长期吸食氯胺酮对泌尿系统的损害

目的:探讨长期吸食氯胺酮导致的泌尿系统损害及其诊治方法。方法:收集我院26例病例进行回顾性分析,其中男20例,女6例。吸食K粉半年-10年。均有严重的尿频、尿急、尿痛和(或)血尿症状,3例排尿困难,2例急迫性尿失禁。尿培养阴性,尿抗酸杆菌检测阴性。19例行B超提示双侧上尿路积水,16例行静脉尿道造影(IVU)及7例行CT检查均提示双侧上尿路积水扩张、膀胱挛缩,10例行膀胱镜检示不同程度膀胱急性炎症状态。均合并不同程度肝肾功能损害。嘱患者戒断毒品并予抗炎、抗胆碱受体等药物。结果:在停止吸食氯胺酮后,14例症状好转,6例予抗胆碱受体药物后缓解,6例口服戊聚硫钠及透明质酸钠灌注治疗后缓解。结论:长期吸食氯胺酮会造成渐进性的泌尿系统损害,其中以下尿路症状为主要表现,并逐渐发展至膀胱挛缩,上尿路积水,最终导致肾功能衰竭。其发生机制及治疗方法尚不明确,还须进一步研究。

Long-Term Ketamine Abuse Leads to Urinary System Dysfunction

Objective:To investigate the diagnosis and treatment of the lower urinary system dysfunction caused by long-term ketamine abuse.Methods:Lower urinary system dysfunction caused by long-term ketamine abuse is a rare disease.In this paper,clinical data of 26 cases were collected and analyzed retrospectively(20 men and 6 women).All of them had abused ketamine for six months to 10 years,and presented with severe lower urinary tract symptoms.All patients had complaint of severe frequency,urgency,pain,and hematuria during emiction,and three of them had dysuria and two of them had urge incontinence.Common urine culturing and detection of acid-fast bacillus were negative.B ultrasound examination of 19 cases demonstrated bilateral hydronephrosis.Sixteen cases of IVU and seven cases of CT investigations demonstrated bilateral hydronephrosis and bladder contraction.Cystoscopy of 10 cases demonstrated acute inflammation.Different levels of abnormal liver function and chronic or acute renal failure were observed.All of the patients were required to withdraw the drug abuse and anti-inflammatory,anti-cholinergic,and other treatment.Results:Fourteen cases'symptoms were reversible after these patients stopped ketamine abuse.Anticholinergic treatment relieved the symptoms of six patients.Pentosan polysulfate sodium and sodium hyaluronate solution relieved the symptoms of another six patients.Conclusion:Long-term ketamine abuse will lead to progressive urinary system dysfunction,which mainly represent lower urinary tract symptoms and gradually develop into bladder contraction,hydronephrosis,and renal failure finally.Underlying aetiology and treatment methods are still unclear,and it need further study.