摘要目的 评估强化门诊戒烟随访对冠心病的吸烟患者戒烟效果及临床预后的影响.方法 入选在我院心血管内科门诊就诊并确诊有冠心病的吸烟患者140例,按1∶1采用随机数字表法分为强化戒烟门诊随访组(随访组)70例和常规治疗组(常规组)70例,分别进行不同干预.于6个月后比较两组的戒烟情况、戒烟误区、心血管事件率、药物使用率、门诊医疗费用和生活质量.并在研究结束时,对该方案进行可行性分析.结果 基线时,两组患者的年龄、性别、伴发疾病、药物使用率差异均无统计学意义(P均＞0.05).随访统计时,随访组的戒烟率高于常规组[34.2％(24/70)比5.7％(4/70),P＜0.01];总心血管事件率低于常规组[21.4％(15/70)比47.1％(33/70),P＜0.01];药物使用率均高于常规组(P均＜0.05),其中降脂药[95.3％(67/70)比80.4％(56/70)]、β受体阻滞剂[82.4％(57/70)比41.3％ (28/70)]和血管紧张素转换酶抑制剂和(或)血管紧张素Ⅱ受体拮抗剂[61.4％(43/70)比34.4％(24/70)]在随访组中的高使用率表现更为明显(P＜0.01);门诊医疗费用中位数明显低于常规组(3789.3元比4984.2元,P＜0.01);参考MYO健康状况调查问卷,生活质量各项评分均明显高于常规组(P＜0.01).对两组戒烟失败原因统计发现,吸烟误区中排名前3位的是:①别人比我吸得更多,现在还健在[90.3％ (56/62)];②吸烟使人放松,消除烦恼[70.9％ (44/62)];③朋友聊天,喝酒吸烟[66.1％ (41/62)].门诊强化戒烟随访患者对该方案总体很满意率达42.8％,满意率达50.0％.结论 强化门诊戒烟随访可以明显提高冠心病吸烟患者的戒烟率、药物使用率以及生活质量,降低医疗费用.

abstractsObjective To evaluate the effects and clinical prognosis of out-patient department-based smoking cessation services for coronary heart disease (CHD) patients.Methods A total of 140 smoking patients diagnosed with coronary heart disease in our cardiovascular department were randomly divided into the intensive smoking cessation clinic follow-up group (intervention group,patients were informed on the importance and methods to quit smoking at the first visit and reminded for that at months interval for 6 months,n =70) and the conventional treatment group (control group,n =70).After 6 months,the smoking status,cardiovascular event rates,drug usage,out-patient medical costs and quality of life were compared between the two groups.Results Age,gender,concomitant diseases,drug usage were similar between the two groups at baseline (all P ＞ 0.05).After 6 months,smoking quit rate [34.2％ (24/70)vs.5.7％ (4/70),P ＜0.01],drug use rates:lipid-lowering drugs [95.3％ (67/70) vs.80.4％ (56/70)],β3 blockers [82.4％ (57/70)vs.41.3％ (28/70)],and ACEI/ARB [61.4％ (43/70)vs.34.4％ (24/70)] were significantly higher in the intervention group than in the control group,while total cardiovascular event rates [21.4％ (15/70) vs.47.1％ (33/70),P ＜ 0.01] and out-patient medical costs (3789.3 RMB vs.4984.2 RMB,P ＜0.01) were significantly lower in the intervention group than in the control group.The quality of life scores derived from MYO health survey questionnaire was significantly higher in the intervention group than in the control group (P ＜ 0.01).The top three reasons responsible for continuous smoking for all patients failed to quit smoking were:①others smoked more than me and still alive and healthy [90.3 ％ (56/62)] ; ②smoking helped me to keep relaxed and reduce trouble in daily work and life [70.9％ (44/62)]; ③smoking was essential while chatting and drinking with friends [66.1％ (41/62)].The overall satisfactory rate to this smoking cessation program was 42.8％ and the satisfactory rate was up to 50.0％ by patients.Conclusions Intensive outpatient smoking cessation follow-up program can significantly improve the smoking cessation rates,the guideline drug use rate and the quality of life while reduce medical costs for coronary heart disease patients.