Steliga Matthew A
Thoracic Surgery, Winthrop P. Rockefeller Cancer Institute, University of Arkansas, Fayetteville, Arkansas.
Semin Thorac Cardiovasc Surg. 2018 Spring;30(1):87-91. doi: 10.1053/j.semtcvs.2018.02.033. Epub 2018 Mar 7.
Tobacco use is an etiologic agent for many diseases treated by cardiac, vascular, and thoracic surgeons and contributes to increased perioperative complications and long-term risk. Smoking cessation may be challenging for patients and can be frustrating for clinicians. Lack of familiarity and pessimistic views toward cessation methods lead to underuse by physicians. Evidence-supported measures that increase chances of cessation include direct physician advice, approved pharmacotherapy, structured counseling, and a follow-up plan. Approved pharmacotherapy consists of varenicline, bupropion, or nicotine replacement therapy in the form of long-acting patches and short-acting forms of nicotine such as gum, lozenges, prescription nasal spray, or prescription inhaler. Direct physician advice is critical and strengthened when combined with more in-depth counseling from a specialist who may have more expertise and time. Integrating assessment and referral to counseling services into a clinical workflow can deliver resources in an efficient manner with the goal of providing the best available resources to all patients.
吸烟是心脏、血管和胸外科医生所治疗的许多疾病的病因，会导致围手术期并发症增加和长期风险升高。戒烟对患者来说可能具有挑战性，对临床医生而言也可能令人沮丧。对戒烟方法缺乏了解以及持悲观态度导致医生对其使用不足。有证据支持的、可增加戒烟几率的措施包括医生直接建议、获批的药物治疗、结构化咨询以及后续跟进计划。获批的药物治疗包括伐尼克兰、安非他酮，或长效贴片以及口香糖、含片、处方鼻喷雾剂或处方吸入器等短效尼古丁形式的尼古丁替代疗法。医生直接建议至关重要，若与可能更具专业知识和时间的专家进行的更深入咨询相结合，则会得到强化。将评估和转介至咨询服务纳入临床工作流程，可以高效地提供资源，目标是为所有患者提供最佳可用资源。
