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研究發現,吸煙會增加2019冠狀病毒病患者成為重症(即需要機器輔助呼吸或深切治療)和死亡的風險 8 , 9 ,和吸煙有密切關係的慢性阻塞性肺病和心血管疾病亦是令病情惡化的重要因素 10 , 11

任何年齡戒煙均有好處

不論任何年齡,戒煙都能為健康帶來即時和長遠的裨益 12 。除了顯著降低患上與吸煙相關疾病的風險,亦有效延緩長期病患者病情惡化,以及降低死亡風險。

- 肺癌 的風險降低五成,若持續戒煙風險會進一步降低 15
- 急性骨髓性白血病、胃癌、胰腺癌、子宮頸癌、肝癌、腎癌和結腸直腸癌的風險會有不同程度的下降 14
- 患糖尿病 的風險降低至非吸煙者的水平 16
10-15年後 - 冠心病 的風險如同非吸煙者 13 戒煙的其他好處 - 戒煙被證實為唯一有效降低吸煙者罹患慢性阻塞性肺病風險的方法,也是延緩慢性阻塞性肺病患者肺功能惡化的唯一方法 14 - 在診斷患上冠心病的病人當中,復發性心肌梗塞和早逝的風險降低五成以上 15

戒煙方法有很多種,包括自行戒煙、網上戒煙程式或短訊、醫護人員簡短戒煙建議、戒煙輔導和藥物治療。這些都是實證有效的方法,不同方法配合使用及增加使用次數更可進一步提高戒煙成功率 17 。其中最有效的戒煙方式是以戒煙輔導配合藥物治療 17 , 18

雖然大部分成功戒煙者都是自行戒煙,但不使用任何輔助戒煙方法的六個月戒煙成功率一般只有百分之三至五 19 。研究顯示,醫護人員提供三分鐘或以下的戒煙建議 17 ,甚至短至一分鐘内的「極簡短戒煙建議」也能增加吸煙者戒煙的機會 21 , 22 , 23 。醫生提供簡短戒煙建議可增加戒煙成功率近七成 24 。另外,戒煙藥物能增加五成至兩倍戒煙成功率 17 。目前香港有兩大類戒煙藥物:尼古丁替代療法(包括戒煙貼、戒煙糖和戒煙香口膠)和瓦倫尼克林。單獨使用尼古丁替代療法可增加戒煙成功率近一倍,而使用瓦倫尼克林或配合使用多種尼古丁替代療法的成功率可以增加兩倍 25

醫護人員的角色

從公共衞生角度而言,向大部分吸煙者提供簡短戒煙建議,相較為一小部分吸煙者提供深入但需時的輔導,或能發揮更大成效 26 。世界衞生組織建議,所有醫護人員應利用三至五分鐘時間,以「5A」和「5R」的方法為病人提供簡短戒煙建議 27

極簡短戒煙建議 (Very Brief Advice)

透過「極簡短戒煙建議」,醫護人員可利用不足三十秒的時間詢問吸煙狀況,建議病人戒煙及提供轉介戒煙服務。「極簡短戒煙建議」已在多國廣泛使用,並證實有效鼓勵吸煙者戒煙,及促使他們使用戒煙服務 17 , 28 , 29 , 30 , 31 , 32 。醫護人員應把握每次診症機會向所有吸煙者建議戒煙。提供「極簡短戒煙建議」過程只需三十秒,當中包括三個步驟:

「極簡短戒煙建議」的三個步驟 詢問 病人有否吸煙或曾經吸煙 建議 所有吸煙者,結合輔導和藥物治療,能達到最佳的戒煙效果 無論吸煙者是否願意戒煙,均可 提議轉介 至戒煙服務 及提供資料單張 。鼓勵不接受轉介的吸煙者使用資料單張,並隨時尋求協助

醫護人員即使未掌握深入的戒煙知識,亦能利用「極簡短戒煙建議」,有效傳遞最重要的戒煙訊息 17

由於尼古丁成癮的關係,戒煙者復吸頗為常見。醫護人員在病人下次覆診時應再次詢問吸煙狀況 33 。醫護人員應對仍未戒煙的病人再次給予「極簡短戒煙建議」;而對那些已戒煙的人,則鼓勵他們不要復吸。

簡短戒煙輔導 (Brief Intervention)

醫護人員亦可以利用三至五分鐘時間向病人進行簡短戒煙輔導,並配合戒煙藥物,例如尼古丁替代療法(包括戒煙貼、戒煙糖和戒煙香口膠)或瓦倫尼克林,協助病人戒煙。醫護人員可以用5A模式 (Ask, Advise, Assess, Assist, Arrange)與準備好戒煙的病人交談並提供建議 27

  • 與戒煙者一同制定戒煙計劃,如擬定戒煙日、 鼓勵戒煙者把戒煙的決定告知家人、同事和朋友,以獲取他們的支持及鼓勵。
  • 給予解決問題的合適技巧和成功戒煙的建議,如盡量避免會引起煙癮的場合
  • 建議使用戒煙藥物和協助轉介
  • 給予相關的戒煙資訊如小冊子、戒煙熱線咭
  • 安排跟進(Arrange)
  • 與戒煙者一同制訂合適的跟進方式,如面談、電話跟進和時間
  • 對成功保持不吸煙者必須加以肯定。若病人仍偶有吸煙的情況,可提醒他把這些「疏忽」作為警惕
  • 如病人回復吸煙的習慣,應分析戒煙失敗的原因及鼓勵他重新戒煙
  • 醫療專業人員資源

    為協助醫護人員使用「極簡短戒煙建議」或「簡短戒煙輔導」,衞生署已提供網上培訓課程、使用「極簡短戒煙建議」及「簡短戒煙輔導」的流程、病人單張和轉介指南,以及詳細戒煙治療實用手冊。醫護人員可於 http://www.livetobaccofree.hk 下載這些資料,或向衞生署索取。
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