吸烟的危害你了解多少

1、Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟的危害你了解多少吸烟的危害你了解多少 Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟的危害你了解多少？ 第三课第三课 Health model, health leader, health advocator.Health model, health leader,

2、 health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 烟草简史 40004000年前，玛雅人开始种植烟草；年前，玛雅人开始种植烟草；14921492年传年传 入欧洲社会；明朝万历年间传入中国，从入欧洲社会；明朝万历年间传入中国，从 此，烟草登堂入室，成为身份与地位的象此，烟草登堂入室，成为身份与地位的象 征，成为社交礼仪的手段，成为自我消遣征，成为社交礼仪的手段，成为自我消遣 的工具，但是的工具，但是 烟草是唯一可用作合法谋杀的

3、商品，人们按 其拟定的用途吸食，便会致死。 1994年版牛津医学手册 Health model, health leader, health advocator.Health model, health leader, health advocator. 4 Tobacco History 1492 “Discovered” by Columbus in the Americas 4 14921492年年, ,哥伦布在航海日志记载哥伦布在航海日志记载, ,西班牙人西班牙人 沿途所见沿途所见, ,男女老幼吸烟男女老幼吸烟, ,蔚然成风蔚然成风. . Health model, health le

4、ader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. Global Spread of Tobacco 5 1530: 欧洲开始种植烟草 155659: 法国、西班牙、葡萄牙和日本开始种植烟草法国、西班牙、葡萄牙和日本开始种植烟草 1604:英国国王提出反烟宣言 1858：中国容许卷烟免关税进口中国容许卷烟免关税进口 1900：

5、中国国企控制烟草业，外烟被逐出市场。 1939：吸烟与肺癌的联系首次被发现联系首次被发现 1964：美国卫生总署报告明确指出男士吸烟可以导致肺癌 1998：世界卫生组织把烟草依赖列入国际疾病分类 2003: 中国签署烟草控制框架公约中国签署烟草控制框架公约 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, heal

6、th advocator. Cultivated tobacco (Nicotiana tabacum) Wild tobacco (Nicotiana rustica) Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. Smoking Tobacco 卷烟 内含烟丝，或经过加工

7、 并混入数百种化学物的烟草。 通常附上过滤嘴。 世界上96%的制造烟草产品为卷烟。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. US Centers for Disease Control, Office on Smoking and Health 比地草烟 在印度广泛流行

8、 在烟草市场中号称自然的烟草 有一系列香味能够掩盖原有的味道 没有过滤嘴，导致焦油和尼古丁的较高含 量 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 丁香烟 产于印度尼西亚 在市场上被称为年轻人潮流和奢侈的象征 含有多种丁香酚和香料，具有麻醉力，可 以深深吸进肺部 Healt

9、h model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. Pan American Health Organization 雪茄 用烟叶卷起风干发酵的烟草制成 与一般的卷烟相比放出更多的 CO 从上个世纪九十年代开始， 学家开始风靡全球。 Health model, health leader,

10、health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 无烟烟草 咀嚼烟草 烟叶中添加了甜味剂和调味剂。包括口嚼烟，散 烟叶和烟卷。或称槟榔烟，是将烟草和槟榔和 植物碱卷在槟榔叶中。嚼烟在印度和东南亚国 家最为流行 鼻烟 分为干烟和湿烟。用口 吸食或者 用鼻吸入 RM Davis, M.D. Health model, health lead

11、er, health advocator.Health model, health leader, health advocator. 目前全世界每天有目前全世界每天有1300013000多人死于烟草。多人死于烟草。 按照该速度计算，从按照该速度计算，从20002000年到年到20302030年吸烟者将从年吸烟者将从 1212亿上升到亿上升到1616亿，每年死于烟草的人数将从亿，每年死于烟草的人数将从490490万上万上 升到升到10001000万；万； 烟草使青少年期开始吸烟的吸烟者中半数死亡，烟草使青少年期开始吸烟的吸烟者中半数死亡， 而这些死亡者中的半数在中年丧生而这些死亡者中的半数在中

12、年丧生 吸烟的流行病学吸烟的流行病学 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 中国世界上最大的烟草大国 我国有3.5亿吸烟者。每年中国死于烟草的 人数100万！ 超过因艾滋病、结核、交通事故以及自杀 的死亡人数总和，占总死亡数的12%。 Health model, he

13、alth leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 在不吸烟者中，51.9%不吸烟者受到烟草危害。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, h

14、ealth leader, health advocator.Health model, health leader, health advocator. 认 识 卷 烟 烟草的成份 卷烟中含卷烟中含 4000 4000 多种化学物质到多种化学物质到20002000年为止烟年为止烟 草中共发现草中共发现6969种致癌物，其中有种致癌物，其中有1111种已经被国际肿种已经被国际肿 瘤研究机构瘤研究机构( IARC)( IARC)定为定为类致癌物。类致癌物。 Health model, health leader, health advocator.Health model, health lea

15、der, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 焦 油 引起肺癌的主要毒性物质，含有大量 的多环芳烃。 单位时间内吸烟的次数越多，焦油生 成量越大：每分钟吸3次的焦油量比每分钟 吸一次多一倍。 越燃近末端，焦油的生成量越高。前 半截和后半截焦油生成比为1：1.4 Health model, health leader, health advocator.Health model, health leader, he

16、alth advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 低焦油香烟安全吗？ 并非如此。 吸烟者可能改变他们的吸入方式。 更深地，更频繁地吸入； 可能会增加每天的吸烟量； - 机器对烟焦油的测定和吸烟者的吸入有所不同。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, healt

17、h leader, health advocator.Health model, health leader, health advocator. 机器对于烟焦油的测定 People dont smoke like machines Air dilution through filter vent holes reduces machine smoked mainstream deliveries. Location of Filter vent holes Finger or lip blockage increases mainstream smoke deliveries(1). Air

18、 dilution may result in larger or more frequent puffs(2) increasing delivery(3). 1.Kozlowski LT, Rickert WS, Pope MA, Robinson JC, Frecker RC (1982) British Journal of Addiction 77, 159-165. 2.Kozlowski LT, OConnor RJ (2002), Tobacco Control, 11, i40-i50. 3.Kozlowski LT, Sweeney CT, Pillitteri, JL (

19、1996) Experimental and Clinical Psychoparmacology, 4, 404-408. Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 烟草的成瘾性 人的大脑中存在着尼古丁的受体。随 着所接受的尼古丁的增多，尼古丁受体的 密度也相应增加。

20、尼古丁代谢速度较快的人比代谢速度 慢的人更容易成瘾。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 烟草的成瘾性 美国医生协会的报告指出： 1）烟草以及其他所有形式的烟草具有成 瘾性； 2）尼古丁是导致成瘾性的主要来源； 3）吸烟成瘾的药理学和其行为特点与海 洛因和可卡因类似

21、。 尼古丁已被公认为是强烈的成瘾性物质。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 烟草的成瘾性 尼古丁和受体结合后，可以导致大脑犒赏中枢 等释放多巴胺等多种物质。刺激愉悦中心，调节 焦虑情绪。 不断重复摄入某一剂量的尼古丁，愉悦反应会 逐渐弱化（药物的耐受），而增加剂量

22、后可以使 这些反应达到某一水平。 停用时出现戒断反应，包括生理上的不快和情 绪症状。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 尼古丁戒断症状 渴望 易怒 挫败感或者愤怒 焦虑 难以集中精力 心律减慢 睡眠紊乱 食欲增大或者体重增加 Source: J Henningfi

23、eld Hungry nicotine receptors Health model, health leader, health advocator.Health model, health leader, health advocator. 判定尼古丁依赖的Fagerstrm量表 问题问题答案答案得分得分 你早上醒来后多长时间开始吸第一支烟你早上醒来后多长时间开始吸第一支烟? ?小于小于5 5分分 6-306-30 3 3 2 2 你觉得在禁止吸烟的地方不吸烟困难吗，比如在教堂、图你觉得在禁止吸烟的地方不吸烟困难吗，比如在教堂、图 书馆、电影院等书馆、电影院等? ? 是是/ /否否1/01

24、/0 哪支烟是你最不想放弃的哪支烟是你最不想放弃的? ?第第1 1支支 其他其他 1 1 0 0 你每天吸多少支烟你每天吸多少支烟? ?103030 0 0 1 1 2 2 3 3 你早上醒来后的那段时间比其他时间吸烟多吗你早上醒来后的那段时间比其他时间吸烟多吗? ?是是/ /否否1/01/0 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model,

25、health leader, health advocator. 一氧化碳 血液中COHb（碳氧血红蛋白）浓度升高， 影响输氧功能及心血管系统，促进胆固醇 储量增多，加速动脉粥样硬化 与尼古丁协同作用，升高血压，增加心率 增加了冠心病和脑卒中发生机率 环境烟雾 Environmental tobacco smoke (ETS) 主流烟雾: 由吸烟者吸烟所呼出的烟 侧流烟雾：烟草直接燃烧所产生的侧 流烟雾要占吸烟者所产生烟雾的 85%，含有 比主流烟雾更大危险性的气体： CO浓度较主流烟雾高 5倍 焦油、尼古丁 3倍 苯并芘 4倍 胺 46倍 Health model, health leade

26、r, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟与疾病 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocat

27、or.Health model, health leader, health advocator. 2004年美国摘自美国外科医生报告 的主要结论 吸烟几乎伤害全身的每一个组织 戒烟既有即时的也有长期的益处，降低 患病风险，改善健康状态。 吸焦油和尼古丁低的烟草对健康没有任 何明显的益处 与吸烟有关疾病的新发现： 主动脉瘤，白血病，白内障，子宫颈 癌，胰腺癌，肾癌，胃癌，牙周炎 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, hea

28、lth leader, health advocator.Health model, health leader, health advocator. Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 我国100万死亡人群回顾性调查和25万人前瞻 性调查，吸烟致死中： COPD占

29、45%； 肺癌占15%； 食管癌、胃癌、肝癌、脑卒中、CHD、肺结 核各占5-8%。 Health model, health leader, health advocator.Health model, health leader, health advocator. Marlboro Cowboy Deadage 51 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator

30、.Health model, health leader, health advocator. Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟与心脑血管疾病 前瞻性研究: 观察2000万人年 吸烟者缺血性心 脏病发病率和冠心 病死亡率超过不吸烟 者70 。 Health

31、model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟者死于冠心病的相对危险（RR） 年龄 非吸烟组 吸烟者每日吸烟量（支） 10 10-19 20-29 30以上 45- 1.0 2.4 3.1 3.1 3.4 55- 1.0 1.5 1.9 2.0 2.1 65- 1.0 1.3 1.6

32、1.6 / 75-84 1.0 1.2 1.4 1.1 / 吸烟增加整个年龄段冠心病和缺血性脑卒 中的危险，但年轻人的危险更大。 Health model, health leader, health advocator.Health model, health leader, health advocator. Framingham26 Framingham26年的随访研究证实：年的随访研究证实： 吸烟是脑卒中的重要危险因素。吸烟是脑卒中的重要危险因素。 戒烟后中风的危险下降，戒烟五年后中风的危险戒烟后中风的危险下降，戒烟五年后中风的危险 等于不吸烟者。等于不吸烟者。 Health mode

33、l, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟与呼吸道疾患 吸烟与肺气肿 因为，吸烟者肺部抗弹性硬蛋 白酶下降，能导致肺气肿的弹性硬蛋白酶增加， 致引起肺气肿的主要成因，由于长期烟雾刺激可 导致呼吸道功能受损 吸烟与肺功能 吸烟是慢性阻塞性肺部疾患 表现肺功能下降，如FEV1.0下降,当下降到

34、一定 程度，可导致气喘和不能多活动。 Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟对妇女、子代的危害 尼古丁 能使胎盘血管收缩、子宫血液 量减少，导致低体重儿童、早产、滞产和围产 期死亡 。 抑制性激素分泌，提早进入绝经期，并出 现更年期综合 Health model,

35、 health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 女性衰老的重要因素：吸烟或被动吸烟女性衰老的重要因素：吸烟或被动吸烟 长期被动吸烟长期被动吸烟损伤皮肤和结缔组织损伤皮肤和结缔组织 女性皱纹增加女性皱纹增加 Health model, health leader, health advocator.Hea

36、lth model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 喉喉: 1980: 1980 食道食道: 1982: 1982 肾肾: 1982 : 1982 鼻、鼻、口腔、咽口腔、咽: 1982: 1982 冠心病冠心病: 1979: 1979 胃胃: 200: 2002 2 子宫子宫颈颈: 200: 2002 2 肝肝: 200: 2002 2 中风中风: 1983: 1983 动脉瘤

37、动脉瘤: 1983: 1983 动脉粥样硬化动脉粥样硬化: : 19831983 肺肺: 1964: 1964 慢性阻塞性肺病慢性阻塞性肺病: : 19641964 膀胱膀胱: 1990: 1990 胰腺胰腺: 1990: 1990 白血病白血病: 2002: 2002 输输尿管尿管: 1990: 1990 最新的科学证据：主动吸烟 /tobacco/sgr/sgr_2004 白内障白内障: 2004: 2004 健康损害健康损害: 2004 Health model, health leader, health advocator.Health model,

38、 health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health

39、advocator. Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. Health model, health leader, health advocator.Health model, health leader, health advocator.Health model

40、, health leader, health advocator.Health model, health leader, health advocator. Health model, health leader, health advocator.Health model, health leader, health advocator. Brazil (2004) Health model, health leader, health advocator.Health model, health leader, health advocator. Singapore (2006) He

41、alth model, health leader, health advocator.Health model, health leader, health advocator. Thailand Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 吸烟危害 Health mod

42、el, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator.Health model, health leader, health advocator. 当您停止吸烟的那一刻起，您会发现. . 20分钟后，血压、脉搏降至正常；手和脚的温度 将恢复如常； 8小时后，血液中的一氧化碳含量将降至正常；血 氧含量恢复如常； 48小时后，嗅觉、味觉将有很大改善； 2-12周后，循环系统得到改善，呼吸得到改善， 行走变得更轻松； Health model, health leader, health advocator.Health model, health leader, health advoca