氯胺酮相关性泌尿系统损害

目的 探讨滥用氯胺酮(K粉)所引发的泌尿系损害及其诊治方法. 方法 因吸食K粉导致泌尿系统损害患者20例.男14例,女6例.平均年龄22岁.吸食K粉1～4年.均有严重的尿频、尿急、尿痛和(或)血尿症状.尿培养阴性.B超提示双侧上尿路积水16例,14例行IVU及10例行CT检查均提示上尿路积水扩张、膀胱挛缩,1例肾乳头坏死,合并不同程度肝肾功能损害.治疗时要求患者戒断毒品并实验性用药. 结果 6例活检病理提示膀胱黏膜炎性改变,在停止或减少滥用K粉后,12例症状逆转,戊聚硫钠及透明质酸钠治疗6例症状缓解. 结论 K粉相关性泌尿系统损害可能是一种以下尿路刺激症状为主要表现的全尿路炎性损害,其发生机制及治疗方法有待进一步研究.

"Street ketamine" associated urinary system dysfunction

Objective To investigate the clinical, pathology, diagnosis and treatment of the lower urinary system dysfunction among chronic recreational ketamine abusers. Methods From 2000-2008, 20 ketamine abusers(14 men and 6 women; mean age, 22.3 years), from 3 hospitals in Guangzhou and Hongkong, and suffering from lower urinary tract dysfunction was reported. All of them had abused ketamine for 1 to 4 years, and presented with severe lower urinary tract symptoms. Complaint of severe frequency, urgency, urge incontinence, and painful haematuria was common. Urine cultures were negative. Six men suffered from severe dysuria. B ultrasound examination of 16 cases demonstrated the presence of bilateral hydronephrosis. Fourteen IVU and 10 CT investigations demonstrated the presence of bilateral hydronephrosis, bladder contraction, and 1 case showed papillary necrosis of the kidney. Different levels of abnormal liver function and chronic/acute renal failure were observed. All of the patients were required to withdraw the narcotics and the experimental medicine were given. Results The biopsies of 6 cases demonstrated the cystitis. Twelve cases' symptoms were reversible after these patients stopped or reduced the frequency and amount of ketamine abuse. Pentosan polysulfate sodium and sodium hyaluronate solution relieved the symptoms of 6 patients. Conclusions "Street ketamine" associated urinary system dysfunction might be a kind of in flammatory process involving the upper and lower urinary tract. Underlying aetiology and treatment methods necessitate further study.