探討急性冠心症患者之心臟復健參與對於戒菸成效之影響

研究背景：心血管疾病長年高居國內外主要死因，吸菸是關鍵的危險因子。急性冠心症（Acute Coronary Syndrome, ACS）患者在接受經皮冠狀動脈介入術治療（Percutaneous Coronary Intervention, PCI）後，戒菸為降低血管再阻塞風險重要的二級預防措施。然而，多數患者在出院後仍面臨高復吸率。心臟復健（Cardiac Rehabilitation, CR）透過運動訓練、生活方式調整與心理支持，被視為能有效促進健康行為並改善預後，預防疾病復發。研究目的：探討急性冠心症接受經皮冠狀動脈介入治療後之吸菸患者，參與門診心臟復健對於出院後短期與中期戒菸成功率之影響。研究方法：本研究採類實驗設計（quasi-experimental design），以方便取樣方式，於中部某醫學中心收案。研究對象為診斷為急性冠心症並接受PCI治療之吸菸患者共50名，依準實驗設計，依收案日期單雙號進行分派為對照組（n=25）與實驗組（n=25）。對照組接受常規照護與臨床戒菸衛教流程；實驗組除上述照護外，於出院返診時由復健科醫師制定個人化運動處方，並介入門診心臟復健治療。追蹤兩組個案於出院後第3個月與第6個月之戒菸成功率，並比較組間差異。研究結果：統計分析顯示，實驗組在出院後第3個月之點戒菸成功率為64%（16人），顯著高於對照組之32%（8人），達統計顯著差異（p = 0.024），95%信賴區間。至出院後6個月，實驗組之戒菸成功率達68%（17人），持續顯著優於對照組之32%（8人）（p = 0.011）仍維持顯著優勢（P < 0.05）。研究結果顯示，接受門診心臟復健介入之個案，在短期與中期的戒菸成效均優於僅接受常規戒菸衛教之個案。結論：結合門診心臟復健之二級預防整合照護模式，能有效提升急性冠心症患者出院後之中長期戒菸成效。建議臨床照護實務應將結構化心臟復健納入急性冠心症患者之常規戒菸介入計畫中，以優化疾病預後並全面提升照護品質。

Background: Cardiovascular disease remains a leading cause of mortality worldwide, with smoking serving as a critical modifiable risk factor. For patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI), smoking cessation is a vital secondary prevention measure to reduce the risk of vascular re-occlusion. However, many patients face high relapse rates following discharge. Cardiac Rehabilitation (CR), encompassing exercise training, lifestyle modification, and psychosocial support, is recognized as an effective approach to promoting healthy behaviors and improving clinical outcomes.Objectives: This study aimed to investigate the effect of participating in outpatient cardiac rehabilitation on short-term and mid-term smoking cessation success rates among patients with ACS who underwent PCI.Methods: A quasi-experimental design was employed, using convenience sampling to recruit 50 participants from a medical center in central Taiwan. Participants were assigned to either a control group (n = 25) or an experimental group (n = 25). The control group received routine care and standard clinical smoking cessation education. The experimental group received the same standard care plus personalized exercise prescriptions formulated by a physiatrist, followed by participation in an outpatient cardiac rehabilitation program. Smoking cessation success rates were tracked and compared between the two groups at 3 and 6 months post-discharge.Results: Statistical analysis revealed that the smoking cessation rate in the experimental group was 64.0% (n = 16) at 3 months post-discharge, significantly higher than the 32.0% (n = 8) observed in the control group (p = 0.024). At 6 months post-discharge, the experimental group maintained a smoking cessation rate of 68.0% (n = 17), which remained significantly superior to the 32.0% (n = 8) in the control group (p = 0.011). Findings indicate that patients receiving outpatient cardiac rehabilitation interventions demonstrated better short-term and mid-term smoking cessation outcomes compared to those receiving routine care alone.Conclusions: An integrated secondary prevention model incorporating outpatient cardiac rehabilitation can effectively improve and maintain long-term smoking cessation rates in patients with ACS. It is recommended that clinical practice should incorporate structured cardiac rehabilitation into routine smoking cessation care plans for ACS patients to optimize patient prognosis and enhance the quality of healthcare.