CAJ | 학술논문

目的探讨麻醉下膀胱水扩张后透明质酸钠灌注治疗重度顽固性间质性膀胱炎(IC)的临床疗效. 方法 IC患者21例.在联合阻滞或静脉麻醉下,以100 cm H2O(1 cm H2O =0.098kPa)压力下灌注膀胱,扩张膀胱10 min,经尿管向膀胱注入透明质酸钠40 mg/50 ml,保留1h后放出.每周灌注1次,4～6次为一个疗程. 结果麻醉下测得膀胱容量(191.6±88.7)ml,扩张后膀胱容量增加至(425.3±79.8) ml(P=0.000).其中2例分别扩张至6.5 min和7.2 min时怀疑膀胱破裂.19例扩张10 min后均有明显的肉眼血尿.17例治疗后24 h拔除尿管,2例因血尿延至72 h拔除,2例怀疑膀胱破裂者4d后拔除.拔除尿管后疼痛即明显减轻,最大排尿量有所增加.第2次灌注前1d,排尿次数较治疗前明显减少[(32.8±10.4)与(18.5±8.0)次/24 h],最大排尿量较治疗前明显提高[(86.7±37.9)与(151.9 ±72.2)ml],疼痛程度较治疗前明显减轻[(8.7±1.0)与(3.0±0.8)分],O'Leary-Sant IC评分和QOL均有明显下降[(30.0±4.2)与(17.0±4.4)分,(5.9±0.3)与(2.4±0.9)分](P=0.000),至第3次灌注时症状继续改善,至第5周第6次灌注时效果达到最佳,至第6个月时症状有所反弹,但与术前相比,差异仍有统计学意义(P=0.000). 结论麻醉下膀胱水扩张治疗重症顽固性IC效果满意,透明质酸灌注能够缓解患者的尿频和疼痛症状,改善效果与治疗持续时间呈正相关.
목적 탐토마취하방광수확장후투명질산납관주치료중도완고성간질성방광염(IC)적림상료효. 방법 IC환자21례.재연합조체혹정맥마취하,이100 cm H2O(1 cm H2O =0.098kPa)압력하관주방광,확장방광10 min,경뇨관향방광주입투명질산납40 mg/50 ml,보류1h후방출.매주관주1차,4～6차위일개료정. 결과 마취하측득방광용량(191.6±88.7)ml,확장후방광용량증가지(425.3±79.8) ml(P=0.000).기중2례분별확장지6.5 min화7.2 min시부의방광파렬.19례확장10 min후균유명현적육안혈뇨.17례치료후24 h발제뇨관,2례인혈뇨연지72 h발제,2례부의방광파렬자4d후발제.발제뇨관후동통즉명현감경,최대배뇨량유소증가.제2차관주전1d,배뇨차수교치료전명현감소[(32.8±10.4)여(18.5±8.0)차/24 h],최대배뇨량교치료전명현제고[(86.7±37.9)여(151.9 ±72.2)ml],동통정도교치료전명현감경[(8.7±1.0)여(3.0±0.8)분],O'Leary-Sant IC평분화QOL균유명현하강[(30.0±4.2)여(17.0±4.4)분,(5.9±0.3)여(2.4±0.9)분](P=0.000),지제3차관주시증상계속개선,지제5주제6차관주시효과체도최가,지제6개월시증상유소반탄,단여술전상비,차이잉유통계학의의(P=0.000). 결론 마취하방광수확장치료중증완고성IC효과만의,투명질산관주능구완해환자적뇨빈화동통증상,개선효과여치료지속시간정정상관.
Objective To evaluate the clinical efficacy of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of interstitial cystitis (IC). Methods Twenty-one IC patients received intravesical sodium hyaluronate therapy under combined blockage or intravenous anesthesia.Bladders were perfused with normal saline under 100 cm H2O perfusion pressure and expanded for 10 min,the bladders were then injected through a catheter with 40 mg/50 ml sodium hyaluronate which was released after 1 h.Intravesical perfusion was applied once every week four to six times in a course of treatment. Results The average bladder capacity was extended from 191.6 ± 88.7 ml before expansion to 425.3 ± 79.8 ml after bladder expansion ( P =0.000).The extension was done under anesthesia.There were two suspected bladder ruptures after starting the bladder expansion at 6.5 min and 7.2 min.There was significant gross hematuria in 19 cases,10 min after bladder expansion.After treatment,the catheters were removed 24 h after manipulation in 17 patients; the catheters were removed 72 h after manipulation in two cases with hematuria;the catheters were removed four days after manipulation in the two cases of suspected bladder rupture.Pain was significantly reduced after the catheters were removed and the maximum urinary output increased slightly.The day before the second injection of sodium hyaluronate,the urinary frequency decreased significantly than before start of treatment (32.8 vs 18.5 times/24 h).The maximum urinary output increased significantly compared with the output before treatment (86.7 vs 151.9 ml).Pain was reduced significantly after treatment (8.7 vs 3.0).The O'Leary-Sant IC score and the QOL were significantly improved (30.0 vs 17.0,5.9 vs 2.4,respectively) (P =0.000).After the third treatment,the symptoms continued to improve.The treatment results were best in the fifth week at the time of the sixth injection of sodium hyaluronate.Symptoms rebounded at six months.However compared with that before treatment,the difference was still statistically significant ( P =0.000). Conclusions Bladder hydrodistention under anesthesia for severe intractable IC patients produces immediate effectiveness.Sodium hyaluronic infusion can alleviate urinary frequency and pain,and the effectiveness and duration of treatment are positively correlated.