸烟引起心血管系统的不良反应包括血压升高、冠状动脉阻力增加、氧气输送的减少、血小板聚集的增加、纤维蛋白原增加、HDL胆固醇的抑制等。戒烟可以相对迅速减少心血管发病率和死亡率，即使是在65岁以后才停止吸烟或者已经具有冠心病（包括心肌梗死）的临床表现的患者戒烟同样可以获益。
结论：当前最有效的戒烟疗法是联合行为干预戒烟和尼古丁替代治疗。在稳定性冠心病冠心病的患者中使用尼古丁替代治疗戒烟是安全、有效的。尽管冠心病的诊断和疾病的威胁是患者自发戒烟的有力刺激，许多患者在心肌梗死或者冠脉搭桥手术后仍然顽固吸烟。研究显示医生戒烟的建议、辅以护士的简短辅导以及随访可以显著增加住院的心肌梗死患者的戒烟成功率，戒烟的花费物有所值。在门诊环境中，医生的建议和咨询同样可以有效帮助冠心病患者或非患者的烟民戒烟。
结论：当前最有效的戒烟疗法是联合行为干预戒烟和尼古丁替代治疗。在稳定性冠心病冠心病的患者中使用尼古丁替代治疗戒烟是安全、有效的。尽管冠心病的诊断和疾病的威胁是患者自发戒烟的有力刺激，许多患者在心肌梗死或者冠脉搭桥手术后仍然顽固吸烟。研究显示医生戒烟的建议、辅以护士的简短辅导以及随访可以显著增加住院的心肌梗死患者的戒烟成功率，戒烟的花费物有所值。在门诊环境中，医生的建议和咨询同样可以有效帮助冠心病患者或非患者的烟民戒烟。
（张永明编译 刘国梁审校）
Cardiol Clin. 1996 Feb;14(1):51-68
Cigarette smoking and coronary heart disease: risks and management.
Rigotti NA, Pasternak RC.
General Internal Medicine Unit, Massachusetts General Hospital, Boston 02114, USA.
Tobacco smoking is the leading preventable cause of death in the United States and an important cause of CHD. The effect of smoking on the cardiovascular system and coronary risk factors is pervasive. Unfavorable effects include acute increases in blood pressure and coronary vascular resistance, reduction in oxygen delivery, enhancement of platelet aggregation, increased fibrinogen, and depression of HDL cholesterol. Smoking cessation reduces cardiovascular morbidity and mortality rates relatively rapidly, even among individuals who stop smoking only after the age of 65 or after developing the clinical manifestations of CHD including myocardial infarction. Behavioral smoking-cessation programs and nicotine-replacement therapy each have been demonstrated to be effective for the treatment of smoking. The most effective treatment currently available is to combine the two. Nicotine-replacement therapy is safe and effective in patients with stable coronary heart disease. Although the threat or diagnosis of CHD is a powerful stimulus to spontaneous smoking cessation, many smokers continue to smoke after events such as myocardial infarction or CABG surgery. Studies have demonstrated that physician advice to stop smoking, supplemented by brief counseling by a nurse and follow-up, dramatically increases the smoking-cessation rate of patients hospitalized with myocardial infarction and is highly cost effective. In the outpatient setting, physician advice and counseling is also effective in helping smokers with or without CHD to stop smoking. This article outlines a simple protocol that has been demonstrated to be effective for counseling smokers.
PMID: 9072291 [PubMed - indexed for MEDLINE]
上一篇：
日本男女人群中吸烟与成人期支气管哮喘发病的关系
下一篇：
生物学基质在评价胎儿期和儿童期环境烟草烟雾暴露中的作用
