目的 探讨综合性戒烟干预对围手术期患者的影响.方法 将2011年10月至2012年10月广州市第十二人民医院外科住院的120例围手术期吸烟患者纳入研究,采用随机数字表法分为观察组和对照组,每组各60例,对照组采用常规干预法指导戒烟,观察组在此基础上增加5A干预法,对不愿戒烟的5例患者,采取“5R法”,并进行出院跟踪随访,评价两组患者出院后1周、1月、6月患者的吸烟量、戒烟率及呼出气一氧化碳(CO)、碳氧血红蛋白(COHb)、尿可替丁(Cotinine)浓度的改变.结果 观察组1年戒烟成功率为53.3%,对照组为8.3%,两组比较,差异有统计学意义(x2=28.45,P=0.00).观察组住院期间院内感染率为5.0%,明显低于对照组的16.7%;观察组患者出院后1周,1月,6月呼出气CO,COHb,Cofinine值均明显低于对照组[呼出气CO浓度:(8.18±3.35)/(14.98±8.43) ppm,(8.01±3.04)/(14.65 ±6.91) ppm,(7.78±3.71)/(14.49±6.13) ppm];[COHb:(1.41±0.54)%/(2.93±1.24)%,(1.39±0.67)%/(2.89±1.52)%,(1.33±0.70)%/(2.78±1.08)%];[Cotinine浓度:(17.05±4.11)/(45.38±20.81) μg/L,(15.23±4.71)/(44.69±19.23)μg/L,(15.15±5.13)/(44.64±21.47) μg/L],两组比较,差异均有统计学意义(t值分别为5.81,6.82,7.26,8.68,6.97,8.69,10.34,11.48,10.34;P<0.01).结论 对围手术期患者进行综合控烟干预能降低患者呼出气CO、血COHb及尿Cotinine浓度,降低院内感染率,提高患者戒烟成功率.
Objective To investigate the effect of comprehensive smoking cessation on pre-operative period patients' prognosis.Methods Totals of 120 cases smoking preoperative patients from 12th People' s Hospital of Guangzhou city between October 2011 and October 2012 were randomly divided into observation group and control group with each group of 60 patients.The patients in control group were given routine intervention,and the observation group given 5A interference and cognition intervention besides routine intervention.The following indexes including the patients' smoking dose,the ratio of smoking cessation succeeded,the concentration of expiratory gas carbon monoxide,the blood carboxyhemoglobin and urine cotinine were detected at the first week,first month and 6th month after the patients were discharged from the hospital.Results The smoking quit rate of observation group was higher than that of the control group (53.3% vs 8.3%),the different were statistical significant (x2 =28.45,P =0.00),and the low nosocomial infection rate was found in the observation group than the control (5.0% vs 16.7%).There was a lower concentration of the expiratory gas CO [(8.18 ±3.35) vs (14.98 ±8.43) ppm,(8.01 ±3.04) vs (14.65 ±6.91) ppm,(7.78 ±3.71) vs (14.49±6.13) ppm],COHb [(1.41 ±0.54)% vs (2.93 ±1.24) %,(1.39 ±0.67)% vs (2.89 ± 1.52) %,(1.33 ± 0.70) % vs (2.78 ± 1.08) %] and urine cotinine [(17.05 ± 4.11) vs (45.38 ±20.81) μg/L,(15.23 ±4.71) vs (44.69±19.23) μg/L,(15.15 ±5.13) vs (44.64±21.47) μ.g/L] in the observation group than those of the control group at the first week,first month and 6th month (t =5.81,6.82,7.26,8.68,6.97,8.69,10.34,11.48,10.34;P < 0.01).Conclusions Perioperative smoking cessation intervention could enhance smoking cessation quit rate,decrease the nosocomial infection rate and lower the concentration of CO,COHb,urine cotinine.