复发
习惯性吸烟者很难戒烟成功。 虽然70%的吸烟者想要戒烟,40%的人每年至少尝试过1次戒烟,但是每年只有3%-4%的吸烟者成功长期戒烟。[11]Messer K, Pierce J, Zhu S-H, et al. The California Tobacco Control Program's effect on adult smokers: (1) Smoking cessation. Tob Control. 2007 Apr;16(2):85-90.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598468/http://www.ncbi.nlm.nih.gov/pubmed/17400944?tool=bestpractice.com
复吸的风险在戒烟后的前8天内最高。 由医生、诊所职员提供的主动戒烟干预或咨询服务(面对面或电话咨询),应该在预期戒烟日期之后最初的一周之前或之内启动。[86]Hughes J, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004 Jan;99(1):29-38.http://www.ncbi.nlm.nih.gov/pubmed/14678060?tool=bestpractice.com
帮助人们避免复吸的行为干预通常针对教授对抗吸烟欲望的技巧。
不幸的是,随机试验还没有表明技能训练干预有效,但研究样本量还不足够大,不能检测到相对小的效果。[87]Hajek P, Stead LF, West R, et al. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev. 2013;(8):CD003999.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003999.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23963584?tool=bestpractice.com
基于网络和电话的干预越来越普及,可帮助患者避免复吸。[81]Shahab L, McEwen A. Online support for smoking cessation: a systematic review of the literature. Addiction. 2009 Nov;104(11):1792-804.http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2009.02710.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19832783?tool=bestpractice.com[82]Taylor GMJ, Dalili MN, Semwal M, et al. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev. 2017;(4):CD007078.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007078.pub5/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28869775?tool=bestpractice.com [
]How do tailored and non-tailored internet-based interventions for smoking cessation in adults compare with active and inactive controls and with each other?https://cochranelibrary.com/cca/doi/10.1002/cca.2055/full显示答案 移动电话干预方式已被证明对为期 6 个月的戒烟结局产生了有益的影响。[83]Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016;(4):CD006611.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006611.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27060875?tool=bestpractice.com [
]Is there randomized controlled trial evidence to support the use of mobile phone-based interventions for smoking cessation?https://cochranelibrary.com/cca/doi/10.1002/cca.1368/full显示答案
复吸的应对
戒烟后复吸很普遍。 应该鼓励患者从以往的经验中学习并且再次尝试戒烟。 很多吸烟者必须做多次尝试才可以成功戒烟。 应该评估复吸时的环境,然后应该尝试新的策略、替代或额外的药物。[2]Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. May 2008 [internet publication].http://www.ncbi.nlm.nih.gov/books/NBK63952/[18]Swartz S, Hays J. Office-based intervention for tobacco dependence. Med Clin North Am. 2004 Nov;88(6):1623-41;xii-iii.http://www.ncbi.nlm.nih.gov/pubmed/15464117?tool=bestpractice.com
在一些有限的试验中,分析了延长药物使用时间的效果。
有两个试验提示,尼古丁口香糖有一定效果,延长使用安非他酮可延迟复吸的时间,但无法阻止复吸。 延长尼古丁替代治疗时间仍需进一步研究。[87]Hajek P, Stead LF, West R, et al. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev. 2013;(8):CD003999.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003999.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23963584?tool=bestpractice.com
有限的证据支持使用伐尼克兰作为预防复发的辅助药物。[48]Cahill K, Lindson-Hawley N, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2016;(5):CD006103.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006103.pub7/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27158893?tool=bestpractice.com
对于成人来讲,与标准持续时间(8周)相比,延长透皮尼古丁疗法的使用时间(24周)可增加戒烟成功率,并减少复吸率。[88]Schnoll RA, Patterson F, Wileyto EP, et al. Effectiveness of extended-duration transdermal nicotine therapy: a randomized trial. Ann Intern Med. 2010 Feb 2;152(3):144-51.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782858/http://www.ncbi.nlm.nih.gov/pubmed/20124230?tool=bestpractice.com