使用厌恶吸烟的方法来戒烟
2009/07/30
目的：
第一、明确快速吸烟和其他厌恶疗法帮助吸烟者把烟戒掉的作用。
第二、明确不同水平的厌恶刺激量效关系
检索策略：我们检索索烟草成瘾实验协作网为实验的专门登记表中各种评价厌恶疗法戒烟的研究。
入选标准：比较厌恶疗法和“非积极”办法戒烟或比较不同厌恶强度的厌恶疗法戒烟的随机实验。实验必须从治疗开始至少随访6个月。
数据收集和分析：抽取的数据来自研究人数的规模，厌恶疗法的形式，结果的测量，随机方法相同，以及完成随访的研究。主要的结果测量是戒烟的最长随访，依据作者最严格测量方法来测量。受试者失访认为是吸烟者。Meta-分析用的是固定效应模型。
主要结果：25个实验符合入选标准，12个实验是快速吸烟，9个为其他厌恶疗法。10个包括一个或更多条件允许厌恶刺激的量-效分析，厌恶疗法与对照组戒烟的OR值为：1.98 (95% CI: 1.36 - 2.90).几个因素决定对这一结果的解释要慎重：入选的实验的漏斗图是不对称的，由于阴性结果的实验的相对缺乏，大多数实验有严重的方法学问题可能会导致假阳性结果，只有一个用了生物化学确认，给出了阴性结果。其他厌恶疗法没有显示有效(OR: 1.15, 95%CI: 0.73 to 1.82)，有一个厌恶刺激水平的边界线(OR 1.66, 95% CI: 1.00 to 2.78).
结论：现有的研究还不能提供充分的证据来证明快速吸烟在戒烟的作用，或者厌恶刺激的量效关系是否存在。轻度厌恶吸烟疗法作用不明确。快速吸烟是一种未经现代严格的方法学保证去评价而获得足够证据的方法。
检索策略：我们检索索烟草成瘾实验协作网为实验的专门登记表中各种评价厌恶疗法戒烟的研究。
入选标准：比较厌恶疗法和“非积极”办法戒烟或比较不同厌恶强度的厌恶疗法戒烟的随机实验。实验必须从治疗开始至少随访6个月。
数据收集和分析：抽取的数据来自研究人数的规模，厌恶疗法的形式，结果的测量，随机方法相同，以及完成随访的研究。主要的结果测量是戒烟的最长随访，依据作者最严格测量方法来测量。受试者失访认为是吸烟者。Meta-分析用的是固定效应模型。
主要结果：25个实验符合入选标准，12个实验是快速吸烟，9个为其他厌恶疗法。10个包括一个或更多条件允许厌恶刺激的量-效分析，厌恶疗法与对照组戒烟的OR值为：1.98 (95% CI: 1.36 - 2.90).几个因素决定对这一结果的解释要慎重：入选的实验的漏斗图是不对称的，由于阴性结果的实验的相对缺乏，大多数实验有严重的方法学问题可能会导致假阳性结果，只有一个用了生物化学确认，给出了阴性结果。其他厌恶疗法没有显示有效(OR: 1.15, 95%CI: 0.73 to 1.82)，有一个厌恶刺激水平的边界线(OR 1.66, 95% CI: 1.00 to 2.78).
结论：现有的研究还不能提供充分的证据来证明快速吸烟在戒烟的作用，或者厌恶刺激的量效关系是否存在。轻度厌恶吸烟疗法作用不明确。快速吸烟是一种未经现代严格的方法学保证去评价而获得足够证据的方法。
（刘超武编译 刘国梁审校）
Cochrane Database Syst Rev. 2004;(3):CD000546
Update of: Cochrane Database Syst Rev. 2000;(2):CD000546
Aversive smoking for smoking cessation.
Hajek P, Stead LF.
Department of Human Science and Medical Ethics, St Bartholomew’s and the Royal London School of Medicine and Dentistry, Turner Street, London, UK, E1 2AD.
BACKGROUND: Aversion therapy pairs the pleasurable stimulus of smoking a cigarette with some unpleasant stimulus. The objective is to extinguish the urge to smoke.
OBJECTIVES: This review has two aims: First, to determine the efficacy of rapid smoking and other aversive methods in helping smokers to stop smoking; Second, to determine whether there is a dose-response effect on smoking cessation at different levels of aversive stimulation.
SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies which evaluated any technique of aversive smoking.
SELECTION CRITERIA: Randomized trials which compared aversion treatments with ’inactive’ procedures or which compared aversion treatments of different intensity for smoking cessation. Trials must have reported follow up of least six months from beginning of treatment.
DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the study population, the type of aversion treatment, the outcome measure, method of randomization and completeness of follow up.The outcome measure was abstinence from smoking at maximum follow up, using the strictest measure reported by the authors. Subjects lost to follow up were regarded as smokers. Where appropriate, we performed meta-analysis using a fixed effect model.
MAIN RESULTS: Twenty-five trials met the inclusion criteria. Twelve included rapid smoking and nine used other aversion methods. Ten trials included two or more conditions allowing assessment of a dose-response to aversive stimulation. The odds ratio (OR) for abstinence following rapid smoking compared to control was 1.98 (95% confidence intervals (CI): 1.36 to 2.90). Several factors suggest that this finding should be interpreted cautiously. A funnel plot of included studies was asymmetric, due to the relative absence of small studies with negative results. Most trials had a number of serious methodological problems likely to lead to spurious positive results. The only trial using biochemical validation of all self reported cessation gave a non-significant result.Other aversion methods were not shown to be effective (odds ratio 1.15, 95% confidence interval 0.73 to 1.82). There was a borderline dose-response to the level of aversive stimulation (OR 1.66, 95% CI: 1.00 to 2.78).
REVIEWERS’ CONCLUSIONS: The existing studies provide insufficient evidence to determine the efficacy of rapid smoking, or whether there is a dose-response to aversive stimulation. Milder versions of aversive smoking seem to lack specific efficacy. Rapid smoking is an unproven method with sufficient indications of promise to warrant evaluation using modern rigorous methodology.
PMID: 15266433 [PubMed - indexed for MEDLINE]
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富于表现的书写作为一种辅助疗法减轻因戒烟增加的体重
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癌症存活者的吸烟预防和戒烟干预
