氯胺酮（K粉）相关性膀胱炎3例诊治分析并文献复习

摘要

目的：：探讨氯胺酮(K粉)相关性膀胱炎的诊断、治疗及发病机制。方法：回顾性分析了3例氯胺酮相关性膀胱炎患者的临床资料，并结合文献复习予以讨论。结果：3例患者中2例表现为严重的下尿路症状，包括尿频、尿急、尿痛以及排尿困难，伴有血尿或急迫性尿失禁。尿常规及培养阴性。影像学检查发现膀胱壁增厚，膀胱容量较小。膀胱镜及病检显示膀胱黏膜不同程度的慢性炎症改变。分别对3例患者给予激素、膀胱水扩张及戒断K粉治疗。经治疗后患者症状明显缓解。随访3~4个月，1例无复发，1例因复吸K粉、1例因术前严重挛缩膀胱症状复现。结论：氯胺酮相关性膀胱炎是一种以下尿路刺激症状为主要特征的泌尿系损害，其发生机制和治疗方法均不明确，早期戒断K粉，及早治疗至关重要。%Objective:To determine the diagnosis, treatment, and pathogenesis of ketamine-associated cystitis. Methods:Clinical data from 3 patients with ketamine-associated cystitis were analyzed retrospectively and discussed in light of relevant literature. Results:In the 3 cases, 2 presented severe lower urinary tract symptoms, including frequency, urgency, dysuria, urge incontinence, and painful haematuria. Urinalysis and urine culture were negative. Imaging examination demonstrated thickening of the bladder wall and a small capacity. Inflammatory changes in the bladder mucosa were observed by cystoscopy and biopsies. After cessation of ketamine use, with the addition of steroids or hydrodistension, the symptoms in the 3 patients improved. The symptoms recurred in 2 patients, as 1 was exposed to ketamine again and 1 had severe bladder contraction after for 3-4 month follow-up. Conclusion:Ketamine-associated cystitis is a new urinary system inlfammatory damage. Its etiology and treatment methods are not clear. early abstinence from ketamine use and early treatment are crucial for patients with ketamine-associated cystitis to avoid irreversible damage.