氯胺酮性膀胱炎11例诊治分析

The diagnosis and comprehensive therapy of ketamine-associated cystitis(report of 11 cases)

目的探讨氯胺酮性膀胱炎的诊断及其运用麻醉下水扩手术疗法及其药物和膀胱灌注综合治疗的临床价值。方法 2008～2011年收治氯胺酮相关性膀胱炎共11例,其中男8例,女3例,平均(25±6)岁。从患者的吸毒史、临床症状、实验室检查、影像学检查及其尿动力学检查对该病做出了正确的诊断,治疗上采取了以麻醉状态下膀胱水压扩张为主,并同时使用2%碳酸利多卡因加地塞米松针剂进行膀胱灌注,术后继续口服托特罗定缓释片等综合治疗。结果 10例(90.9%)术后病理检测均提示膀胱内黏膜慢性炎症性改变。平均随访(8±4)个月,患者下尿路症状(LUTS)明显改善,膀胱容量平均(240±60)mL,残余尿量(10±5)mL,最大尿流率(Qmax)(14.5±2.8)mL/s。结论麻醉状态下水扩张能显著地增加膀胱容量,配合膀胱灌注治疗和口服托特罗定缓释片等综合治疗,可有效治疗氯胺酮性膀胱炎。

Objective To evaluate the efficacy and safety of comprehensive treatment of ketamine-associated cystitis with water dilation under anesthesia. Methods From 2008 to 2011, 11 cases （8 males and 3 females; mean age 25 years） were admitted with severe lower urinary tract symptoms （LUTS）, which were diagnosed as ketamine-associated cystitis based on drug abuse history, clinical symptoms, laboratory testing, radiographic and urodynamic examinations. Anesthesia was performed in all cases with water dilation to expand small bladder capacity until the muscles of cyst revealed, then 2% alkalised lidocaine and dexamethasone were intravesically perfused. After operation, M-receptor blocker was taken orally. Results The biopsies of 10 patients （90. 9%） showed bladder wall inflammation and fibrosis. LUTS was significantly relieved after bladder dilation within 30 days. The functional bladder capacities increased to （240±60）mL and Qmax to （14.5 ± 2.8）mL/s. Conclusions Comprehensive therapies including water dilation under anesthesia, intravesical perfusion with alkalised lidocaine and dexamethasone, and oral medications are safe and effective in the treatment of katamine-associated Cystitis.