哮喘联盟

   摘要
   背景：关于主动吸烟对冠状动脉旁路移植术（CABG）术后结局是否存在有害影响尚有争议，戒烟计划也常常推迟到术后进行。本研究旨在探索戒烟对术后结局的潜在好处。
   方法：我们对在某单个机构进行了CABG的大量患者进行回顾性分析。采用广义提高回归模型判断吸烟类别的多项倾向得分，对所有感兴趣的结果计算治疗对患者的平均影响。
   结果：研究共纳入6113例首次接受单独CABG的患者。基线时，共有640例（10.4%）目前吸烟者，3309例（54.1%）曾吸烟者和2164例（35.3%）不吸烟者。多层倾向得分加权分析显示相比目前吸烟，戒烟存在有利影响，目前吸烟可增加所有主要肺并发症（比值比[OR]，1.54；95%可信区间[CI]，1.13-2.10，P = .006），包括重插管（OR，1.95；95% CI，1.17-3.25；P = .01）、完全气道造口术（OR，3.04；95% CI，1.49-6.18；P = .002）、肺感染/实变（OR, 1.44；95% CI，1.02-2.02；P = .03）。尽管戒烟不能显著改善这些结果，戒烟与院内死亡风险降低趋势有关，但趋势仍不明显。
   结论：本研究显示CAGB前戒烟可降低严重肺部并发症风险。目前发现表明戒烟计划不应推迟到手术后才开始。
 

（刘国梁 审校）
J Thorac Cardiovasc Surg. 2013 Nov 1. pii: S0022-5223(13)01139-2. doi: 10.1016/j.jtcvs.2013.09.042. [Epub ahead of print]

 

Smoking cessation before coronary artery bypass grafting improves operative outcomes.
 

Benedetto U, Albanese A, Kattach H, Ruggiero D, De Robertis F, Amrani M, Raja SG; on behalf of the Harefield Cardiac Outcomes Research Group.
 

Abstract
BACKGROUND: The detrimental effect of active smoking on operative outcome after coronary artery bypass grafting (CABG) is still debated and smoking cessation programs are usually deferred until after surgery. The potential benefit from smoking cessation on postoperative outcomes is investigated in this study.
METHODS: A retrospective analysis on a large cohort of patients who underwent CABG at a single institution was performed. Generalized boosted regression modeling was used to estimate the multinominal propensity scores for smoking status categories and the average treatment effect on the treated was calculated for all outcomes of interest.
RESULTS: A total of 6113 patients who underwent isolated CABG for the first time were included. At baseline, there were 640 (10.4%) current smokers, 3309 (54.1%) ex-smokers, and 2164 (35.3%) nonsmokers. Multilevel propensity score weighted analysis showed a beneficial effect of smoking cessation compared with current smoking, which increased the risk for all major pulmonary complications (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.13-2.10; P = .006), including reintubation (OR, 1.95; 95% CI, 1.17-3.25; P = .01), full tracheostomy (OR, 3.04; 95% CI, 1.49-6.18; P = .002), lung infection/consolidation (OR, 1.44; 95% CI, 1.02-2.02; P = .03). Although smoking cessation did not significantly improve other outcomes, it was associated with a nonsignificant trend toward a decreased risk for in-hospital mortality (OR, 1.83; 95% CI, 0.85-3.91; P = .1).
CONCLUSIONS: This study showed that smoking cessation before CABG reduced the risk of serious pulmonary complications. The present findings indicate that embarking on a smoking cessation program should not be deferred until after surgery.
 

J Thorac Cardiovasc Surg. 2013 Nov 1. pii: S0022-5223(13)01139-2. doi: 10.1016/j.jtcvs.2013.09.042. [Epub ahead of print]