Hong Y L, Yee C H, Tam Y H, Wong J Hm, Lai P T, Ng C F
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.
Hong Kong Med J. 2018 Apr;24(2):175-181. doi: 10.12809/hkmj177086. Epub 2018 Apr 6.
Ketamine is an N-methyl-d-aspartate receptor antagonist, a dissociative anaesthetic agent and a treatment option for major depression, treatment-resistant depression, and bipolar disorder. Its strong psychostimulant properties and easy absorption make it a favourable candidate for substance abuse. Ketamine entered Hong Kong as a club drug in 2000 and the first local report of ketamine-associated urinary cystitis was published in 2007. Ketamine-associated lower-urinary tract symptoms include frequency, urgency, nocturia, dysuria, urge incontinence, and occasionally painful haematuria. The exact prevalence of ketamine-associated urinary cystitis is difficult to assess because the abuse itself and many of the associated symptoms often go unnoticed until a very late stage. Additionally, upper-urinary tract pathology, such as hydronephrosis, and other complications involving neuropsychiatric, hepatobiliary, and gastrointestinal systems have also been reported. Gradual improvement can be expected after abstinence from ketamine use. Sustained abstinence is the key to recovery, as relapse usually leads to recurrence of symptoms. Both medical and surgical management can be used. The Youth Urological Treatment Centre at the Prince of Wales Hospital, Hong Kong, has developed a four-tier treatment protocol with initial non-invasive investigation and management for these patients. Multidisciplinary care is essential given the complex and diverse psychological factors and sociological background that underlie ketamine abuse and abstinence status.
氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂、一种解离麻醉剂，也是治疗重度抑郁症、难治性抑郁症和双相情感障碍的一种选择。其强烈的精神刺激特性和易于吸收的特点使其成为药物滥用的一个热门候选对象。氯胺酮于2000年作为一种俱乐部毒品进入香港，2007年发表了首篇关于氯胺酮相关性膀胱炎的本地报告。氯胺酮相关性下尿路症状包括尿频、尿急、夜尿、排尿困难、急迫性尿失禁，偶尔还有疼痛性血尿。氯胺酮相关性膀胱炎的确切患病率难以评估，因为药物滥用本身以及许多相关症状往往直到很晚阶段才被注意到。此外，也有报告称存在上尿路病变，如肾积水，以及涉及神经精神、肝胆和胃肠系统的其他并发症。停止使用氯胺酮后有望逐渐好转。持续戒除是康复的关键，因为复发通常会导致症状再次出现。药物治疗和手术治疗均可采用。香港威尔士亲王医院的青少年泌尿外科治疗中心已为这些患者制定了一个四层治疗方案，初始阶段采用非侵入性检查和治疗。鉴于氯胺酮滥用及戒除状况背后复杂多样的心理因素和社会学背景，多学科护理至关重要。
