心血管醫(yī)生戒煙知識(shí)及策略-slide1-文庫吧
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【正文】 95％ 吸煙使冠脈介入治療后發(fā)生 Q波心梗的風(fēng)險(xiǎn)增高 aThe probability of an event (developing a disease) occurring in exposed people pared with the probability of the event in nonexposed people. Adjusted for the baseline variables significantly associated with each end point. Hasdai et al. N Engl J Med. 1997。336:755761. Q波心梗 (MI) 相對(duì)風(fēng)險(xiǎn) 可信區(qū)間 95％ 不吸煙者 戒煙者 吸煙者 吸煙增加致命性和非致命性腦卒中風(fēng)險(xiǎn) aThe probability of an event (developing a disease) occurring in exposed people pared with the probability of the event in nonexposed people. Adjusted for age, followup period, history of diabetes, hypertension, high cholesterol levels, and relative weight (in 5 categories). Colditz et al. N Engl J Med. 1988。318(15):937941. 1 . 03 . 82 . 92 . 50123456114 1524 不吸煙者 ≥25 吸煙者每日吸煙量（支） 相對(duì)風(fēng)險(xiǎn) 可信區(qū)間 95％ ? 青年、中年女性，發(fā)生腦卒中的風(fēng)險(xiǎn)可能與吸煙量相關(guān) 024681012吸煙增加出血性卒中風(fēng)險(xiǎn) aThe probability of an event (developing a disease) occurring in exposed people pared with the probability of the event in nonexposed people. Adjusted for age, exercise, alcohol consumption, body mass index, history of hypertension, and history of diabetes. Kurth et al. Stroke. 2023。34:27922795. 總出血性腦卒中 腦內(nèi)出血 蛛網(wǎng)膜下腔出血 不吸煙者 (n=20,339) 每日吸煙量少于 15支 (n=1914) 每日吸煙量多于 15支 (n=3265) 相對(duì)風(fēng)險(xiǎn) 可信區(qū)間 95％ 吸煙增加腦卒中死亡風(fēng)險(xiǎn) aTwentyyear ageadjusted mortality per 10,000 personyears for men. P.014 for trend. Hart et al. Stroke. 1999。30:19992023. 3 0 . 93 9 . 05 0 . 601020304050601524 115 ≥25 吸煙者每日吸煙量（支） 死亡率 /10000人 *年 吸煙增加外周血管疾病危險(xiǎn) ? 吸煙使發(fā)生 PVD的時(shí)間早 10年 ? 吸煙使發(fā)生 PVD的風(fēng)險(xiǎn)增加 1016倍，高于冠心病的發(fā)生風(fēng)險(xiǎn) 吸煙與下列血管疾病的風(fēng)險(xiǎn)增加有關(guān) : – 無癥狀的 PVD – 間歇性跛行 – PVD的進(jìn)展 – 因 PVD并發(fā)癥引起的截肢 – 股幗動(dòng)脈旁路失敗 – 血管手術(shù)后的死亡 Freund KM, The Framingham Study: 34 years of followup. Ann Epidemiol 1993。 3:417424 吸煙與主動(dòng)脈瘤發(fā)生有量效關(guān)系 ? 吸煙促進(jìn)主動(dòng)脈擴(kuò)張 ? 吸煙增加主動(dòng)脈瘤死亡風(fēng)險(xiǎn) Witteman JC,. Circulation 1993。 88:21562162 Wilmink TB, J Vasc Surg 1999。 30:10991105 1. CDC. Surgeon General Report 2023 2. American Cancer Society. Guide to Quitting Smoking2023 肺功能改善減少咳嗽鼻竇充血呼吸急促等 3個(gè)月 肺癌發(fā)生率是繼續(xù)吸煙者的 3050% CAD危險(xiǎn)減少 50% CAD危險(xiǎn)與正常不吸煙者相似 卒中危險(xiǎn)恢復(fù)到正常不吸煙者水平 1年 5 年 10 年 15 年 戒煙 戒煙使冠心病風(fēng)險(xiǎn)減少 aThe ratio of the odds of development of disease in exposed persons to the odds of development of disease in nonexposed persons. Adjusted for sex, region, diet, alcohol, physical activity, consumption of fruits, vegetables, and alcohol. Adapted from Teo. Lancet. 2023。368:647658. 戒煙使急性心梗風(fēng)險(xiǎn)降低 P.0001 吸煙者 13 510 1015 ?20 戒煙者 (戒煙年數(shù) ) 35 1520 4 2 1 比值比 可信區(qū)間 95％ ? 戒煙數(shù)年后，發(fā)生急性心梗的風(fēng)險(xiǎn)明顯降低 ? 與吸煙者相比，冠狀動(dòng)脈介入治療后戒煙者整體死亡風(fēng)險(xiǎn)明顯下降 生存率 (%) 100 80 60 40 20 0 0 2 3 4 5 6 7 8 9 10 11 12 時(shí)間（年） Hasdai. N Engl J Med. 1997。336(11):755761. 戒煙者 持續(xù)吸煙者 戒煙使冠狀動(dòng)脈介入治療后死亡率下降 戒煙使冠狀動(dòng)脈旁路移植術(shù)后死亡
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