CAJ | 학술논문

目的探讨碱化利多卡因膀胱灌注扩张治疗氯胺酮相关性膀胱炎的临床价值.方法 2008-2009年收治氯胺酮相关性膀胱炎7例.男6例,女1例.平均年龄26(19～38)岁.其中复发病例3例共10次.患者均有氯胺酮滥用史,伴有严重尿频、尿急、尿痛等下尿路症状(LUTS);白天排尿间隔时间(20±15)min,夜尿12～20次,每次尿量(50±15)ml.B超检查示膀胱壁增厚、容积缩小;上尿路积水3例.尿动力学检查功能性膀胱容量平均50(20～100)ml,Qmax3.7～10.8 ml/s,残余尿量0～24 ml.膀胱感觉敏感性增高、顺应性下降3例.蛛网膜下腔加硬膜外麻醉下行膀胱镜检查术,见膀胱黏膜呈广泛出血样改变.患者均在麻醉下行膀胱水压扩张、术后留置硬膜外导管镇痛和2%碳酸利多卡因20 ml加5%碳酸氧钠10 ml膀胱灌注并口服清除氧自由基药物等综合治疗.结果 2例膀胱活检提示慢性炎症伴肉芽肿样增生改变.膀胱灌注治疗7～10 d后患者LUTS均明显改善,膀胱容量平均(150±30)ml,排尿间隔(85±25)min,Qmax(11.5±3.8)ml/s,夜尿3～5次.3例复发者重复上述治疗.平均随访7(2～17)个月,患者症状均明显好转,每次排尿量平均(250±80)ml,夜尿0～2次.结果麻醉状态下以碱化利多卡因膀胱灌注扩张能迅速、有效地增加膀胱容量,改善LUTS,是治疗氯胺酮相关性膀胱炎一种简单有效的方法.
목적 탐토감화리다잡인방광관주확장치료록알동상관성방광염적림상개치.방법 2008-2009년수치록알동상관성방광염7례.남6례,녀1례.평균년령26(19～38)세.기중복발병례3례공10차.환자균유록알동람용사,반유엄중뇨빈、뇨급、뇨통등하뇨로증상(LUTS);백천배뇨간격시간(20±15)min,야뇨12～20차,매차뇨량(50±15)ml.B초검사시방광벽증후、용적축소;상뇨로적수3례.뇨동역학검사공능성방광용량평균50(20～100)ml,Qmax3.7～10.8 ml/s,잔여뇨량0～24 ml.방광감각민감성증고、순응성하강3례.주망막하강가경막외마취하행방광경검사술,견방광점막정엄범출혈양개변.환자균재마취하행방광수압확장、술후류치경막외도관진통화2%탄산리다잡인20 ml가5%탄산양납10 ml방광관주병구복청제양자유기약물등종합치료.결과 2례방광활검제시만성염증반육아종양증생개변.방광관주치료7～10 d후환자LUTS균명현개선,방광용량평균(150±30)ml,배뇨간격(85±25)min,Qmax(11.5±3.8)ml/s,야뇨3～5차.3례복발자중복상술치료.평균수방7(2～17)개월,환자증상균명현호전,매차배뇨량평균(250±80)ml,야뇨0～2차.결과 마취상태하이감화리다잡인방광관주확장능신속、유효지증가방광용량,개선LUTS,시치료록알동상관성방광염일충간단유효적방법.
Objective To evaluate the efficacy and safety of intravesical alkalised lidocaine therapy for the treatment of ketamine-associated cystitis. Methods From 2008 to 2009,7 cases of patients (6 males and 1 female; mean age 26 years) were admitted with severe lower urinary tract symptoms (LUTS). Three cases had painful hematuria. All cases had history of abuse ketamine. B ultrasound examination revealed marked thickness of the bladder wall and small bladder capacity. Urodynamic study were performed showing the functional bladder capacities between 20 to 100 ml(average 50 ml),Qmax between 3.7 to 10.8 ml/s, RUV between 0 to 24 ml. Urodynamic analyses showed hypersensitive bladder and decreased bladder compliance. Cystoscopy showed diffuse reddish swelling of the bladder mucosa and hemorrhagic cystitis. All patients were required to withdraw the ketamine and treated with bladder hydrodistention therapy (intravesical alkalised lidocaine with heparin). Results The biopsies of 2 patients showed bladder wall inflammation and fibrosis. LUTS was significantly relieved after bladder installation within 7 days. The functional bladder capacities increased between 150±30 ml,Qmax 11.5±3.8 ml/s. Four cases became asymptomatic. Three recurrent cases after reabused ketamin for 1 to 3 months received same intraversical treatment. All cases were followed up for 2 to 17 months. Conclusion Intravesical hydrodistention therapy with alkalised lidocaine and heparin could be the safe and effective therapy in the treatment of katamine-associated cystitis.