門診戒菸成功之影響因子探討

Predicting Factors of Smoking Cessation in Outpatient Smoking Cessation Clinic

10.3966/168232812017092703002

劉瑞瑤(Jui-Yao Liu)；陳曾基(Tzeng-Ji Chen)；黃信彰(Shinn-Jang Hwang)

門診戒菸 ； 尼古丁置換治療 ； 戒菸成功預測因子 ； nicotine replacement therapy ； predictive factors ； smoking cessation

台灣家庭醫學雜誌

27卷3期（2017 / 09 / 01）

146 - 153

繁體中文

目的：探討戒菸門診中，影響個案戒菸成功的各種因素，以建立預測模式。方法：研究對象為2001年至2002年至某醫學中心戒菸門診接受戒菸治療之個案，以電話追蹤其吸菸狀況。戒菸成功定義為經門診戒菸治療（包括尼古丁置換治療及行為諮商）後達到每日吸菸量為零且維持六個月以上，且於門診治療期間測試吐氣一氧化碳濃度小於或等於8 ppm者。以單變項邏輯迴歸分析戒菸治療前之各變項如性別、年齡、菸齡、每日吸菸量、尼古丁耐受問卷分數、戒菸意願，與戒菸治療期間之各變項如體重變化、尼古丁戒斷症狀、尼古丁替代療法之長短及副作用等與戒菸成功之相關性，再以逐步多變項邏輯迴歸建立預測模式。結果：共153位戒菸門診個案，平均年齡為52.7歲，男性佔90.8%，每日吸菸量平均24.1支，菸齡平均32.2年，平均就診3.1次，接受尼古丁置換治療平均3.2週。從療程開始持續戒菸至第六個月的比率為33.3%，一年的持續戒菸率為30.6%，18個月的持續戒菸率為27.8%。以逐步多變項邏輯迴歸分析發現菸齡≥40年比＜40年的調整後勝算比為3.1（95%信賴區間=1.3-7.6），治療後第一週內完全不吸菸比第一週內有吸菸者的調整後勝算比為9.7（95%信賴區間=4.1-23.3），尼古丁置換治療週數≥二週者比僅治療一週者的調整後勝算比為4.2（95%信賴區間=1.6-11.1）。結論：菸齡≥40年、戒菸治療後一週內完全不吸菸、及尼古丁置換治療週數達二週或以上者為門診戒菸成功之預測因子。

Purpose: To investigate the predictive factors of smoking cessation with nicotine replacement therapy (NRT) and behavior counseling in an outpatient smoking cessation clinic. Methods: A total of 153 smokers visiting the smoking cessation clinic hosted by the Family Medicine Department of Taipei Veterans General Hospital in 2001 and 2002 were recruited as study subjects. Each subject received behavior counseling and nicotine replacement therapy on a weekly or bi-weekly basis with the smoking status of each subject checked by telephone follow up every three months. The study examined both pre-interventional variables (gender, age, daily cigarette consumption, years of smoking, willingness to quit smoking, score of Fagerström Test for Nicotine Dependence, etc.) and post-interventional variables (abstinence status during the first two weeks, body weight change, nicotine withdrawal symptom, NRT side effect, duration of NRT, etc.) to establish a predictive model for smoking cessation by multivariate logistic regression. Results: The subjects recruited were mainly male (90.8%), with a mean age of 52.7 years, consumed an average of 24.1 cigarettes per day, and received NRT for an average of 3.2 weeks. The post-interventional persistent abstinence rates at 6, 12, 18 months were 33.3%, 30.6%, and 27.8% respectively. By the multivariate logistic regression model, the predictive factors of at least 6 months of abstinence included years of smoking ≥ 40 years (adjusted OR 3.1, 95% confidence interval [CI] 1.3-7.6), complete abstinence during the first week (adjusted OR 9.7, 95% CI 4.1- 23.3), and at least 2 weeks of nicotine replacement therapy (adjusted OR 4.2, 95% CI 1.6-11.1). Conclusion: Longer than 40 years of smoking, total abstinence during the first week of intervention, and at least 2 weeks of nicotine replacement therapy were the predictive factors for 6 months of abstinence after outpatient smoking cessation intervention in this study.

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