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1、Adapted from Picciotto et al. Nicotine Tob Res. 1999;1:S121-S125.DDDDD 包含nAChR 的2 亚单位- 尼古丁- 多巴胺脑腹侧被盖区脑腹侧被盖区伏核伏核轴轴突突D奖赏奖赏效效应应Adinoff. Harv Rev Psychiatry. 2004;12:305-320. http:/ Accessed May 1, 2007.OHOHNH2多巴胺多巴胺Adapted from Picciotto et al. Nicotine Tob Res. 1999;1:S121-S125; Corringer et al. J Phy
2、s Paris. 2006;99:162-171.DDDDDDDDDD脑腹侧被盖区脑腹侧被盖区伏核伏核轴轴突突奖赏奖赏效效应应D 包含 nAChR 的2 亚单位- 尼古丁- 多巴胺Jarvis MJ. BMJ. 2004; 328:277-279. 2. Picciotto MR, et al. Nicotine and Tob Res. 1999: Suppl 2:S121-S125.Caggiula et al. Physiol Behav. 2002;77:683-687.尼古丁戒断 Philip Morris. Internal presentation. 1984, 20th Mar
3、ch; Kenny et al. Pharmacol Biochem Behav. 2001;70:531-549.坐立不安或性急坐立不安或性急(10周)焦虑焦虑(可能随着戒烟加重或减轻)烦躁或抑郁情绪烦躁或抑郁情绪(4周)易怒易怒, ,受挫感或生气受挫感或生气(4周) 难集中注意力难集中注意力 (4周)失眠失眠/睡眠紊乱睡眠紊乱(4周)Diagnostic and Statistical Manual of Mental Disorders, IV-TR. Washington, DC: APA; 2006: Available at http:/. Accessed November 7,
4、 2006. West RW, et al. Fast Facts: Smoking Cessation. 1st ed. Oxford, United Kingdom. Health Press Limited. 2004.12345678910N = 40. Mean adjusted withdrawal scores are from an analysis of covariance with baseline cigarettes per day and baseline scores on the items shown as covariates. Gross et al. P
5、sychopharmacology. 1989;98:334-341.0.00.51.01.5校正后平均戒断评分校正后平均戒断评分aClasses of withdrawal syndrome are defined by groups of respondents who endorsed similar combinations of symptoms. Estimates of prevalence for different classes of withdrawal were obtained along with expected frequencies of endorsemen
6、t for each symptom of withdrawal by type.Madden et al. Addiction. 1997;92(7):889-902.心理渴望易激惹紧张不平静注意力难以集中头痛昏昏欲睡呕吐心率减缓食欲增加手抖抑郁失眠0.00.91.00.80.70.60.50.40.10.20.3轻度中度重度戒断症状尼古丁戒断症状发生概率Fiore MC, Bailey WC, Cohen SJ, et al. Clinical Practice Guideline: Treating Tobacco Use and Dependence. US Department of
7、 Health and Human Services. Public Health Service; June 2000. Available at: www.surgeongeneral.gov/tobacco/default.htm. Jarvis MJ. Why people smoke. BMJ. 2004;328:277-279.做为一个成瘾性医学问题，尼古丁成瘾需要长期临床干预，戒烟是一个反复的长期过程临床常见， 属于成瘾特性，不能完全靠个人毅力解决, 长期吸烟者凭个人努力戒断者仅 3%5%复复 吸吸戒戒 烟烟 治疗的手段常需联合药物、行为及社会环境支持等方法:应使用指南推荐药物，并按照指南完成疗程才能取得较好的疗效心理、社会、生理及环境等多种因素的介入使得戒烟是一个系统工程干干 预预