膀胱水压扩张联合药物灌注治疗氯胺酮相关性膀胱炎的长期随访研究

Bladder pressure expansion with drug perfusion for the treatment of ketaminea ssociated cystitis： long-term results

目的探讨膀胱水压扩张联合碱化利多卡因、肝素、地塞米松膀胱灌注治疗氯胺酮相关性膀胱炎的长期随访效果。方法回顾性分析2008年1月至2011年9月收治的22例氯胺酮相关性膀胱炎患者的临床资料，男19例，女3例。年龄19～38岁，平均（26±5）岁。在蛛网膜下腔麻醉＋硬膜外麻醉下行膀胱镜检＋膀胱水压扩张术。扩张后留置硅胶三腔导尿管，用2%碳酸利多卡因20 ml＋5%碳酸氢钠10 ml，同时加入地塞米松10 mg＋肝素钠2.5万U行膀胱灌注，灌注后夹闭尿管直到患者不能忍受，放开尿管并记录每次尿量。每天灌注3次，共灌注5 d。随访记录术后1周、1个月、3个月、6个月、5年的临床资料，随访内容包括膀胱过度活动症症状评分（overactive bladder symptom score，OABSS）、尿量、最大尿流率（Qmax）、日间及夜间排尿次数。将术后第5年数据分别与治疗前、治疗后1周以及1、3、6个月的数据进行比较。结果本组22例手术均顺利完成，术中、术后无发热、膀胱破裂等并发症发生。术后随访5年，术后第5年的膀胱容量为（238.3±37.3）ml，日间排尿次数（9.2±2.3）次，夜间排尿次数（2.1±1.3）次，Qmax（18.2±8.3）ml/s，OABSS（4.4±2.4）分。分别与治疗前[膀胱容量（30.1±25.3）ml，日间排尿次数（24.7±8.3）次，夜间排尿次数（9.5±6.4）次，Qmax（3.5±8.3）ml/s，OABSS（13.5±2.3）分]、治疗后1周[（膀胱容量（100.4±15.1）ml，日间排尿次数（15.3±3.3）次，夜间排尿次数（5.2±3.3）次，Qmax（14.6±6.3）ml/s，OABSS（9.4±3.6）分]、1个月[（膀胱容量（121.9±15.1）ml，日间排尿次数（13.6±4.5）次，夜间排尿次数（4.1±2.9）次，Qmax（15.4±8.8）ml/s，OABSS（7.1±3.7）分]比较差异均有统计学意义（均P〈0.01）。与治疗后3个月的膀胱容量（158.3±18.3）ml比较差异有统计学意义（P〈0.01）。与治疗后6个月数据比较差异无统计学意义（P〉0.05）。结论麻醉状态下行水压扩张后再联合碱化利多卡因、肝素、地塞米松膀胱灌注是治疗氯胺酮相关性膀胱炎的有效方法，长期效果良好、稳定，且无明显并发症。

Objective To study the long-term efficacy of bladder pressure expansion and perfusion therapy by bladder hydraulic expansion with alkalify lidocaine, heparin, dexamethasone for the treatment of ketamine correlation cystitis Methods From January 2008 to September 2011 ,the data from 19 male and 3 female patients ,who were diagnosed as ketamine-associated cystitis was retrospectively analyzed. The mean age was （26 ± 5 ）years old. All patients accepted bladder pressure expansion under the spinal and epidural anesthesia. After expansion, the silicon three-channel catheters were left in those patients. 2% lidocaine （20 ml） and 5% bicarbonate （10 ml） was perfused into the bladder. Meanwhile, the heparin （2.5 U） and dexamethasone （10 mg） were added into the solution, as well. After perfusion, the catheter was clamped until the patient could not tolerate. The perfusion was performed three times every day for 5 days. The volume of urine was recorded each time. The OABSS score, urine volume, maximum urine flow rate, day and night urination frequency were followed within 5 years. And the data was compared with those preoperative and postoperative 1 week, 1 month, 3 months, 6 months. Results 22 patients accepted the procedure successfully. No complications, such as fever or bladder rupture, occurred. At the end of 5 years, the bladder volume daily urinating frequency, night urinating frequency, maximal flow rate , OABSS score were （238.3 ± 37.3） ml, 9.2 ± 2. 3,2. 1 ± 1.3, （18.2 ±8.3） ml/s,4.4 ± 2.4, respectively. Compared to the one week and one month after the operation, those results have significant difference （P 〈 0.01 ）. Compared to the 3 months after the procedure, the bladder volume has significant difference [ （238. 3±37.3）ml vs. （158.3 ± 18.3）ml, P 〈0.01 ]. No significant differences were noticed in those items 6 months after the procedure （P 〉 0.05）. Conclusion The long-term efficacy of bladder pressure expansion with alkaline lidocaine, heparin and dexamethasone the anesthesia in the treatment of ketamine associated cystitis is good. The outcome is stable, and no obvious complications.