膀胱水扩张联合三联药物治疗间质性膀胱炎/膀胱疼痛综合征

Effect of bladder hydrodistention combined with the three drugs on interstitial cystitis/ bladder pain syndrome

目的探讨膀胱水扩张联合肝素+利多卡因+碳酸氢钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征患者的安全性及有效性。方法回顾性分析2014-01至2019-02武警特色医学中心泌尿外科全麻下行膀胱镜下水扩张术25例患者,采用三联药物(注射用低分子肝素钠4万U+2%利多卡因10 ml+5%碳酸氢钠10 ml与生理盐水配成50 ml溶液)膀胱灌注,每周灌注1次,共8次后改为每月1次。对比治疗前后间质性膀胱炎症状评分及间质性膀胱炎问题评分、视觉模拟疼痛评分及排尿日记,并进行疗效评估。结果在治疗后1、3、6、12个月,症状改善率分别为92%、88%、80%、60%。O’Leary-Sant症状评分、O’Leary-Sant问题评分、排尿次数、夜尿次数、疼痛评分均有改善,与治疗前比较,差异有统计学意义(P<0.01),最大膀胱容量在治疗后1、3、6个月增加,到第12个月时,最大膀胱容量缩小至治疗前水平,所有患者均未出现毒性反应及不良反应。结论膀胱水扩张联合肝素、利多卡因、碳酸氢钠膀胱灌注治疗膀胱疼痛综合征及间质性膀胱炎是安全、有效的,能明显减轻患者的临床症状。

Objective To investigate the safety and effectiveness of bladder hydrodistention combined with intravesical instillation of three drugs(heparin,lidocaine and sodium bicarbonate)in the treatment of patients with interstitial cystitis/bladder pain syndrome.Methods The clinical data of 25 patients who had undergone bladder hydrodistention under general anesthesia between January 2014 and February 2019 in the Department of Urology was retrospectively analyzed.Intravesical instillation of three-drug combination(low-molecular-weight heparin aodium for injection 40,000 u,2%lidocaine 10 ml,and 5%sodium bicarbonate 10 ml)was administered once per week for 8 weeks,and then once a month.The interstitial cystitis symptom index,interstitial cystitis problem index(O’Leary-Sant problem index),visual analog score for pain,voiding frequency,bladder capacity,and side effects were recorded.Results At 1,3,6 and 12 months after treatment,the remission rate was 92%,88%,80%and 60%respectively.The O’Leary-Sant symptom index,O’Leary-Sant problem index,voiding frequency and pain score were improved after treatment(P<0.01).The maximum bladder capacity improved at 1,3 and 6 months,and was reduced to the pretreatment level at 12 months.No significant adverse reactions occurred in any of the patients.Conclusions Bladder hydrodistention combined with intravesical instillation of three drugs for bladder pain syndrome and interstitial cystitis is safe and effective,which can significantly reduce clinical symptoms and improve the quality of life of patients.