男性冠心病住院病患出院後三個月成功戒菸相關因素之探討

Factors Associated With Successful Smoking Cessation in Male Patients With Coronary Artery Disease at 3 Months After Hospital Discharge

背景 冠心病患者若能戒菸，則能降低其心臟病的再發率及死亡率，然冠心病患者出院後之吸菸率仍偏高。目的 探討男性冠心病住院病患出院後三個月成功戒菸的相關因素。 方法 採相關性研究法，以方便取樣，在北部二所醫學中心的心臟病房進行收案，共165位個案，三個月 後追蹤到的個案為154位。住院期間個案填寫一份結構式問卷，內容包括：基本資料、吸菸和戒菸 史、尼古丁成癮程度、認為吸菸引起心臟病的程度、吸菸結果的重要性、自我效能和出院後戒菸的 意願；而疾病相關資料則經查詢病歷獲得。於個案出院後三個月以電話追蹤戒菸狀態，若自述已戒菸者，則以吐氣一氧化碳（carbon monoxide, CO）濃度來確認，運用多元邏輯斯迴歸分析檢測戒菸成功的預測因子。 結　果 在出院後三個月戒菸狀況，個案自述未吸菸者有57人（37.01%），以吐氣CO測試確認戒菸成功則有 48人，戒菸率為31.17%。研究發現，疾病診斷為急性冠心症候群者、住院天數較長者，及出院戒菸意願較高者，較能戒菸成功。結論／ 實務應用針對冠心症且住院男性病患，吐氣CO測試能較精確呈現戒菸狀況；針對疾病診斷為心絞痛者、住院天數較短者及出院戒菸意願較低者，醫護人員需更強調戒菸的重要性。

Background: The promising effects of smoking cessation for coronary artery disease (CAD) patients include decreased risks of subsequent clinical events and mortality. However, most CAD patients continue to smoke after being hospitalized for a cardiac event. Purpose: To explore the factors that are associated with successful smoking cessation in CAD male patients at 3 months after hospital discharge. Method: A correlational design was applied. A convenience sample (N = 165) was recruited from the cardiac wards of two medical centers in northern Taiwan and 154 of these completed the 3-month follow up. The medical charts of the participants were reviewed to obtain their disease-related factors. All of the participants finished one questionnaire during their hospital stay. This questionnaire collected data on participant demographics, smoking and quitting history, and nicotine addiction as well as the causal attribution of heart disease to smoking, importance of smoking outcomes, self-efficacy for quitting, and post-discharge intention to quit. Information on post-discharge smoking status was collected via phone calls to the participants at three-months after hospital discharge and, for participants who claimed to have not smoked since discharge, was further confirmed by measuring their expired CO (carbon monoxide) level. Multiple logistic regression analysis was used to examine the identified predictors of successful smoking cessation. Results: The 3-month self-reported rate of abstinence was 37.01% (n = 57), while the rate of abstinence as confirmed by expired CO was 31.17% (n = 48). Those with acute coronary syndrome, longer hospital stays, and higher postdischarge intention to quit were more likely to quit smoking. Conclusions / Implications for Practice: The abstinence rate as confirmed by expired CO for hospitalized male patients with CAD is more accurate than the rate obtained by self-reporting. Healthcare providers should stress the importance of smoking cessation, especially for those who have been diagnosed with angina, are hospitalized for shorter periods of time, and indicate a lower post-discharge intention to abstinence.