吸烟和婴儿猝死综合征
2009/07/30
目的：
a)严格的调查吸烟和婴儿猝死综合征二者之间可能的联系的流行病学证据。
b)回顾吸烟与婴儿猝死综合征有关的病理学和生理学机理。
c)介绍与吸烟婴儿猝死综合征有关的预防。
超过60个研究应经证明母亲在怀孕期间吸烟和婴儿猝死综合征危险性的联系，关于俯卧睡姿的干预项目，与母亲吸烟相关的相对危险度干预前RR = 2.86 (95% CI = 2.77, 2.95)，干预后RR = 3.93 (95% CI = 3.78, 4.08) 。从流行病来讲，很难区分母亲主动吸烟和被动吸烟的作用。更加清楚的证据可以从暴露于烟草环境来获得，是通过调查父亲是吸烟者而母亲是非吸烟者的婴儿猝死综合征的危险性来获得的。已经有7个这样的研究完成了，校正RR值为1.49 (95% CI = 1.25, 1.77).
烟草的病理和生理的作用表明:首要作用来自母亲的吸烟是胎儿在子宫内暴露于烟雾，假如吸烟与婴儿猝死综合征存在联系，那么三分之一的婴儿猝死综合征的死亡可以通过胎儿在子宫内不暴露于母亲所吸的烟雾。
超过60个研究应经证明母亲在怀孕期间吸烟和婴儿猝死综合征危险性的联系，关于俯卧睡姿的干预项目，与母亲吸烟相关的相对危险度干预前RR = 2.86 (95% CI = 2.77, 2.95)，干预后RR = 3.93 (95% CI = 3.78, 4.08) 。从流行病来讲，很难区分母亲主动吸烟和被动吸烟的作用。更加清楚的证据可以从暴露于烟草环境来获得，是通过调查父亲是吸烟者而母亲是非吸烟者的婴儿猝死综合征的危险性来获得的。已经有7个这样的研究完成了，校正RR值为1.49 (95% CI = 1.25, 1.77).
烟草的病理和生理的作用表明:首要作用来自母亲的吸烟是胎儿在子宫内暴露于烟雾，假如吸烟与婴儿猝死综合征存在联系，那么三分之一的婴儿猝死综合征的死亡可以通过胎儿在子宫内不暴露于母亲所吸的烟雾。
（刘超武编译 刘国梁审校）
Rev Environ Health. 2006 Apr-Jun;21(2):81-103. Links
Smoking and the sudden infant death syndrome.
Mitchell EA, Milerad J.
Department of Paediatrics, University of Auckland, New Zealand. e.mitchell@auckland.ac.nz
The aims of this review are (a) to critically examine the epidemiologic evidence for a possible association between smoking and the sudden infant death syndrome (SIDS), (b) to review the pathology and postulated physiological mechanism(s) by which smoking might be causally related to SIDS, and (c) to provide recommendations for SIDS prevention in relation to tobacco smoking. Over 60 studies have examined the relation between maternal smoking during pregnancy and risk of SIDS. With regard to prone-sleep-position intervention programs, the pooled relative risk associated with maternal smoking was RR = 2.86 (95% CI = 2.77, 2.95) before and RR = 3.93 (95% CI = 3.78, 4.08) after. Epidemiologically, to distinguish the effect of active maternal smoking during pregnancy from involuntary tobacco smoking by the infants of smoking mothers is difficult. Clear evidence for environmental tobacco smoke exposure can be obtained by examining the risk of SIDS from paternal smoking when the mother is a non-smoker. Seven such studies have been carried out. The pooled unadjusted RR was 1.49 (95% CI = 1.25, 1.77). Consideration of the pathological and physiological effects of tobacco suggests that the predominant effect from maternal smoking comes from the in utero exposure of the fetus to tobacco smoke. Assuming a causal association between smoking and SIDS, about one-third of SIDS deaths might have been prevented if all fetuses had not been exposed to maternal smoking in utero.
PMID: 16898673 [PubMed - indexed for MEDLINE]
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