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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 林志杰 | K他命引發膀胱病變：文獻回顧 | 2011/6/28 下午 08:56:17 | 0 |
| 原 文 | 題 目 | Ketamine-induced vesicopathy: a literature review |
| 作 者 | S. Middela, I. Pearce | |
| 出 處 | The International Journal of Clinical Practice | |
| 出版日期 | 2011 | |
| 評 論 |
K他命(Ketamine)，俗稱拉k，此篇文章作者鑑於最近三年有許多文獻發表探討K他命濫用的病人產生下泌尿道症狀，因而以關鍵字「ketamine」、「bladder」、「cystitis」，輸入Pubmed、Medline、Google scholar等資料庫，搜尋到相關二十篇文章，共有110個病人。回顧所有文章，作者提及k他命濫用者使用K他命的量與膀胱症狀的嚴重度不一定有正相關，而且三軍總醫院蔡醫師他們發表，症狀常是在開始使用K他命後一個月就會有，而變嚴重即常是在使用超過一年後。病人的症狀主要是以「剌激性」為主，如強烈急尿感、極度頻尿、排尿疼痛、血尿等。在疾病相關診斷檢查方面，腎功能評估很重要，且尿路動力學檢查顯示逼尿肌過動，且尿容量常是小於150西西。此外，部份文章也提及使用簡易超音波來檢查上泌尿道有無腎水腫，其中膀胱輸尿管交接處發炎的病人會被查到雙側腎水腫。膀胱鏡鏡檢常會發現有潰瘍性膀胱炎併嚴重發炎及黏膜脫落，病理切片顯示潰瘍、發炎細胞浸潤及不同程度的纖維化。由於並無確立致病機轉，所以在治療上並沒有統一治療的共識，唯一最重要的就是「停止濫用K他命」。因為膀胱鏡檢的發現跟間質性膀胱炎接近，有學者發表可能是上皮通透性問題導致glycosaminoglycans滲漏，所以也用玻尿酸(Hyaluranic acid)施行膀胱灌注或是口服Pentosan polysulphate (Elmiron-愛泌羅)，在治療後病人的症狀也會得到不同程度的改善。有部份文獻更進一步闡述，施行尿液分流治療有時是須要的，甚至是在嚴重的個案要接受膀胱加大手術或移除膀胱，但這仍有爭議。 K他命的濫用造成膀胱發炎的後續問題，別無他法，戒斷K他命是王道，但使用K他命除了造成身體的問題，心理的問題也是一個治療重點，這些病患常無法成功的戒斷，因此心靈上的支持與救贖常是影響治療是否成功的一項關鍵因素。對於K他命的致病機轉實為謎團待解，到底多長時間、多大劑量會使得其傷害不可逆轉，這仍須大家努力找出解答。 |
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| abstract | Ketamine consumption is on the increase as a recreational abuse substance. It is reported to cause lower urinary tract symptoms (LUTS), and published accounts of its deleterious effects are increasing. We reviewed the available literature regarding the urological impact of ketamine abuse and its management. Twenty-two publications were found in total after a search of all databases including Pubmed, Medline and Google Scholar using the words ‘ketamine’, ‘bladder’ and ‘cystitis’ with no limits imposed. There are approximately 110 cases reported in the literature in the form of case series, case reports and letters. The effect of ketamine abuse on the bladder is universally similar; however, there is no uniform method adopted in reporting the symptoms, diagnosis and management. Very little is known regarding the pathogenesis of its effects on the urinary tract. Patients with severe irritative LUTS, a positive history of ketamine abuse and the absence of any other aetiology should be considered to have ketamine-induced vesicopathy. Effort must be made to elicit the history of drug abuse in those with no found cause of LUTS, especially in the young. Presently, ketamine cessation is the only effective treatment modality to prevent deterioration of the renal function and indeed offer the possibility of symptom resolution. Management akin to that formulated for interstitial cystitis patients would appear to offer the greatest opportunity for effective treatment. | |
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