电针治疗对脊髓损伤后逼尿肌过度活动患者疗效的影响

目的观察电针治疗对脊髓损伤后逼尿肌过度活动患者疗效的影响,比较电针和普通针刺八髎穴治疗脊髓损伤性逼尿肌过度活动疗效区别,探讨电针治疗脊髓损伤后逼尿肌过度活动的机制。方法选择2014年1月至2017年6月在安徽医科大学第二附属医院康复医学科治疗的脊髓损伤性逼尿肌过度活动患者48例,其中男性28例,女性20例;年龄18~65岁,平均年龄42岁。按照入院顺序随机分为治疗组和对照组。治疗组24例,其中男性15例,女性9例;平均年龄36.83岁。对照组24例,其中男性13例,女性11例;平均年龄44.63岁。对照组采用常规膀胱训练及普通针刺八髎穴治疗,治疗组采用常规膀胱训练及电针八髎穴进行治疗。比较两组患者治疗前和治疗4周后排尿频率、尿失禁次数、平均尿量、膀胱容量、残余尿量和生活质量(QOL)的变化,并评价两组的疗效差异。结果排尿日记评定结果:治疗组治疗后排尿频率、平均尿量、尿失禁次数分别为(5.89±1.07)次、(357.58±84.71) mL、(3.20±1.46)次;组内治疗前后比较,差异有统计学意义(P 0.05)。对照组治疗后排尿频率、平均尿量、尿失禁次数分别为(7.98±2.53)次、(288.83±84.75) mL、(5.24±2.54)次;组内治疗前后比较,差异有统计学意义(P 0.05)。治疗后,治疗组排尿频率、尿失禁次数少于对照组,平均尿量高于对照组;两组比较,差异有统计学意义(P 0.05)。尿动力学评定结果:治疗组治疗后膀胱容量、残余尿量分别为(339.79±87.92) mL、(103.63±42.69) mL。治疗后膀胱容量增加,残余尿量减少;治疗前后比较,差异有统计学意义(P 0.05)。对照组治疗后膀胱容量和残余尿量分别为(277.29±64.25) mL、(136.79±49.1) mL。治疗后膀胱容量增加,残余尿量减少;治疗前后比较,差异有统计学意义(P 0.05)。治疗后,治疗组膀胱容量增加量大于对照组,残余尿量少于对照组;两组比较,差异有统计学意义(P 0.05)。QOL评定结果:治疗组治疗后QOL为(6.63±3.85)分;治疗前后比较,差异有统计学意义(P 0.05)。对照组治疗后QOL为(11.29±6.36)分;治疗前后比较,差异有统计学意义(P 0.05)。治疗组QOL评分低于对照组,差异有统计学意义(P 0.05)。结论电针疗法对脊髓损伤性逼尿肌过度活动患者能够显著改善其排尿频率、尿失禁次数、膀胱容量、残余尿量等膀胱功能,提高患者QOL,整体效果要优于普通针刺治疗。     

原发性遗尿症患儿治疗前后自我意识变化的初探

目的分析评估儿童原发性遗尿症（PNE）自我意识评价状况以及遗尿治疗对自我意识的影响。方法选择2005年7月至2006年1月在复旦大学附属儿科医院确诊的8～16岁PNE患儿为研究对象。排除患有可引起尿床的器质性疾病、治疗前存在高血压、单亲家庭、父母离异、有其他家庭问题及慢性疾病的患儿。指导PNE患儿自己填写Piers-Harris儿童自我意识量表（PHCSS）。随后患儿分3组接受不同方法治疗遗尿：生物反馈治疗组、口服醋酸去氨加压素治疗组和口服中药治疗组，疗程均为1个月。治疗结束3个月后再次指导患儿自己填写PHCSS。通过心理分析软件分析两次自我意识评价结果。结果研究期间共纳入PNE患儿54例，男29例，女25例，平均年龄（10．0±0．6）岁。其中轻度遗尿15例，中度遗尿20例，重度遗尿19例。治疗遗尿前54例患儿自我意识评价结果中焦虑得分显著低于常模（P〈0．01）；并且轻、中和重度PNE患儿焦虑得分均显著低于常模（P〈0．01），不同遗尿严重程度患儿得分差异无统计学意义。其中12例接受生物反馈治疗，14例接受醋酸去氨加压素治疗，28例接受中药治疗。治疗后有44例接受了自我意识评价随访，治疗遗尿后患儿焦虑得分较治疗前明显增加（P〈0．05），其中口服醋酸去氨加压素组治疗后焦虑得分明显提高（P〈0．05）。遗尿治疗有效的患儿得分明显高于治疗前（P〈0．05），而治疗无效的患儿治疗前、后自我意识各项得分差异无统计学意义。结论治疗前PNE患儿自我意识评价结果中焦虑得分低下，通过治疗遗尿其自我意识评价也可得到改善，并且临床疗效好的患儿自我意识改善明显。     

不同功能性电刺激方案联合生物反馈治疗儿童神经源性逼尿肌尿道无收缩尿失禁的疗效

目的:研究不同功能性电刺激(FES)方案联合生物反馈治疗儿童神经源性逼尿肌尿道无收缩(NADS)尿失禁的疗效。方法:纳入68例NADS尿失禁患儿,采用随机数字表法分为对照组(n=34)和观察组(n=34)。对照组在每次治疗中,均以患儿可耐受的初始阈电流强度进行FES联合生物反馈治疗;观察组则在每次治疗中期,在初始阈电流基础上增加电流强度至患儿可耐受的新的阈刺激强度,并持续至治疗结束。每次治疗时间为40 min,每周3次,疗程为12周。在治疗结束后至少6个月门诊随访疗效。分析两组治疗前后及随访6个月时的尿动力学检查(UDS)指标与尿失禁症状,对比两种方案疗效。结果:两组患儿治疗结束及随访6个月时,UDS指标逼尿肌漏尿点压、膀胱容量、逼尿肌最大压力、逼尿肌顺应性与尿失禁症状72 h总排尿次数、总尿失禁次数、国际尿失禁咨询委员会问卷评分均明显改善(P0.05),且观察组均显著优于对照组(P0.05);治疗结束及随访6个月时,观察组总有效率均显著高于对照组(P0.05)。结论:FES联合生物反馈治疗儿童NADS尿失禁,疗效确切且持续稳定,治疗中期增加电流强度方案疗效更佳,临床应用价值高。     

盆底磁刺激治疗女性压力性尿失禁近期疗效初探

目的探讨盆底磁刺激治疗女性压力性尿失禁的短期临床效果。方法20例压力性尿失禁患者，平均年龄为（52．5±11．0）岁．平均产次（1．4±0．6）次：11例（56％）处于绝经期。接受Neocontrol 盆底磁刺激治疗8周，根据治疗前后患者主观和客观临床参数评分进行疗效评价，并进行治疗前后生活质量评分和膀胱充盈试验，治疗结束后随访3个月,随诊率100％。结果治疗结束后75％患者不再漏尿，15％患者症状得到改善。1h尿垫试验结果平均溢尿量减少7．6g,3d溢尿次数平均减少5．1次。16例患者治疗前后行膀胱灌注试验,治疗后初始排尿欲膀胱容量和最大膀胱容量较治疗前增大,差异有统计学意义（P〈0．05）。所有患者生活质量评分显著提高（P〈0．05）。治疗中未见任何副作用。治疗后随诊3个月，治愈患者中60％症状复发。结论盆底磁刺激是治疗压力性尿失禁的安全、有效、简便、无痛的方法，但疗效持续时间较短。     

汶川震后孤儿创伤后应激障碍认知行为治疗的初步观察

目的:对汶川震后的创伤后应激障碍(PTSD)孤儿进行心理干预,探讨认知行为治疗技术的效果.方法:选取汶川地震11个月后的创伤后应激障碍患儿12例,均为孤儿(年龄11 ～ 15岁),其中1例脱落,5例完成了每周1次共8次的团体心理治疗,6例完成了每周1～2次共8次的个体心理治疗.采用事件影响量表(IES)、心理治疗效果评定量表(FEP)、UCLA孤独量表、焦虑自评量表(SAS)和自尊量表(SES)在治疗前、治疗后及3年后随访时进行评定.结果:治疗后11例患儿的PTSD症状均明显缓解,随访时症状无反复,IES总分治疗前、治疗后及随访时逐次降低[(31.6±10.2) vs.(18.2±10.3)vs.(9.0±2.8),均P＜0.001];FEP量表总分、SAS焦虑量表和UCLA孤独量表得分治疗后均低于治疗前[(45.7±16.4) vs.(67.1±23.2),(40.3±9.2) vs.(50.1±10.3),(44.2±8.2) vs.(51.4±10.5);均P＜0.05],随访时与治疗结束时比较差异无统计学意义(P＞0.05).SES评分治疗前、治疗后及随访时逐次升高[(24.6±3.3) vs.(27.9±4.1) vs.(31.8±2.8),均P＜0.05].结论:本研究提示,认知行为治疗适用于地震灾后应激障碍儿童少年,效果良好.     

小儿遗尿症162例临床特点与治疗

目的分析儿童遗尿症的临床特点并对其治疗方法进行探讨。方法对162例符合小儿遗尿症的患儿行尿常规及选择性地进行实验室和物理检查。明确病因者给予相应治疗,全部患儿行心理行为指导及排尿训练,43例加用盐酸丙米嗪（11例）或去氨加压素（32例）治疗。结果162例中有家族遗传史的72例（44.4%）,隐性脊柱裂（spina bifida occulta,SBO）39例,其他病因23例,无确切病因者28例。157例表现为原发性夜间遗尿症（primary nocturnal enuresis,PNE）。23例病因明确者19例治疗有效;其余139例中78例经单纯心理行为指导及排尿训练有效,31例加用药物治疗有效。结论在遗尿症患儿诊治过程中,应作必要的检查,以排除器质性疾病;对PNE患儿的治疗中要注意心理行为问题的早期发现及干预;采用心理行为及药物的综合治疗可收到良好的效果。     

琥珀酸索利那新片联合行为疗法对成年人原发性夜间遗尿症的疗效

目的:观察琥珀酸索利那新片(卫喜康)联合行为疗法治疗成年人原发性夜间遗尿症(PNE)的疗效。方法:收集2010年1月～2011年6月诊治的成年人PNE患者85例,随机分为对照组和治疗组,对照组(n=42)给予行为治疗,治疗组(n=43)在行为治疗的同时,分别于每晚睡前口服卫喜康5mg,3个月后比较两组临床疗效。结果:对照组治疗有效率为23.81%(10/42),痊愈率为2.38%(1/42),治疗组治疗有效率为74.42%(32/43),痊愈率为18.60%(8/43),治疗组有效率和治愈率明显高于对照组,差异有统计学意义(P<0.01)。结论:卫喜康联合行为疗法治疗成年人PNE安全有效,能显著提高患者生活质量。     

遗尿及其矫正

遗尿是一种影响人的身体和心理的不良的行为习惯。造成遗尿的原因主要是生理的、遗传的、情绪的．也可能是社会学习的结果。对遗尿行为的治疗主要使用药物治疗、心理治疗．唤醒强化治疗膀味扩约肌训练、排尿觉醒训练和平床训练。1员尿的表现有道尿行为的儿童经常不自觉地尿床或尿裤，且这种行为并非81生理性病变引起。这种遗尿现象·每月至少有1到2次，对于5～6岁的孩子来说，至少有1次。对于大一点的孩子来说．至少有1次。这种遗尿行为可以分为两大类：一是首级边尿·一是次级遗尿。前者是指在扩约肌成熟阶段前形成的遗尿行为。这时的遗尿…     

小儿突发性遗尿症的病因和治疗

儿科遗尿症是世界性疾病,它对小儿的心智和性格发展造成负面影响.本文对近年门诊的3～14岁突发性(6个月内)不能自觉地控制排尿的儿童15例作回顾性病因分析和治疗探讨.15例患儿以男孩居多(12例,达80%),女孩3例(20%),男:女为4:1,无脑部、肾脏、内分泌及类似家族史.病程为一周至六个月.临床特点:遗尿为一时性有时夜间遗尿1～2次,时而消失,时而再现,个别除夜间遗尿还伴有日间尿失禁.经临床作尿常规,中段尿培养、尿微量蛋白测定、空腹血糖、头部及腰骶部X线摄片、脑电图、五官科检查,排除脑部、肾脏、糖尿病、鼻岬肥大等异常所致遗尿的可能性.结果:5例包茎,3例X线摄片骶椎部隐裂(第3骶椎),2例夜间有蛲虫从肛门爬出,5例无任何阳性体征唯有局部痒感主诉.病因归类为:少数为脊髓或膀胱等器质性疾病引起,如脊柱裂可因先天畸形影响腰骶部脊髓神经而致尿失禁;多数为神经官能性紊乱,受外界不良环境影响和部分内因(包茎、蛲虫、局部分泌物积聚、过分清洁所致局部充血等)偶然起作用,使大脑产生一定强度的兴奋灶导致大脑皮层和皮层下中枢的功能失调而不自觉排尿.治疗以针对病因,除器质性外,更应重视心因性.加强少年儿童精神道德教育并列入儿科当前又一重要研究课题.     

团体心理治疗对胃癌患者生活质量及情绪状况的效果

目的:探索团体心理治疗对胃癌患者生活质量及情绪状况的效果.方法:采用开放对照试验设计,将已确诊为胃癌且已完成临床治疗的54名患者,分为团体心理干预组(n=26)和空白对照组(n=28).对干预组进行每周1次,每次100 min,共10周的团体心理干预,对照组研究期间不接受任何形式的心理干预.采用生活质量核心问卷(QLQ-C30)、焦虑自评量表(SAS)和抑郁自评量表(SDS)分别进行基线、对照组基线评分10周后或干预组10次心理治疗结束当周复评,以及干预组干预后3个月随访.结果:10周末复评时,对照组脱落6人,干预组脱落5人;3个月随访时,收回有效问卷21份.干预组10周末测评在QLQ-C30整体健康和生活质量(平均秩次1.52 vs.1.95,P＜0.05)得分高于基线,在恶心呕吐(平均秩次2.40 vs.1.86)、呼吸困难(平均秩次2.40 vs.1.81)、失眠(平均秩次2.40 vs.1.98)、食欲丧失(平均秩次2.40 vs.1.81)、SAS[(45.7±13.4) vs.(36.7±9.2)]、SDS[(33.9±11.0)vs.(27.8±8.8)]得分上均低于基线(均P＜0.05),并且得分差异在干预后3个月随访时仍然存在.对照组基线与10周末测评的各量表评分差异均无统计学意义(均P ＞0.05).结论:本研究提示,团体心理治疗能够改善胃癌患者的生活质量及焦虑抑郁情绪,促进康复.     

针灸疗法对儿童遗尿症患儿血浆ADH的影响

目的探讨针灸疗法对原发性遗尿症患儿血浆ADH的影响。方法用酶联免疫吸附法测定25例原发性遗尿症患儿治疗前后白天（10am）及夜间（11pm）血清ADH水平,并测定凌晨（7am）和白天（3pm）血尿液渗透压。结果治疗前组在11pm的ADH水平较10am的ADH水平明显降低,差异具有统计学意义（P〈0.05）;治疗后组在11pm和10am的ADH水平无明显变化,差异无统计学意义（P〉0.05）;与治疗前相比较,治疗后组患儿10am的ADH水平无明显变化,差异无统计学意义（P〉0.05）,而11pm则明显升高,差异具有统计学意义（P〈0.05）。晨尿（7am）渗透压治疗前组明显低于治疗后组（P〈0.01）,而白天（3pm）尿渗透压二组之间差异无显著性（P〉0.05）;而血渗透压二组均相对稳定,无明显差异（P〉0.05）。结论针灸疗法对改善患儿遗尿症有明显作用,其机制可能是通过刺激机体ADH释放增多而引起的。     

Brainstem evaluation in children with primary nocturnal enuresis

We investigated the brainstem integrity in children with primary nocturnal enuresis (PNE) using auditory brainstem responses (ABR), blink reflex and exteroceptive suppression of the masseter muscle. We examined 23 children with PNE (16 male, 7 female; mean age: 10.4 years) and 19 control subjects (11 male, 8 female; mean age: 11.8 years). ABR parameters such as wave latencies, amplitudes and interpeak latencies and blink reflex parameters such as R1 and R2 amplitude and latencies were not significantly different between the 2 groups. Although S2 parameters of the exteroceptive suppression of the masseter muscle were easily and completely obtained from the control subjects, in the PNE group S2 onset latency and duration were not recorded in 26% of the study children (n = 6) (P = 0.01). S2 duration time was significantly lowered in the enuretic group (left side: P = 0.001 and right side: P = 0.003). S2 duration time changes in the enuretic group supports a possible brainstem dysfunction in children with PNE.     

Primary nocturnal enuresis: omega-3 fatty acids may be of therapeutic value

Primary nocturnal enuresis (PNE), or bed-wetting, is a distressing urinary condition which can persist through childhood and beyond. Altered prostaglandin and nitric oxide production have been observed in children with PNE, and prostaglandin inhibitors are known to be of therapeutic value. Omega-3 fatty acids have the potential to influence the symptoms of PNE by inhibition of prostaglandin and renal nitric oxide production. In addition, children with PNE have an inappropriate startle response and an apparent maturational delay of the central nervous system. Research clearly shows that omega-3 fatty acids play a critical role in the development and function of the central nervous system. It is our contention that inadequate omega-3 intake may play a role in the lack of inhibitory input to the startle and micturition centers in PNE.     

Dry-Bed Training for Nocturnal Enuresis in Three Children With Multiple Problems

Behavioral approaches to nocturnal enuresis (bed-wetting) have a high success rate, but studies often exclude children who have multiple problems. We report treatment by the dry-bed method of three children with primary nocturnal enuresis who also had other somatic and behavioral difficulties: a 5-year-old boy with cystic fibrosis and asthma, an 11-year-old girl with learning disabilities and chronic urinary infections, and a 9-year-old boy with a speech impediment and daytime incontinence. These children, coping with multiple problems and frequent medical visits, were not very motivated to begin a program for enuresis. Yet, treatment for these three children involved one, one, and four clinic visits, respectively, with follow-up phone calls. Enuresis was completely eliminated in the first two cases and greatly reduced in the third; gains persisted at 3-, 12-, and 30-month follow-ups. Anecdotal reports indicated generalized improvement in these children's functioning after the successful treatment of enuresis.     

Internalizing and externalizing problem behavior in children with nocturnal and diurnal enuresis: a five-factor model perspective

OBJECTIVES: To describe personality traits, internalizing, and externalizing problems of 6- to 12-year-old children with nocturnal and diurnal enuresis, examining differences from healthy referents, and investigating the association between personality traits and problem behavior. METHODS: Eighty-five children with combined nocturnal and diurnal enuresis were compared with 56 children with nocturnal enuresis and 155 healthy children on personality characteristics and problem behavior. RESULTS: Post hoc analyses of multivariate analyses indicated that parents of children with combined nocturnal and diurnal enuresis reported on average lower conscientiousness and higher neuroticism scores in their children than parents of healthy children, although the magnitude of these differences was moderate. Considerable differences in mean scores were found for the Child Behavior Checklist (CBCL) total problem scale and moderate differences for internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) problems in children with nocturnal and diurnal enuresis compared with healthy referents. Regression analyses across enuretic and healthy groups demonstrated that personality trait and problem behavior scales share substantial variance. CONCLUSION: Moderate to substantially higher levels of problem behavior is demonstrated in children with nocturnal and diurnal enuresis, who also display slightly higher neuroticism and lower conscientiousness scores.     

The genetics of primary nocturnal enuresis: inheritance and suggestion of a second major gene on chromosome 12q.

Primary nocturnal enuresis (PNE), or bedwetting at night, affects approximately 10% of 6 year old children. Genetic components contribute to the pathogenesis and recently one locus was assigned to chromosome 13q. We evaluated the genetic factors and the pattern of inheritance for PNE in 392 families. Dominant transmission was observed in 43% and an apparent recessive mode of inheritance was observed in 9% of the families. Among the 392 probands the ratio of males to females was 3:1 indicating sex linked or sex influenced factors. Linkage to candidate regions was tested in 16 larger families segregating for autosomal dominant PNE. A gene for PNE was excluded from chromosome 13q in 11 families, whereas linkage to the interval D13S263-D13S291 was suggested (Zmax = 2.1) in three families. Further linkage analyses excluded about 1/3 of the genome at a 10 cM resolution except the region around D12S80 on chromosome 12q that showed a positive two point lod score in six of the families (Zmax = 4.2). This locus remains suggestive because the material was not sufficiently large to give evidence for heterogeneity. Our pedigree analysis indicates that major genes are involved in a large proportion of PNE families and the linkage results suggest that such a gene is located on chromosome 12q.     

The efficacy of different forms of acupuncture for the treatment of nocturnal enuresis in children: A systematic review and meta-analysis

BackgroundThe efficacy of different forms of acupuncture for the treatment of nocturnal enuresis in children is not known.ObjectiveTo determine the efficacy of different forms of acupuncture, such as manual acupuncture, laser/electroacupuncture, acupoint injection, and moxibustion, for the treatment of nocturnal enuresis.MethodsA literature search was conducted on Medline, EMBASE, Web of Science, CINAHL, PubMed, Physiotherapy Evidence Database, and Scopus from database inception to September 2020. The Cochrane risk of bias tool was utilised to evaluate the risk of bias in each included study. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool.ResultsThirteen trials (n = 890) were included. Meta-analyses revealed significantly greater numbers of children reporting improved nocturnal enuresis in the moxibustion (p = 0.004), acupoint injection (p = 0.020), and laser acupuncture (p = 0.001) groups than in the control groups. Meta-analyses showed no significant differences in the numbers of children reporting the complete cure of nocturnal enuresis between laser acupuncture and desmopressin (p = 0.57).ConclusionsThe review identified moxibustion, acupoint injections, and laser acupuncture as effective treatments for nocturnal enuresis in children. However, the evidence for these interventions is limited and of very-low-grade quality. The effects of laser acupuncture compared with desmopressin remain inconclusive.     

Prevalence and risk factors for childhood nocturnal enuresis.

A large population based study was carried out to describe the epidemiology of nocturnal enuresis and to outline medical management of the problem. Parents of 1,806 schoolchildren were surveyed and prevalence was ascertained at 13% with two thirds classified as primary enuretics. Significant associated factors included social class, unemployment, family stress and a parental family history of enuresis. Enuretics were more likely to be behind at school, have behavioural problems, soiling and daytime wetting. Enuresis was distressful for the family yet most children never saw a doctor about the problem. In those that did, less than two thirds had a urine test and 40% of parents remained dissatisfied with the outcome of the visit to the doctor. Children were more likely to be prescribed medicine than other treatments whereas the enuresis alarm was recommended for only one in ten children. These findings illustrate that nocturnal enuresis continues to be a problem, that the characteristics of Irish enuretics differ from those in other countries and that medical management of enuresis has room for improvement.