氯胺酮致泌尿系统损害35例临床分析

Clinical analysis of ketamine-associated urinary tract dysfunction:a report of 35 cases

目的探讨氯胺酮(K粉)引发泌尿系损害的诊治方法及可能机制。方法滥用K粉患者35例,年龄18-35岁,吸食K粉1-5年,均因严重的下尿路症状就诊,尿培养阴性,尿找结核菌阴性,尿红细胞形态正常或畸形,5例出现肾功能不全,IVP和CT检查提示10例出现双侧集合系统扩张和输尿管上段或全长扩张,其中膀胱挛缩2例并膀胱输尿管反流。结果患者停止或减少滥用K粉并药物治疗,30例血尿消失,20例尿频、下尿路症状缓解或消失,2例膀胱挛缩经保守治疗后,膀胱容量恢复正常。结论 K粉致沁尿系损害是一种以下尿路刺激症状为主要表现的全尿路可逆性炎症表现,停止使用K粉及对症处理可取得满意的效果。膀胱挛缩患者采用保守治疗,也能取得较好的效果。

Objective To explore the diagnosis and treatment of the ketamine-associated urinary system dysfunction and its possible mechanism.Methods A total of 35 ketamine abusers aged 18-35 years were collected.All of them had abused ketamine for 1-5 years,and presented with severe lower urinary tract symptoms.Urinalysis showed no bacterial pyuria and were negative for tuberculosis.The appearance of erythrocyte in urine was normal or abnormal.Five patients had renal dysfunction.Intravenous pyelography（IVP） and CT examination demonstrated the presence of bilateral pyelectasia and dilatation of ureter in 10 patients,of whom 2 patients had bladder contracture complicated with bladder and vesico-ureteric reflux.Results All patients were required to withdraw the ketamine abuse or reduced the frequency and amount of ketamin and given medicine.Hematuria disappeared in 30 patients,and the lower urinary tract symptoms relieved or disappeared in 20 patients.Two patients with bladder contracture restored to normal bladder capacity after the conservative treatment.Conclusion Ketamine-associated urinary system dysfunction might be a kind of reversible inflammatory process involving the upper and lower urinary tract.Stopping ketamine and conservative treatment are effective for the disease.Even the patients with contracture of bladder could have a better outcome after the conservative treatment.