护理宣教对急性心肌梗死女性吸烟患者戒烟成功及预后的影响
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摘要
目的:探讨院内护理宣教对我国急性心肌梗死患者中女性吸烟患者戒烟效果及临床预后的影响。方法:纳入并分析了自2015年1月至2017年1月,就诊于我院心内科患有急性心肌梗死的女性患者2 619例。按照患者吸烟状态将人群分为两组:吸烟组(入院时仍然吸烟者和已戒烟者)及非吸烟组(从未吸烟者)。比较两组患者基线资料。吸烟患者随机分为"干预组"和"对照组",分别接受"5 A"戒烟干预方案和常规护理。观察戒烟成功率并比较1年后戒烟成功的患者与戒烟未成功患者的预后。结果:在患有急性心肌梗死的女性患者中,吸烟者共计414(15.8%)例。相比于非吸烟者,吸烟者更年轻(66.2vs.70.3)岁,两组有高血压者(241vs.1 095;58.2%vs. 49.7%)、糖尿病(103 vs. 331;24.9%vs. 15.0%)、心力衰竭病史(18vs. 55;4.3%vs. 2.5%)比例更高。经戒烟护理宣教后随访1年,有161例(38.9%)戒烟成功。相比于未戒烟者,戒烟成功患者全因死亡率(4.3%vs. 8.1%)及再住院率(3.1%vs. 11.9%)更低。结论:在女性急性心肌梗死人群中,与非吸烟者相比,吸烟者合并其他心血管疾病危险因素比例更高。戒烟护理宣教对患者戒烟有着重要意义,对改善预后有着重要价值。
Objective: To investigate the effect of nursing education on quitting smoking and clinical outcomes among female patients with acute myocardial infarction(AMI). Methods: The study included 2619 female patients with AMI from January 2015 to January 2017. Patients were divided into two groups according to smoking status: smokers(current smokers and ex-smokers) and non-smokers(patients who never smoke). Patient characteristics were compared between these two groups. Smokers were randomly assigned to "intervention group" and "control group", and received "5 A" smoking cessation intervention and routine care respectively. Rate of successful quitting were assessed and clinical outcomes were compared between patients who quit smoking and who continue to smoke. Results: There were 414(15.8%) smokers among female patients with AMI. Compared with non-smokers, smokers were younger(66.2 vs. 70.3 years), and more often had hypertension(241 vs. 1 095)(58.2% vs. 49.7%), diabetes(103 vs. 331)(24.9% vs. 15.0%), heart failure(18 vs. 55)(4.3% vs. 2.5%). At one-year follow-up, 161(38.9%) patients successfully quitted smoking. Compared with patients who continue to smoke, successful quitters had lower all-cause mortality(13 vs. 26)(4.3% vs. 8.1%) and re-admission rate(5 vs. 30)(3.1% vs. 11.9%). Conclusions: Among female patients with AMI, smokers more often had more cardiovascular risk factors than non-smokers. Smoking cessation intervention is of great clinical significance and has the potential to improve patients' outcome.
Objective: To investigate the effect of nursing education on quitting smoking and clinical outcomes among female patients with acute myocardial infarction(AMI). Methods: The study included 2619 female patients with AMI from January 2015 to January 2017. Patients were divided into two groups according to smoking status: smokers(current smokers and ex-smokers) and non-smokers(patients who never smoke). Patient characteristics were compared between these two groups. Smokers were randomly assigned to "intervention group" and "control group", and received "5 A" smoking cessation intervention and routine care respectively. Rate of successful quitting were assessed and clinical outcomes were compared between patients who quit smoking and who continue to smoke. Results: There were 414(15.8%) smokers among female patients with AMI. Compared with non-smokers, smokers were younger(66.2 vs. 70.3 years), and more often had hypertension(241 vs. 1 095)(58.2% vs. 49.7%), diabetes(103 vs. 331)(24.9% vs. 15.0%), heart failure(18 vs. 55)(4.3% vs. 2.5%). At one-year follow-up, 161(38.9%) patients successfully quitted smoking. Compared with patients who continue to smoke, successful quitters had lower all-cause mortality(13 vs. 26)(4.3% vs. 8.1%) and re-admission rate(5 vs. 30)(3.1% vs. 11.9%). Conclusions: Among female patients with AMI, smokers more often had more cardiovascular risk factors than non-smokers. Smoking cessation intervention is of great clinical significance and has the potential to improve patients' outcome.
引文
[1] 马丽媛,吴亚哲,王文,等.《中国心血管病报告2017》要点解读[J].中国心血管杂志,2018(1):3-6.
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[4] Thygesen K,Alpert J S,Jaffe A S,et al.Third universal definition of myocardial infarction[J].Eur Heart J,2012,55(3):2506-2507.
[5] 马丽媛,吴亚哲,王文,等.《中国心血管病报告2017》要点解读[J].中国心血管杂志,2018(1):3-6.
[6] 2015中国成人烟草调查报告.中国疾病预防控制中心.梁晓峰主编.北京:人民卫生出版社,2015.
[7] Thorndike AN,Rigotti NA,Stafford R S,et al.National patterns in the treatment of smokers by physicians[J].JAMA,1998,279(8):604-608.
[8] 中华人民共和国国家卫生和计划生育委员会.中国临床戒烟指南(2015年版)[J].中华健康管理学杂志,2016,10(2):88-95.
[9] Simmons VN,Litvin EB,Unrod M,et al.Oncology healthcare providers‘ implementation of the 5A’s model of brief intervention for smoking cessation:patients’ perceptions[J].Patient Educ Couns,2012,86(3):414-419.
[10] Ambrose JA,Barua RS.The pathophysiology of cigarette smoking and cardiovascular disease:An update[J].J Am Coll Cardiol,2004,43(10):1731-1737.
[11] Bucholz EM,Beckman AL,Kiefe CI,et al.Smoking status and life expectancy after acute myocardial infarction in the elderly[J].Heart,2015,102(2):133.
[2] 2015中国成人烟草调查报告.中国疾病预防控制中心.梁晓峰主编.北京:人民卫生出版社,2015.
[3] Pagidipati NJ,Peterson ED.Acute coronary syndromes in women and men[J].Nat Rev Cardiol,2016.
[4] Thygesen K,Alpert J S,Jaffe A S,et al.Third universal definition of myocardial infarction[J].Eur Heart J,2012,55(3):2506-2507.
[5] 马丽媛,吴亚哲,王文,等.《中国心血管病报告2017》要点解读[J].中国心血管杂志,2018(1):3-6.
[6] 2015中国成人烟草调查报告.中国疾病预防控制中心.梁晓峰主编.北京:人民卫生出版社,2015.
[7] Thorndike AN,Rigotti NA,Stafford R S,et al.National patterns in the treatment of smokers by physicians[J].JAMA,1998,279(8):604-608.
[8] 中华人民共和国国家卫生和计划生育委员会.中国临床戒烟指南(2015年版)[J].中华健康管理学杂志,2016,10(2):88-95.
[9] Simmons VN,Litvin EB,Unrod M,et al.Oncology healthcare providers‘ implementation of the 5A’s model of brief intervention for smoking cessation:patients’ perceptions[J].Patient Educ Couns,2012,86(3):414-419.
[10] Ambrose JA,Barua RS.The pathophysiology of cigarette smoking and cardiovascular disease:An update[J].J Am Coll Cardiol,2004,43(10):1731-1737.
[11] Bucholz EM,Beckman AL,Kiefe CI,et al.Smoking status and life expectancy after acute myocardial infarction in the elderly[J].Heart,2015,102(2):133.