CAJ | 학술논문

目的探讨综合疗法治疗氯胺酮相关性膀胱损害的临床疗效.方法 2008年2月至2012年12月中山大学附属第五医院和珠海市妇幼保健院收治13例氯胺酮相关性膀胱损害病例,男8例,女5例;2例可见肉眼血尿,9例镜下血尿;合并不同程度蛋白尿13例;其中1例患者孕2周;病程4 ～ 20个月;13例患者分别有9个月至6年的氯胺酮接触史,其中6例频繁混用氯胺酮、摇头丸7例间断、较长期地吸食氯胺酮.给予戒断毒品、心理干预、口服α或M-受体阻滞药和膀胱功能训练等综合治疗.根据O'Leary-Sant间质性膀胱炎症状评分(ICSI)、问题评分(ICPI)和最大测压膀胱容量评估疗效 .结果 13例患者经综合治疗20d后,尿频、尿急症状逐渐改善,随着治疗期延长,症状改善越明显 .治疗第20天,患者肝肾功能恢复、尿常规正常、病原微生物培养复查阴性;5例肾积水患者2例消失,2例减轻,1例变化不明显治疗后,最大测压膀胱容量明显增加[(194 ±39)ml 比(98 ±90)ml],ICSI、ICPI明显下降[(3.6 ± 1.5)分比(13.9 ±3.1)分,(2.5±1.9)分比(8.9 ±2.6)分],差异均有统计学意义(P＜0.01) .接尿间隔时间(85 ±26) min,夜尿0～3次,最大尿流量(14.2 ± 5.3) m/s.控制排尿期间,3例出现明显耻骨上区疼痛,注射回苯三酚后缓解 .随访6～18个月,平均(12 ± 3)个月,12例症状缓解明显或消失;1例复吸食者症状复发.结论及时戒毒、心理干预和膀胱功能训练等综合疗法是治疗氯胺酮相关性膀胱损害有效的方法.
목적 탐토종합요법치료록알동상관성방광손해적림상료효.방법 2008년2월지2012년12월중산대학부속제오의원화주해시부유보건원수치13례록알동상관성방광손해병례,남8례,녀5례;2례가견육안혈뇨,9례경하혈뇨;합병불동정도단백뇨13례;기중1례환자잉2주;병정4 ～ 20개월;13례환자분별유9개월지6년적록알동접촉사,기중6례빈번혼용록알동、요두환7례간단、교장기지흡식록알동.급여계단독품、심리간예、구복α혹M-수체조체약화방광공능훈련등종합치료.근거O'Leary-Sant간질성방광염증상평분(ICSI)、문제평분(ICPI)화최대측압방광용량평고료효 .결과 13례환자경종합치료20d후,뇨빈、뇨급증상축점개선,수착치료기연장,증상개선월명현 .치료제20천,환자간신공능회복、뇨상규정상、병원미생물배양복사음성;5례신적수환자2례소실,2례감경,1례변화불명현치료후,최대측압방광용량명현증가[(194 ±39)ml 비(98 ±90)ml],ICSI、ICPI명현하강[(3.6 ± 1.5)분비(13.9 ±3.1)분,(2.5±1.9)분비(8.9 ±2.6)분],차이균유통계학의의(P＜0.01) .접뇨간격시간(85 ±26) min,야뇨0～3차,최대뇨류량(14.2 ± 5.3) m/s.공제배뇨기간,3례출현명현치골상구동통,주사회분삼분후완해 .수방6～18개월,평균(12 ± 3)개월,12례증상완해명현혹소실;1례복흡식자증상복발.결론 급시계독、심리간예화방광공능훈련등종합요법시치료록알동상관성방광손해유효적방법.
Objective To explore the treating strategies of ketamine associated bladder dysfunction.Methods All 13 cases of ketamine associated bladder dysfunction underwent combined therapy (including withdrawal of ketamine,psychological intervention,α or M-receptor blockers and bladder training) from February 2008 to December 2012.The efficacies were assessed using the standards of O' Learv-Sant interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) and the maximum capacity of bladder.Results Ketamine associated bladder dvsfunction was characterized by severe lower urinary tract symptoms for the reasons of the non-specific inflammation of the bladder mucosa,capacity of bladder decreased,overactive bladder.After combined therapy within 20 days,the lower urinary tract symptoms significantly relieved,bladder capacities increased [(194 ± 39) ml vs(98 ± 90) ml] and ICSI score,ICPI score decreased significantlv compared with before the treatments respectively [(3.6 ± 1.5) scores vs (13.9 ± 3.1) scores,(2.5 ± 1.9) scores vs (8.9 ± 2.6) scores] (P ＜ 0.01).All cases were followed-up for 6-18 months[average was (12 ± 3) months],symptoms disappeared or were significantly relieved in 12 patients; symptoms reappeared in I case for re-abused ketaminre.Conclusion The combined therapy (including withdrawal of ketamine,psychological intervention,α or M-receptor blockers and bladder training) can be the safe and effective therapy in the treatment of ketamine associated bladder dysfunction.