臺灣博碩士論文加值系統

研究目的：既往研究證實吸菸是各種疾病的相關危險因子，但國內文獻針對住院吸菸病人之戒菸研究仍顯不足，因此本研究旨在探討住院吸菸病人於出院後有無藥物治療及電話衛教諮詢的持續介入是否影響戒菸成效，找出戒菸行為階段的重要預測因子，以期研究結果可供日後協助住院吸菸病人戒除菸癮之參考。

材料與方法：本研究為準實驗設計研究的單盲隨機對照試驗，於2016年1月至2017年6月在花蓮地區某醫學中心以立意取樣方式招募住院吸菸病人共63位，合併結構式問卷收集人口學資料、尼古丁成癮度、過去戒菸經驗、目前吸菸狀況、吸菸年數、每日吸菸支數、本次戒菸理由、誘引吸菸狀況及戒斷症狀的資料。利用統計軟體SPSS for Windows 22.0版進行分析，使用描述性統計及推論性統計，運用獨立樣本t檢定、卡方檢定、羅吉斯迴歸分析與費雪精確性檢定之統計方法進行分析比較相關變項因子及第1、3個月點戒菸成功率之成效。

研究結果：研究結果發現有意願戒菸者之尼古丁成癮度皆為中度成癮以上，即便已生病住院仍有77.8%的病人想吸菸，有68.25%表示在初次誘引吸菸外在因素數量高於10個（p=0.007），一個月後仍想吸菸的戒菸者在三個月後誘引吸菸內在因素數量高於一個月後不想吸菸的戒菸者有顯著關聯(p=0.033)，無人因經濟因素而產生戒菸動機。

研究結論：研究結果顯示，兩組想吸菸因素數量多寡皆與戒菸行為有顯著相關，一個月後仍想吸菸的戒菸者在三個月後誘引吸菸內在因素數量高於一個月後不想吸菸的戒菸者，戒菸者可能會因持續性的吸菸意念而導致復吸行為，故醫護人員提供定期的衛教輔導，增強個人問題解決能力相當重要。

Objectives: Smoking is a proven risk factor related to many chronic diseases. Little domestic research on smoking cessation relative to post-hospitalized smokers exists. The purpose of this study is to explore whether intervention with pharmacotherapy and telephone counseling affects smoking cessation rates among smokers after being discharged from a hospital stay. We sought to identify important factors related to smoking cessation, and expect that the results of our study will serve to improve the rates of smoking cessation among post-hospitalization patients.

Materials and methods: This study’s data was obtained at a medical center in Hualien Taiwan using a quasi-experimental design of single-blind trials. Between January 2016 and June 2017, we applied purposive sampling in randomly selecting 63 inpatient smokers. Of these, 31 were placed into the control group and 32 were assigned to receive the additional intervention. Upon completion of the study, useful data was obtained from a total of 50 patients (24 in control group; 26 in study group). Our structured questionnaire addressed factors such as: demographics, nicotine dependence, past experience in smoking cessation, current smoking status, duration of smoking, daily smoking quantity, reasons for attempting to quit, situations generating a desire to smoke, and withdrawal symptoms. The questionnaire was initially completed by 63 patients during their hospitalization, and again after a one month and a three month interval, resulting in valid data from 50 smokers. Independent-Samples T Test, Chi-square Test, logistic regression analysis, and Fisher exact test were applied using SPSS for Windows 22.0 to analyze covariant and abstinence rates.

Results: The results indicated that those who wanted to quit smoking had moderate nicotine addiction. Even when sick, 77.8% of patients still wanted to smoke. Upon entrance to our study, 68.25% of patients had more than 10 external factors affecting cessation（p=0.007）. The number of intrinsic affecting factors affecting those who still wanted to smoke one month later was higher than those who did not want to smoke, and the same was reported after three months (p=0.033). Furthermore, none of the patients reported being motivated to quit by economic reasons.

Conclusions: The results showed that the number of affecting factors in both the study group and the control group were significantly associated with smoking cessation behavior. The number of intrinsic affecting factors in those who still wanted to smoke was higher than those who did not want to smoke after one month, and was also higher after three months. Smokers who wanted to quit smoking may tend to resume smoking because of continuous smoking intention. Therefore, it is important that health care workers provide periodic assistance and improve personal problem solving ability.

目錄

中文摘要 2
Abstract 3
圖目錄 7
表目錄 8
第一章、 前言 9
第一節、研究背景與重要性 9
第二節、研究動機 12
第三節、研究目的 13
第二章、 文獻探討 14
第一節、吸菸與疾病的相關性 14
一、 國內成年人吸菸盛行率 14
二、 吸菸對健康的影響 15
第二節、住院戒菸治療現況與重要性 17
第三節、戒菸藥物治療 26
第四節、名詞定義 30
第三章、 研究方法 32
第一節、研究設計 32
第二節、研究架構 33
第三節、研究假設 37
第四節、研究對象 38
第五節、研究工具 39
第六節、資料處理與分析 42
第四章、研究結果 43
第一節、住院吸菸病人的人口學變項與生理檢查結果 45
第二節、住院吸菸病人的吸菸情形分析結果 47
第三節、持續戒菸治療與否在各變項之差異性分析 51
第四節、吸菸情形對持續戒菸治療的預測力 56
第五章、討論與建議 60
第一節、不同人口學變項與戒菸成效之相關分析 60
第二節、不同吸菸情形變項與戒菸成效之相關分析 62
第三節、戒菸治療模式與戒菸成效之相關分析 64
第六章、結論 65
參考文獻 67
附錄 76
附錄一、戒菸衛教暨個案管理紀錄表 76
附錄二、花蓮慈濟醫院研究倫理委員會研究計畫許可書 82
附錄三、臨床試驗受試者同意書 83

圖目錄
圖 1 歷年18歲以上成人吸菸率及未來目標 15
圖 2 研究步驟圖 32
圖 3 研究架構圖 33
圖 4收案流程圖 44

表目錄
表 1 一、二代戒菸服務對照表 18
表 2 住院病人使用戒菸輔助介入相關研究文獻 21
表 3 戒菸藥物之療效比較之後設分析 27
表 4 本研究使用之戒菸藥物 28
表 5 本研究中自變項之操作型定義 34
表 6 本研究中依變項之操作型定義 36
表 7 研究對象基本資料描述性分析 46
表 8 研究對象尼古丁成癮度描述性分析 49
表 9 研究對象人口學資料之卡方檢定分析結果 52
表 10 研究對象吸菸情形之卡方檢定分析結果 53
表 11 戒菸治療模式與追蹤情形之卡方檢定分析結 55
表 12 第一個月戒菸成功在吸菸情形差異比較之羅吉斯迴歸模式分析 57
表 13 戒菸治療模式與追蹤後是否有吸菸想法之獨立樣本Ｔ檢定 58
表 14 第一個月戒菸者與想吸菸因素數量之獨立樣本Ｔ檢定 59

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