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目的了解年轻人中服用氯胺酮者是否会加重下尿路的症状。方法监测6例长期使用娱乐性氯胺酮患者的严重的下尿路症状,通过获得详细的病史资料和体格检查以及进一步的研究,来确定娱乐性氯胺酮的使用和这些症状的关系。结果所有病例的尿培养结果阴性。3例患者进行了静脉尿路造影,显示双侧上段输尿管狭窄,双侧轻度肾盂积水。挛缩的膀胱尿动力学检查显示当膀胱容量达到30～50 ml时逼尿肌不稳定并伴有尿漏。膀胱镜提示膀胱容量缩小伴全膀胱红斑病变。3例患者进行了膀胱组织病理活检,显示慢性炎症改变。停用氯胺酮以及膀胱内透明质酸钠溶液灌注治疗可以一定程度缓解患者的临床症状。结论氯胺酮相关尿路功能障碍是相对新出现的临床现象,其病理机制尚不清楚,目前的治疗策略为停用氯胺酮和膀胱内透明质酸钠溶液灌注治疗。
Objective To understand whether taking ketamine in young people aggravates the symptoms of lower urinary tract. Methods Six patients with long-term use of recreational ketamine were monitored for signs of lower urinary tract symptoms. Detailed history data and physical examinations, as well as further studies, were performed to determine the relationship between recreational ketamine use and these symptoms. Results Urinalysis was negative in all cases. Three patients underwent intravenous urography, showing bilateral superior ureter stenosis, bilateral mild hydronephrosis. Contractile bladder urodynamic examination revealed detrusor instability accompanied by urinary leakage when the bladder volume reached 30-50 ml. Cystoscopy prompted bladder capacity reduction with the whole bladder erythema. Three patients underwent histopathological biopsies of the bladder showing changes in chronic inflammation. The withdrawal of ketamine and intravesical sodium hyaluronate solution perfusion therapy can alleviate the patient’s clinical symptoms to some extent. Conclusions Ketamine-related urinary tract dysfunction is a relatively new clinical phenomenon. The pathological mechanism is unclear. The current treatment strategy is to stop ketamine and intravesical sodium hyaluronate infusion.