氯胺酮相关性泌尿系统损害及治疗

Ketamine-abuse related urinary system dysfunction and treatment

目的探讨滥用氯胺酮（K粉）所引发泌尿系损害的临床特征及其诊治方法。方法回顾性分析2006~2010年间我院收治的因长期吸食K粉导致泌尿系统损害患者,收集关于其人口学信息、临床症状、检查结果及治疗结局的信息,进行描述性分析。结果共有10例患者（男/女=4/6）,中位数年龄25（22~30）岁,吸食氯胺酮中位数时间2（1~4）年）,临床上均有不同程度的尿路刺激症状和（或）血尿。B超示双侧上尿路积水3例;3例行IVU及CT检查均示上尿路积水扩张、膀胱挛缩;1例血生化检查示合并肝肾功能损害;4例活检病理示膀胱黏膜炎性改变。6例在停止或减少吸食氯胺酮后症状缓解;2例在行抗感染及胆碱能受体阻滞剂（托特罗定）治疗后症状缓解;1例在行膀胱镜下膀胱壁肉毒素注入后症状缓解;1例在行膀胱扩大术后症状缓解。结论氯胺酮相关性泌尿系统损害可能是一种以下尿路刺激症状为主要表现的全尿路炎性损害,其发生机制及治疗方法有待进一步研究及完善。

Objective To explore ketamine-abuse related urinary system dysfunction and treatment.Methods Clinical data of 10 cases of urinary system damage due to ketamine-abuse treated during 2006 and 2010 were retrospectively reviewed,including the demographic data,clinical manifestations,examination and treatment outcomes.Descriptive statistics were used to analyze the results.Withdrawal of ketamine and other experimental drugs was mandatory during the treatment.ResultsAltogether 10 patients were included（M/F=4/6）,median age 25（range：22-30）years.The median duration of ketamine-abuse was 2（range：1-4）years.All patients had varied degrees of frequent urination,urgency dysuria and hematuria.Urine cultures were all negative.Ultrasound displayed3 patients had bilateral hydronephrosis.IVU and CT tests indicated3 patients had upper urinary tract dilation and bladder contracture.One patient had coexisting liver and renal function damage.Biopsy results showed4 patents had inflammatory lesion of bladder mucosa.Symptoms relief occurred after：1discontinuation of ketamine-abuse or dosage decrease,in 6 patients;2antibiotics and M-receptor blocker treatment,in2 patients;3botox injection of bladder wall under cystoscope,in 1 patient;4bladder augmentation,in 1 patient.Conclusions The lower urinary tract irritative symptoms are the main clinical manifestations of urinary system dysfunction associated with ketamine-abuse.Further studies are still needed to describe the mechanism and to guide clinical treatment.