Rigotti N A, Munafo M R, Stead L F
Massachusetts General Hospital, General Internal Medicine Unit, S50-9, Boston, Massachusetts 02114, USA.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD001837. doi: 10.1002/14651858.CD001837.pub2.
An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Initiating smoking cessation services during hospitalisation may help more people to make and sustain a quit attempt.
To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients.
We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PSYCINFO in January 2007, and CINAHL in August 2006 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted.
Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted for psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow up of less than six months.
Two authors extracted data independently for each paper, with disagreements resolved by consensus.
Thirty-three trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (Odds Ratio (OR) 1.65, 95% confidence interval (CI) 1.44 to 1.90; 17 trials). No statistically significant benefit was found for less intensive counselling interventions. The one study that tested a single brief (<=15 minutes) in-hospital intervention did not find it to be effective (OR 1.16, 95% CI 0.80 to 1.67). Counselling of longer duration during the hospital stay was not associated with a higher quit rate (OR 1.08, 95% CI 0.89 to 1.29, eight trials). Even counselling that began in the hospital but had less than one month of supportive contact after discharge did not show significant benefit (OR 1.09, 95% CI 0.91 to 1.31, six trials). Adding nicotine replacement therapy (NRT) did not produce a statistically significant increase in cessation over what was achieved by intensive counselling alone (OR 1.47, 95% CI 0.92 to 2.35, five studies). The one study that tested the effect of adding bupropion to intensive counselling had a similar nonsignificant effect (OR 1.56, 95% CI 0.79 to 3.06). A similar pattern of results was observed in smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the odds of smoking cessation (OR 1.81, 95% CI 1.54 to 2.15, 11 trials), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period.
AUTHORS' CONCLUSIONS: High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. These interventions are effective regardless of the patient's admitting diagnosis. lnterventions of lower intensity or shorter duration have not been shown to be effective in this setting. There is insufficient direct evidence to conclude that adding NRT or bupropion to intensive counselling increases cessation rates over what is achieved by counselling alone, but the evidence of benefit for NRT has strengthened in this update and the point estimates are compatible with research in other settings showing that NRT and bupropion are effective.
住院为帮助人们戒烟提供了一个契机。个体在感到脆弱的时候可能更愿意接受帮助，并且可能发现在吸烟受到限制或禁止的环境中更容易戒烟。在住院期间启动戒烟服务可能有助于更多人尝试戒烟并维持戒烟状态。
确定针对住院患者启动的戒烟干预措施的有效性。
我们检索了Cochrane烟草成瘾组登记册，其中包括2007年1月从CENTRAL、MEDLINE、EMBASE和PSYCINFO中识别出的论文，以及2006年8月从CINAHL中识别出的论文，以查找针对住院患者戒烟干预措施的研究，使用的检索词包括（医院和患者*）或hospitali或inpatient或admission*或admitted。
对行为、药物或多成分干预措施进行的随机和半随机试验，以帮助当前吸烟者或近期戒烟者（定义为在入院前一个多月已戒烟）的住院患者戒烟。干预必须在医院开始，但可在出院后继续。我们排除了因精神障碍或药物滥用而入院患者的研究、未报告戒烟率的研究以及随访时间少于六个月的研究。
两位作者独立为每篇论文提取数据，分歧通过协商解决。
33项试验符合纳入标准。在住院期间开始并在出院后至少持续一个月进行支持性联系的强化咨询干预措施可提高出院后的戒烟率（比值比（OR）1.65，95%置信区间（CI）1.44至1.90；17项试验）。未发现强度较低的咨询干预措施有统计学上的显著益处。一项测试单次简短（<=15分钟）住院干预措施的研究未发现其有效（OR 1.16，95%CI 0.80至1.67）。住院期间持续时间较长的咨询与较高的戒烟率无关（OR 1.08，95%CI 0.89至1.29，8项试验）。即使是在医院开始但出院后支持性联系少于一个月的咨询也未显示出显著益处（OR 1.09，95%CI 0.91至1.31，6项试验）。添加尼古丁替代疗法（NRT）并未比单独的强化咨询在戒烟方面产生统计学上的显著增加（OR 1.47，95%CI 0.92至2.35，5项研究）。一项测试在强化咨询中添加安非他酮效果的研究也有类似的不显著效果（OR 1.56，95%CI 0.79至3.06）。因心血管疾病（CVD）入院的吸烟者中观察到类似的结果模式。在这个亚组中，强化干预及后续支持增加了戒烟的几率（OR 1.81，95%CI 1.54至2.15，11项试验），但强度较低的干预措施则不然。一项针对因CVD入院的吸烟者进行的强化干预（包括咨询和药物治疗）试验评估了临床和医疗保健利用终点，发现在两年的随访期内全因死亡率和住院再入院率显著降低。
在住院期间开始并包括出院后至少一个月支持性联系的高强度行为干预措施可促进住院患者戒烟。这些干预措施无论患者的入院诊断如何均有效。强度较低或持续时间较短的干预措施在这种情况下未显示出有效。没有足够的直接证据得出结论，即与单独的咨询相比，在强化咨询中添加NRT或安非他酮可提高戒烟率，但在本次更新中NRT有益的证据得到了加强，点估计与其他环境中的研究结果一致，表明NRT和安非他酮是有效的。
