膀胱疼痛综合征合并间质性膀胱炎以阿米替林和透明质酸钠联合治疗分析

Combination therapy of amitriptyline and sodium hyaluronate for bladder pain syndrome with interstitial cystitis

目的探讨阿米替林联合透明质酸钠治疗膀胱疼痛综合征合并间质性膀胱炎的效果。方法将36例膀胱疼痛综合征合并间质性膀胱炎(PBS/IC)患者纳入本次研究中,所有患者均来自本院泌尿科,病例资料的入选时间自2017年1月至2018年1月。给予所有患者口服盐酸阿米替林片治疗,同时采用40 mg无菌透明质酸钠液(西施泰)进行膀胱灌注治疗。随访干预6个月,对比治疗前后患者的排尿情况。采用O'Leary-Sant间质性膀胱炎问卷评分表从问题指数(ICSI)和症状指数(ICPI)两方面进行评估,对比尿频及盆腔疼痛(PUF)评分,并观察临床治疗效果和不良反应发生情况。结果36例患者经过6个月的治疗后,其症状改善总有效率高达77.77%;患者在治疗后3个月与6个月的夜尿次数、排尿次数均少于治疗前,排尿总量以及平均尿量均多于治疗前,差异具有统计学意义(P<0.05);患者在治疗后3个月与6个月的ICSI、ICPI以及PUF评分均低于治疗前,差异具有统计学意义(P<0.05)。阿米替林联合膀胱灌注透明质酸钠治疗后,患者的体征均趋于稳定,无局部刺激症状,未见全身不良反应发生。结论PBS/IC患者采用口服阿米替林联合膀胱灌注透明质酸钠治疗取得了显著的治疗效果,能够显著改善患者的临床指标,减轻临床症状,且无明显不良反应,临床应用安全有效,值得临床借鉴和推广。

Objective To investigate the effect of amitriptyline combined with sodium hyaluronate in the treatment of bladder pain syndrome with interstitial cystitis.Methods 36 patients with bladder pain syndrome complicated with interstitial cystitis(PBS/IC)were enrolled in this study.All patients were from the urology department of our hospital.The data of cases were selected from January 2017 to January 2018.All patients were treated with amitriptyline hydrochloride tablets orally and bladder instillation with 40 mg sterile sodium hyaluronate solution.The patients were followed up for 6 months to compare their urination before and after treatment.O'Leary-Sant Interstitial Cystitis Questionnaire was used to evaluate the problem index(ICSI)and symptom index(ICPI).The frequency of urine and pelvic pain score(PUF)were compared,and the clinical efficacy and adverse reactions were observed.Results After 6 months of treatment,the total effective rate of symptom improvement was 77.77%.The number of nocturnal urination and the number of urination in 3 and 6 months after treatment were less than those before treatment.The total amount of urination and the average amount of urine were more than those before treatment.The difference was statistically significant(P<0.05).The scores of ICSI,ICPI and PUF in 3 months and 6 months after treatment were lower than those before treatment,and the difference was statistically significant(P<0.05).After amitriptyline combined with intravesical instillation of sodium hyaluronate,the symptoms of patients tended to be stable,without local irritation symptoms,and no systemic adverse reactions occurred.Conclusion Oral amitriptyline combined with intravesical instillation of sodium hyaluronate in PBS/IC patients has achieved remarkable therapeutic effect.It can significantly improve the clinical indicators and alleviate clinical symptoms without obvious adverse reactions.It is safe and effective in clinical application and worthy of clinical reference and promotion.