多药联合治疗间质性膀胱炎的临床分析

董锐; 徐肇斌; 王国举; 王宁华; 龙武林; 刘钰

多药联合治疗间质性膀胱炎的临床分析

- 武汉科技大学附属汉阳医院泌尿外科(武汉, 430050)

详细信息

通讯作者: 董锐,E-mail:dongruidrlr@yahoo.cn

中图分类号: R694.3

收稿日期: 2012-07-25

The efficacy and safety of combined medical therapy for interstitial cystitis

- Department of Urology, Hanyang Hospital of Wuhan University of Science and Technology, Wuhan, 430050, China

More Information

Corresponding author: DONG Rui, E-mail: dongruidrlr@yahoo.cn

Received Date: 25 July 2012

摘要

摘要: 目的：探讨多种药物联合治疗间质性膀胱炎（IC）的有效性和安全性。方法：24例女性IC患者，平均年龄（43.4±8.9）岁，随机分为A、B两组，每组12例。A组口服阿米替林、托特罗定；B组除口服A组药物外加用碱化利多卡因联合肝素膀胱灌注治疗，将2%利多卡因15 ml+肝素50 000 U+5%碳酸氢钠10 ml+0.9%氯化钠10 ml混合液行膀胱灌注，保留30 min，每周两次。观察并对比A、B两组治疗前及治疗后3个月和6个月每日排尿次数、最大排尿量、疼痛评分，O'Leary-Sant IC评分和生活质量评分（QOL）情况。并记录不良反应发生情况。结果：①治疗3个月和6个月后，A、B两组各项指标明显改善，分别与治疗前相比差异均有统计学意义（P<0.05）；而且，治疗后相同时间段A、B两组各项指标之间差异也均有统计学意义（P<0.05）。治疗后不同时间段，A组各项指标之间差异无统计学意义（P>0.05），而B组各项指标之间差异均有统计学意义（P<0.05）。②A、B两组患者全部接受完治疗，A组中共有3例出现倦怠、2例出现口干，均可耐受；B组中2例出现倦怠，2例灌注后出现轻度肉眼血尿，均自行缓解。结论：阿米替林、托特罗定同时使用是治疗IC合适的口服药物方案，而服药同时早期就进行利多卡因加肝素膀胱灌注的联合治疗方案，不仅能够显著提高IC治疗的短期效果，也可以增加远期疗效，而且耐受性和安全性较好，是值得临床推广的方案。
- 间质性膀胱炎 /
- 药物治疗 /
- 膀胱灌注 /
- 联合
Abstract: Objective: To evaluate the efficacy and safety of combined medical therapy in the treatment of interstitial cystitis(IC).Method: Twenty-four female patients with IC, mean age (43.4±8.9) years, were randomly divided into two groups, including Group A (n=12) and Group B (n=12). Group A were treated with amitriptyline and tolterodine. Group B were treated with the oral drugs of group A and intravesical irrigation with combination of heparin 50 000 U, 2% Lidocaine 15 ml and 5% sodium bicarbonate 10 ml, 30 minutes every time, twice per week for 6 months. The prior- and post-treatment assessments were conducted for the voiding frequency, maximal voiding volume, pain score, O'Leary-Sant IC symptom and problem index, and quality of life score(QOL). Adverse events were recorded.Result: ① After treatment for 3 and 6 months, all assessment indexes of the two groups were significantly improved (P<0.05). However, the extent of each index improvement of B groups was better than that of A group at the same post-treatment period time(P<0.05). In addition, there was no significant difference between 3 and 6 months of post-treatment in each index of group A (P>0.05), whereas the difference was significant in group B (P<0.05). ② No patient quitted from the treatment. In group A, 3 patients felt drowsiness and 2 patients felt mouth dryness. In group B, Mild macroscopic hematuria occurred after intravesical irrigation in 2 patients, and drowsiness was recorded in 2 patients. These side effects could be tolerated by the patients.Conclusion: Using amitriptyline and tolterodine is an effective and appropriate oral drug therapy in the treatment of IC. Meanwhile, intravesical irrigation with combination of heparin and alkalinized lidocaine early can significantly improve not only the short-term effects but also the long-term efficacy, and the side effects are well tolerated. Thus, this combined medical therapy might be potentially used clinically.
- interstitial cystitis /
- drug therapy /
- intravesical irrigation /
- combination

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参考文献(12)

[1]	Oberpenning F, van Ophoven A, Hertle L. Interstitial cystitis:an update[J]. Curr Opin Urol, 2002, 12:321-332.
[2]	Harnno P M. Interstitial cystitis and related disorders[M]//Walsh P C, Retick A B, Vanghan E D. Campbell' urology. Philadelphia, Saunders, 2002:631-667.
[3]	Parsons C L, Bullen M, Kahn B S, et al. Gynecologic presentation of interstitial cystitis as detected by intravesical potassium sensitivity[J]. Obstet Gynecol, 2001, 98:127-132.
[4]	Parsons C L. The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis[J]. Urology, 2007, 69:9-16.
[5]	Theoharides T C, Kempuraj D, Sant G R. Mast cell involvement in interstitial cystitis:a review of human and experimental evidence[J]. Urology, 2001, 57:47-55.
[6]	Sant G R, Kempuraj D, Marchand J E, et al. The mast cell in interstitial cystitis:role in pathophysiology and pathogenesis[J]. Urology, 2007, 69:34-40.
[7]	Rothrock N E, Lutgendorf S K, Hoffman A, et al. Depressive symptoms and quality of life in patients with interstitial cystitis[J]. J Urol, 2002, 167:1763-1767.
[8]	Hertle L, van Ophoven A. Long-term results of amitriptyline treatment for interstitial cystitis[J]. Aktuelle Urol, 2010, 41 Suppl 1:S61-S65.
[9]	Diokno A C, Appell R A, Sand P K, et al. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder:results of the OPERA trial[J]. Mayo Clin Proc, 2003, 78:687-695.
[10]	Parsons C L. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis[J]. Urology, 2005, 65:45-48.
[11]	Dell J R, Butrick C W. Multimodal therapy for painful bladder syndrome/interstitial cystitis[J]. J Reprod Med, 2006, 51:253-260.
[12]	Butrick C W, Howard F M, Sand P K. Diagnosis and treatment of interstitial cystitis/painful bladder syndrome:a review[J]. J Womens Health (Larchmt), 2010, 19:1185-1193.