孕前及孕期戒烟药物治疗，我们了解多少？
2009/11/17
重要性：已知孕期吸烟会给孕妇和胎儿带来巨大的健康危害，而药物治疗能提高戒烟率，但尚需检测关于孕期药物戒烟的应用价值。
文献综述：我们对在非孕期成人中推荐作为一线戒烟的药物进行综述。此外，对动物研究中观察到的吸烟危害和药物治疗的潜在风险进行综述。并对在孕妇中进行的研究进行更详细的分析，包括（a）观察性研究，（b）短期安全性和长期非对照性研究，以及（c）随机对照临床试验（有效性和疗效研究）。
讨论：由于孕期使用药物戒烟的安全性和有效性尚未明确，因而无明确的推荐治疗方案。有效性试验显示，尼古丁替代治疗（NRT）能提高孕期戒烟率，但疗效研究并未显示出NRT相对安慰剂在戒烟疗效上的优势。样本量小和较差的治疗顺应性（剂量或治疗疗程）是导致安慰剂－对照NRT试验中无显著疗效的主要原因。然而这些试验显示，NRT并未对生育过程产生负面影响或增加胎儿出生体重。基于上述结果，以及药物治疗的潜在风险，社会心理学干预应该是吸烟孕妇戒烟的首选治疗。目前，尚需更多的研究来全面了解孕期应用不同药物进行戒烟治疗的潜在风险和可能优势。
（刘国梁 审校）
Nicotine Tob Res. 2009 Aug 28.
What do we know about the role of pharmacotherapy for smoking cessation before or during pregnancy?
Oncken CA, Kranzler HR.
Significance Given the substantial health risks of smoking during pregnancy, and the potential of pharmacotherapy to enhance quit rates, a need exists to examine the utility of pharmacotherapy for smoking cessation during pregnancy. Literature Review We briefly review the first-line medications that are recommended for smoking cessation in nonpregnant adults. Additionally, we review the toxicity of tobacco smoke and the potential risks of pharmacotherapy as evidenced by animal studies. We review in more detail studies conducted in pregnant women, including (a) observational studies, (b) short-term safety and longer term uncontrolled studies, and (c) randomized controlled clinical trials (both effectiveness and efficacy studies). Discussion Because the safety and efficacy of pharmacotherapy for smoking cessation during pregnancy have not been established, no definitive recommendations can be made on the topic. Effectiveness trials have shown that nicotine replacement therapy (NRT) enhances smoking cessation during pregnancy, but efficacy trials have not shown an advantage for NRT compared with placebo treatment. Small sample size or poor medication compliance (with either the dose or the duration of treatment) may contribute to lack of efficacy in placebo-controlled NRT trials. However, these trials showed that NRT did not adversely affect birth outcomes and increased birth weight. Based on these findings and the fact that all medications have some risk, psychosocial interventions should be the first treatment option for pregnant smokers. Additional research is needed to determine fully the risks and benefits of the various pharmacotherapies for smoking cessation during pregnancy.
Oncken CA, et al. Nicotine Tob Res. 2009 Aug 28.
文献综述：我们对在非孕期成人中推荐作为一线戒烟的药物进行综述。此外，对动物研究中观察到的吸烟危害和药物治疗的潜在风险进行综述。并对在孕妇中进行的研究进行更详细的分析，包括（a）观察性研究，（b）短期安全性和长期非对照性研究，以及（c）随机对照临床试验（有效性和疗效研究）。
讨论：由于孕期使用药物戒烟的安全性和有效性尚未明确，因而无明确的推荐治疗方案。有效性试验显示，尼古丁替代治疗（NRT）能提高孕期戒烟率，但疗效研究并未显示出NRT相对安慰剂在戒烟疗效上的优势。样本量小和较差的治疗顺应性（剂量或治疗疗程）是导致安慰剂－对照NRT试验中无显著疗效的主要原因。然而这些试验显示，NRT并未对生育过程产生负面影响或增加胎儿出生体重。基于上述结果，以及药物治疗的潜在风险，社会心理学干预应该是吸烟孕妇戒烟的首选治疗。目前，尚需更多的研究来全面了解孕期应用不同药物进行戒烟治疗的潜在风险和可能优势。
（刘国梁 审校）
Nicotine Tob Res. 2009 Aug 28.
What do we know about the role of pharmacotherapy for smoking cessation before or during pregnancy?
Oncken CA, Kranzler HR.
Significance Given the substantial health risks of smoking during pregnancy, and the potential of pharmacotherapy to enhance quit rates, a need exists to examine the utility of pharmacotherapy for smoking cessation during pregnancy. Literature Review We briefly review the first-line medications that are recommended for smoking cessation in nonpregnant adults. Additionally, we review the toxicity of tobacco smoke and the potential risks of pharmacotherapy as evidenced by animal studies. We review in more detail studies conducted in pregnant women, including (a) observational studies, (b) short-term safety and longer term uncontrolled studies, and (c) randomized controlled clinical trials (both effectiveness and efficacy studies). Discussion Because the safety and efficacy of pharmacotherapy for smoking cessation during pregnancy have not been established, no definitive recommendations can be made on the topic. Effectiveness trials have shown that nicotine replacement therapy (NRT) enhances smoking cessation during pregnancy, but efficacy trials have not shown an advantage for NRT compared with placebo treatment. Small sample size or poor medication compliance (with either the dose or the duration of treatment) may contribute to lack of efficacy in placebo-controlled NRT trials. However, these trials showed that NRT did not adversely affect birth outcomes and increased birth weight. Based on these findings and the fact that all medications have some risk, psychosocial interventions should be the first treatment option for pregnant smokers. Additional research is needed to determine fully the risks and benefits of the various pharmacotherapies for smoking cessation during pregnancy.
Oncken CA, et al. Nicotine Tob Res. 2009 Aug 28.
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公共场所禁烟能提高1年内安非他酮和戒烟咨询的戒烟效果
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伐尼克兰能减弱静脉注射尼古丁对人体产生的某些主观及生理学的影响
