心内戒烟 tang幻灯片.ppt

* * 2007版《中国临床戒烟指南》的调查数据显示（左图），吸烟可以导致多种疾病 吸烟致死的疾病中COPD（即慢性非阻塞性肺疾病）占45%，肺癌占15%，食管癌、胃癌、 肝癌、脑卒中、CHD（指冠状动脉粥样硬化心脏病）和肺结核各占5%～8%。 吸烟是许多疾病的患病危险因素，烟草几乎可以损害人体的所有器官，诸如心血管系统、呼吸系统、生殖系统、内分泌腺和皮肤等。 与吸烟相关的疾病及病变包括高血压、CHD、中风、消化性溃疡、癌症（肺、唇、口、鼻、咽、喉、食管、胃、肝、肾、膀胱、胰腺和子宫颈）、COPD、哮喘、血栓闭塞性脉管炎、阳萎、主动脉瘤、周围血管病、粒细胞性白血病、肺炎、白内障、克隆病、髋关节骨折、牙周病等。 * * 很多人会认为，烟草依赖只是一种个人习惯而已，其实，烟草依赖不只是一种个人习惯，而是一种明确界定的慢性病。 1998年世界卫生组织决议将烟草依赖作为一种疾病列入国际疾病分类(ICD-10,F17.2) ，确认烟草是目前对人类健康的最大威胁。 烟草依赖的特点是无法克制的尼古丁觅求冲动，以及强迫性地、连续地使用尼古丁，以体验其带来的欣快感和愉悦感，并避免可能产生的戒断症状，实质就是尼古丁成瘾。 * Key Point The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) classifies nicotine dependence as a mental disorder. DSM-IV-TR defines nicotine dependence as any 3 of the following symptoms occurring within a 1-year time period: Tolerance to nicotine with decreased effect and increasing dose to obtain same effect Withdrawal symptoms with cessation Persistent desire to smoke despite efforts to decrease intake Extensive time spent smoking or purchasing tobacco Postponing work, social, or recreational events in order to smoke Continuing to smoke despite health hazards. Reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. Washington, DC: American Psychiatric Association; 2000. * Key Point Nicotine stimulates dopamine release in areas of the brain that are believed to be involved in the reward and satisfaction effect associated with smoking. After inhalation, nicotine preferentially binds to nAChR located in the mesolimbic-dopamine system of the brain within seconds. Nicotine specifically activates ?4β2 nicotinic receptors in the ventral tegmental area (VTA), causing an immediate dopamine release at the nAcc. The dopamine release is believed to be a key component of the reward circuitry associated with cigarette smoking. Reference Picciotto MR, Zoli M, Changeux J-P. Use of knock-out mice to determine the molecular basis for the actions of nic