Assadian Afshin, Rotter Romana, Senekowitsch Christian, Assadian Ojan, Hagmüller Georg W, Kunze Michael
Department of General and Vascular Surgery, Wilhelminenspital Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2006 May;118(7-8):212-6. doi: 10.1007/s00508-006-0572-7.
Smoking is one of the most important risk factors for the development and progression of atherosclerosis. Smoking cessation is an obligatory element in the management of vascular problems and in patients scheduled for vascular interventions. The aim of this study was to assess the prevalence of patients smoking before and after vascular surgical procedures and to evaluate the requirements for inpatient programs for smoking cessation and nicotine replacement therapy.
500 patients admitted for vascular interventions were included in this prospective study. Smoking status was evaluated both objectively and subjectively. All patients underwent measurements of exhaled breath carbon monoxide to quantify nicotine dependency and all answered a standardized Fagerström questionnaire both on admission and after surgery to identify current smokers.
Of 500 vascular patients included in the study, only 70 (14 %) never had smoked, 243 (49 %) had given up smoking before admission and 161 (32 %) were current smokers. Of the current smokers, 64 (40 %) did not smoke during hospitalization but 97 (60 %) continued to smoke in hospital. Of these 97 patients, 78 (80 %) were men and 19 women; their mean age was 61 +/- 4 years (range 40-84). Four patients had surgery for infrarenal aortic aneurysm, 40 underwent carotid endarterectomy and 53 had peripheral arterial occlusive disease (PAD). There was no difference between abstinent patients and continuing smokers in previous cigarette consumption or Fagerström score, a predictor for long-term smoking behavior. Patients with carotid artery stenosis were significantly more abstinent while hospitalized (P = 0.006); patients with PAD, however, were more likely to continue smoking as inpatients (P = 0.004). Sixty-five percent of continuing smokers stated that they would stop smoking in hospital if counseling and nicotine replacement therapy were provided. With regard to their predominant location of atherosclerosis, patients with PAD were less willing than those with carotid stenosis to abstain from smoking while hospitalized (53 % vs 88 %, respectively; P < 0.001).
A substantial proportion of patients admitted for vascular surgery are smokers. More than half of these continue to smoke in the hospital, an environment where smoking is prohibited by law. Counseling, nicotine replacement therapy and smoking-cessation programs are urgently needed for vascular surgical inpatients.
吸烟是动脉粥样硬化发生和发展的最重要危险因素之一。戒烟是血管问题管理以及计划进行血管介入治疗的患者治疗过程中的必要环节。本研究的目的是评估血管外科手术前后患者的吸烟率，并评估住院戒烟项目和尼古丁替代疗法的需求。
本前瞻性研究纳入了500例接受血管介入治疗的患者。对吸烟状况进行了客观和主观评估。所有患者均接受呼出气体一氧化碳测量以量化尼古丁依赖程度，并且在入院时和手术后均回答了标准化的法格斯特龙问卷以确定当前吸烟者。
在纳入研究的500例血管疾病患者中，只有70例（14%）从未吸烟，243例（49%）在入院前已戒烟，161例（32%）为当前吸烟者。在当前吸烟者中，64例（40%）在住院期间不吸烟，但97例（60%）在医院继续吸烟。在这97例患者中，78例（80%）为男性，19例为女性；他们的平均年龄为61±4岁（范围40 - 84岁）。4例患者接受了肾下腹主动脉瘤手术，40例接受了颈动脉内膜切除术，53例患有外周动脉闭塞性疾病（PAD）。在既往吸烟量或法格斯特龙评分（长期吸烟行为的预测指标）方面，戒烟患者和继续吸烟者之间没有差异。颈动脉狭窄患者在住院期间显著更易戒烟（P = 0.006）；然而，PAD患者作为住院患者更有可能继续吸烟（P = 0.004）。65%的继续吸烟者表示，如果提供咨询和尼古丁替代疗法，他们会在医院戒烟。就动脉粥样硬化的主要部位而言，PAD患者在住院期间比颈动脉狭窄患者更不愿意戒烟（分别为53%和88%；P < 0.001）。
接受血管手术的患者中有相当一部分是吸烟者。其中超过一半的人在医院继续吸烟，而医院是依法禁止吸烟的环境。血管外科住院患者迫切需要咨询、尼古丁替代疗法和戒烟项目。
