碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎

Bladder installation of alkaline iidocaine for the treatment of ketamine-associated cystitis

目的 探讨碱化利多卡因膀胱灌注扩张治疗氯胺酮相关性膀胱炎的临床价值.方法 2008-2009年收治氯胺酮相关性膀胱炎7例.男6例,女1例.平均年龄26（19～38）岁.其中复发病例3例共10次.患者均有氯胺酮滥用史,伴有严重尿频、尿急、尿痛等下尿路症状（LUTS）;白天排尿间隔时间（20±15）min,夜尿12～20次,每次尿量（50±15）ml.B超检查示膀胱壁增厚、容积缩小;上尿路积水3例.尿动力学检查功能性膀胱容量平均50（20～100）ml,Qmax3.7～10.8 ml/s,残余尿量0～24 ml.膀胱感觉敏感性增高、顺应性下降3例.蛛网膜下腔加硬膜外麻醉下行膀胱镜检查术,见膀胱黏膜呈广泛出血样改变.患者均在麻醉下行膀胱水压扩张、术后留置硬膜外导管镇痛和2%碳酸利多卡因20 ml加5%碳酸氧钠10 ml膀胱灌注并口服清除氧自由基药物等综合治疗.结果 2例膀胱活检提示慢性炎症伴肉芽肿样增生改变.膀胱灌注治疗7～10 d后患者LUTS均明显改善,膀胱容量平均（150±30）ml,排尿间隔（85±25）min,Qmax（11.5±3.8）ml/s,夜尿3～5次.3例复发者重复上述治疗.平均随访7（2～17）个月,患者症状均明显好转,每次排尿量平均（250±80）ml,夜尿0～2次.结果 麻醉状态下以碱化利多卡因膀胱灌注扩张能迅速、有效地增加膀胱容量,改善LUTS,是治疗氯胺酮相关性膀胱炎一种简单有效的方法.

Objective To evaluate the efficacy and safety of intravesical alkalised lidocaine therapy for the treatment of ketamine-associated cystitis. Methods From 2008 to 2009,7 cases of patients （6 males and 1 female; mean age 26 years） were admitted with severe lower urinary tract symptoms （LUTS）. Three cases had painful hematuria. All cases had history of abuse ketamine. B ultrasound examination revealed marked thickness of the bladder wall and small bladder capacity. Urodynamic study were performed showing the functional bladder capacities between 20 to 100 ml（average 50 ml）,Qmax between 3.7 to 10.8 ml/s, RUV between 0 to 24 ml. Urodynamic analyses showed hypersensitive bladder and decreased bladder compliance. Cystoscopy showed diffuse reddish swelling of the bladder mucosa and hemorrhagic cystitis. All patients were required to withdraw the ketamine and treated with bladder hydrodistention therapy （intravesical alkalised lidocaine with heparin）. Results The biopsies of 2 patients showed bladder wall inflammation and fibrosis. LUTS was significantly relieved after bladder installation within 7 days. The functional bladder capacities increased between 150±30 ml,Qmax 11.5±3.8 ml/s. Four cases became asymptomatic. Three recurrent cases after reabused ketamin for 1 to 3 months received same intraversical treatment. All cases were followed up for 2 to 17 months. Conclusion Intravesical hydrodistention therapy with alkalised lidocaine and heparin could be the safe and effective therapy in the treatment of katamine-associated cystitis.