Etiology and pathology of enuresis among primary school children in Isfahan, Iran

OBJECTIVE: To determine the etiology and pathogenesis of enuresis among primary school children by using a special ultrasound (US) protocol for the assessment of bladder dysfunction and to compare excretion of urinary sodium and calcium in enuretic children. METHODS: We conducted this cross sectional study on 66 enuretic children aged 6-12 years from September 2005 to January 2006 in Isfahan University of Medical Sciences, Iran. Ultrasound (US) was designed for the evaluation of bladder parameters using bladder volume and wall thickness index (BVWI%), and expected percentage bladder volume index for kidney volume. RESULTS: Sixty children (90.9%) had nocturnal enuresis, 5 (7.5%) had diurnal enuresis and one child (1.6%) had nocturnal and diurnal enuresis. Urinary infection was detected in one child (1.5%). The incidence of urinary system abnormalities was 10.6% in all enuretic children. Hypercalciuria was seen in 9.2% and natriuresis in 20.3%. Normal bladder function (BVWI 70% to <130%) was seen in 67%, small bladder with a thick wall (BVWI <70%) in 27% and large bladder capacity with a thin wall (BVWI >130%) was seen in 6% of children with primary nocturnal enuresis (PNE). There was a significant difference in BVWI between children with PNE and secondary nocturnal enuresis (p=0.01). CONCLUSION: Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Our results show that US measured bladder parameters can provide useful clues for the underlying bladder dysfunction and may help to guide clinical management.     

神经源性夜遗尿与单症状性夜遗尿尿动力学表现

目的 :探讨神经源性夜遗尿与单症状性夜遗尿的尿动力学表现。方法 :对 36例神经源性夜遗尿患者和14例单症状性夜遗尿患者进行尿动力学测定。结果 :神经源性夜遗尿患者除表现为夜遗尿症状外 ,多伴有白天排尿异常。单症状性夜遗尿患者排尿后残余尿量、逼尿肌功能过度活跃发生率、逼尿肌收缩乏力发生率显著低于神经源性夜遗尿患者 (P <0 .0 5 ) ;单症状性夜遗尿患者膀胱顺应性、最大尿道压和最大尿道闭合压显著高于神经源性夜遗尿患者 (P <0 .0 5 )。结论 :对于夜遗尿患者应区分是否存在神经损害 ,并进行尿动力学检查 ,了解膀胱尿道的功能状态 ,从而进行针对性治疗     

儿童功能性遗尿症的人格分析

目的分析小儿功能性遗尿症的人格个性特点。方法对41例功能性遗尿症儿童和30例正常对照组儿童采用艾森克人格问卷(少年)进行对照分析。结果功能性遗尿症组患儿的E维度和N维度平均得分与正常对照组儿童比较,差异有显著性意义(P<0.01);两组儿童的P维度和L维度平均分比较则差异无显著性意义(P>0.05)。结论对于排除器质性因素以外的功能性遗尿症儿童,焦虑或抑郁等的不良心理因素起重要的作用,心理行为的干预治疗是该类患儿的主要治疗方法之一。     

儿童功能性遗尿症的人格分析

目的 分析小儿功能性遗尿症的人格个性特点。方法 对41例功能性遗尿症儿童和30例正常对照组儿童采用艾森克人格问卷（少年）进行对照分析。结果 功能性遗尿症组患儿的E维度和N维度平均得分与正常对照组儿童比较,差异有显著性意义（P〈0.01）;两组儿童的P维度和L维度平均分比较则差异无显著性意义（P〉0.05）。结论 对于排除器质性因素以外的功能性遗尿症儿童,焦虑或抑郁等的不良心理因素起重要的作用,心理行为的干预治疗是该类患儿的主要治疗方法之一。     

肥胖症伴阻塞性睡眠呼吸暂停综合征患者夜尿次数的研究

目的：探讨肥胖症伴阻塞性睡眠呼吸暂停综合征（OSAS）患者夜尿次数的变化。方法：根据睡眠期多导睡眠监测中的呼吸暂停低通气指数（AHI）结果,将肥胖症伴OSAS患者（50例）分为肥胖症伴轻度OSAS组（27例）和肥胖症伴中重度OSAS组（23例）,选肥胖症患者（20例）作为对照组,并记录各观察单位的夜尿次数。并对肥胖症伴OSAS患者作夜尿次数分别与睡眠期AHI、最低脉氧饱和度（Lowest SaO2）的相关性分析。结果：与对照组夜尿次数（1.0±0.19次）相比,肥胖症伴轻度OSAS组（2.1±0.31次,P〈0.01）与肥胖症伴中重度OSAS组（3.2±0.65次,P〈0.01）均明显增多,且肥胖症伴OSAS两组间有明显差异（P〈0.01）,夜尿次数随OSAS程度加重而增高,相关性分析显示肥胖症伴OSAS患者夜尿次数与呼吸暂停低通气指数呈显著正相关（r=0.675,P〈0.01）,与最低脉氧饱和度呈显著负相关（r=-0.734,P〈0.01）。结论：肥胖症伴OSAS患者夜尿次数显著增高且与OS-AS的严重程度相关。     

4. Bedwetting and toileting problems in children

Bedwetting (nocturnal enuresis) is common. It occurs in up to 20% of 5 year olds and 10% of 10 year olds, with a spontaneous remission rate of 14% per year. Weekly daytime wetting occurs in 5% of children, most of whom (80%) also wet the bed. Bedwetting can have a considerable impact on children and families, affecting a child's self-esteem and interpersonal relationships, and his or her performance at school. Primary nocturnal enuresis (never consistently dry at night) should be distinguished from secondary nocturnal enuresis (previously dry for at least 6 months). Important risk factors for primary nocturnal enuresis include family history, nocturnal polyuria, impaired sleep arousal and bladder dysfunction. Secondary nocturnal enuresis is more likely to be caused by factors such as urinary tract infections, diabetes mellitus and emotional stress. The treatment for monosymptomatic nocturnal enuresis (bedwetting with no daytime symptoms) is an alarm device, with desmopressin as second-line therapy. Treatment for non-monosymptomatic nocturnal enuresis (bedwetting with daytime symptoms--urgency and frequency, with or without incontinence) should initially focus on the daytime symptoms.Bedwetting without daytime symptoms, the most common toileting problem, can be effectively treated with an alarm device.     

Significance of recent onset nocturnal enuresis in adult men: a prospective study

INTRODUCTION: Although literature on childhood nocturnal enuresis and its persistence into adulthood is abundant, recent onset nocturnal enuresis in adults is a poorly studied symptom. OBJECTIVE: To determine the significance of recent onset nocturnal enuresis in adult males in relation to lower urinary tract pathology, and its treatment. METHODS: All men with recent onset nocturnal enuresis attending a urology unit over a period of 12 months were evaluated prospectively. Their treatment and outcome were recorded. RESULTS: There were 30 patients (mean age 64 years). Ultrasonography revealed upper urinary tract dilatation in 22 patients. Another six patients had post-void residual urine volume over 500 mL without upper tract dilatation. Only two patients did not have ultrasonographic evidence of bladder outflow obstruction. Elevated blood urea was noted in 14 patients. Twenty patients underwent transurethral resection of the prostate (TURP) and one patient with balanitis xerotica obliterans had circumcision and meatotomy. Three patients were taught clean intermittent self catheterisation, and three patients preferred indwelling urethral catheters. One patient while awaiting TURP died of a myocardial infarction. Eight patients, who were treated with alpha-adrenergic antagonists initially, required further intervention later as the response to medical therapy was poor. CONCLUSIONS: Recent onset nocturnal enuresis in adult males is a symptom closely associated with significant lower urinary tract pathology requiring early urological intervention. Considering its impact on management it is reasonable to classify recent onset nocturnal enuresis as a lower urinary tract symptom in adult men and including it in symptom scores used to assess bladder outflow obstruction.     

30例遗尿症儿童的个性特征与生活质量调查

目的探讨遗尿症儿童的个性特征及生活质量。方法采用儿童艾森克个性问卷(EPQ)及儿少生活质量问卷(ISLQ)，对30例遗尿症儿童及32例健康儿童进行对照研究。结果患儿组的E量表分、N量表分与对照组间差异有显著性意义，生活质量各维度均分及总体满意度患儿组与对照组问差异有显著性意义。结论遗尿症儿童个性特征倾向于内向性，有忧虑、抑郁及自卑感，生活质量受到明显损害。     

表现为遗尿的神经源性膀胱影像尿动力学诊断

目的探讨影像尿动力学诊断以遗尿为主要临床表现的神经源性膀胱患者的膀胱功能改变.方法对2例经B超影像尿动力学检查证实为神经源性膀胱的病例进行回顾性分析.结果2例患者均以遗尿为主诉就诊,B超尿动力学检查表现为充盈期膀胱颈口不能完全关闭,排尿期膀胱颈口不开放,膀胱大量残余尿,上尿路损害,瘫痪性膀胱.结论对于临床表现为遗尿的患者,影像尿动力学检查可以全面地了解膀胱尿道功能.     

正压通气治疗对阻塞性睡眠呼吸暂停综合征是心律失常的作用

目的：探讨阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患病情严重程度与夜间心律失常的关系,以及经鼻持续气道内正压（ｎ－ＣＰＡＰ）通气治疗对心律失常的作用。方法：１０１例阻塞性睡眠呼吸暂停综合征患按呼吸紊乱指数分轻、中、重三组,观察夜间平均心率变化、最大心率变化、最慢心率、最快心率及心律失常累计时间,比较组间差异性,并对１６例患进行了ｎ－ＣＰＡＰ治疗前后各项参数的比较。结果：夜间心率变化和夜间心律失常     

氢氯噻嗪治疗儿童夜尿症的随机对照研究

目的：探讨氢氯噻嗪治疗夜尿症的有效性。方法：前瞻性纳入2010年1月～2010年9月我院夜尿症患儿100例,实际纳入病例95例,将其分为实验组（47例）和对照组（48例）。实验组服用氢氯噻嗪,对照组服用安慰剂。评估夜尿症的缓解情况及药物不良反应,并比较两组间的差异。结果：所有纳入患者均对药物有较好的耐受性。氢氯噻嗪和安慰剂均能明显缓解夜尿症的发生（57.4%vs 33.3%）,差异具有统计学意义（P=0.018）,但氢氯噻嗪降低夜尿症频率缓解程度50%以上者较安慰剂效果更明显（48.1%vs 12.5%）,差异具有统计学意义（P=0.018）。结论：氢氯噻嗪能安全而有效地缓解儿童夜尿症,但是在以后的研究和临床中其临床效果仍有待于进一步证实。     

阻塞性睡眠呼吸暂停综合征患者心律失常的临床分析

目的 探讨阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS）与心律失常的关系.方法 对经多导睡眠仪监测（polysomnography,PSG）确诊的OSAS 69例患者行24h动态心电图（Holter）监测,同时选择21例单纯鼾症患者作为对照组.结果 OSAS组患者体重、呼吸暂停低通气指数（apnea hypopnea index,AHI）和最低血氧饱和度（lowest saturation,LSaO2）与对照组差异有统计学意义（P＜0.05、P＜0.01）;OSAS组心律失常发生率为62.32%,并且随OSAS病情加重,心律失常发生率升高、时间延长及恶性程度加重.结论 OSAS患者心律失常的发生与呼吸暂停低通气指数及低氧血症密切相关.     

儿童原发性夜间遗尿症的临床分析

[摘要]目的 了解儿童原发性遗尿症（PNE）的临床特点。方法 对112 例确诊为PNE的患儿临床表现及其相关因素进行问卷调查, 并进行描述性统计分析。结果 患儿遗尿发生次数1 ～3夜/周25例（22.3%）,4 ～6夜/ 周54例（48.2%）,7夜/周33例（29.5%）；0 ～1次/夜24例（21.4%）,1 ～2次/夜60例（53.6%）,2 ～3次/夜24例（21.4%）,>3次/夜4例（3.57%）。 遗尿发生时间:前半夜（12时前）54例（48.2％）,后半夜（12时后）36例(32.1%),不定时者22例（19.6%）。其中后半夜中1 ～3Am 24例（66.7%）。其中夜间经常自行起床排尿10例( 8.9 %) ；偶尔自行起床排尿32例( 28.6 %) ；从不自行起床排尿70例( 62.5 %).尿湿后仍沉睡，较难唤醒者81.3％。 60例（53.6%）患儿因尿床而不愿或拒绝户外野营、学校寄宿、亲朋家住宿；其中8 ～13岁患儿39例(79.6％)，5 ～8岁患儿21例(33.3％)。结论 多数PNE患儿缺乏夜间排尿控制技能, 可能存在睡中觉醒障碍。遗尿可导致患儿沮丧、自卑，影响其社会活动，随年龄增大其影响愈明显。     

夜间遗尿症儿童气质与家庭环境特征研究

目的 探讨夜间遗尿症儿童的气质纬度及家庭环境特点,为其综合干预与治疗提供理论依据.方法 采用问卷调查与专科随访相结合的方式.选择5～6岁夜间遗尿症儿童94例,采用病例对照研究的方法探讨夜间遗尿症儿童的气质纬度和家庭环境特征.结果 夜间遗尿症儿童气质维度方面的活动水平、反应强度、坚持度及反应阈得分[分别为(3.89±0.83)分,(4.02±0.88)分,(4.25±0.57)分,(3.11±0.67)分]高于对照组[分别为(3.66±0.78)分,(3.59±0.79)分,(4.04±0.58)分,(2.94±0.69)分],差异有统计学意义(P＜0.05),规律性、趋避性、适应度及注意分散度得分[分别为(4.57±1.08)分,(4.51±0.94)分,(4.77±0.75)分,(4.42±0.84)分]低于对照组[分别为(4.80±0.84)分,(4.90±0.89)分,(5.25±0.80)分,(4.65±0.73)分],差异有统计学意义(P＜0.05);家庭环境特征方面病例组在情感表达、独立性、成功性、知识性、娱乐性方面的得分[分别为(5.62±1.68)分,(4.83±1.74)分,(5.85±1.77)分,(3.94±1.87)分,(4.72±2.20)分]低于对照组[分别为(6.13±1.39)分,(5.56±1.41)分,(6.46±1.90)分,(4.72±2.04)分,(5.36±2.32)分],差异有显著统计学意义(P＜0.01),而控制性的得分(4.51±2.08)分高于对照组(4.03±1.91)分,差异有统计学意义(P＜0.05).结论 夜间遗尿症儿童有独特的气质特点,其家庭环境不良.在对夜间遗尿症儿童进行综合干预时,应改善其家庭环境并结合其气质特点进行,以促进患儿的早日康复.     

微觉醒与低氧对阻塞性睡眠呼吸暂停综合征合并高血压患者昼夜血压的影响

目的　研究睡眠过程中反复发生的微觉醒与低氧是否影响阻塞性睡眠呼吸暂停综合征(OSAS)合并高血压患者的昼夜血压水平。方法　 6 0例OSAS患者根据门诊血压、2 4h动态血压和多导睡眠图监测结果分为OSAS合并高血压组 (OSAS +HT组 ,30例 )与单纯OSAS组 (OSAS组 ,30例 )。测定运动微觉醒指数 (MAI)、皮质微觉醒指数 (CAI)、呼吸暂停低通气指数 (AHI)、血氧饱和度低于90 %的时间 (OLT90 %)和 2 4h平均收缩压 (ASBP)与舒张压 (ADBP)。以OSAS +HT组 2 4h平均收缩压与舒张压分别与MAI、CAI、AHI、OLT90 %、体重指数和年龄作多元逐步回归分析。结果　影响OSAS +HT组 2 4h收缩压与舒张压的第一重要因素是MAI(ASBP :r =0 485 ,P <0 0 1;ADBP :r =0 40 7,P <0 0 5 ) ,第二重要因素 :OLT90 %(ASBP :r=0 382 ,P <0 0 5 ;ADBP :r=0 36 9,P <0 0 5 )。结论　反复发生于呼吸暂停终末的运动微觉醒与低氧是影响OSAS合并高血压患者昼夜血压水平的重要因素 ,它们可能是参与OSAS患者长期高血压形成的重要因素。     

阻塞性睡眠呼吸暂停综合征患者血浆血管内皮生长因子浓度测定

目的探讨伴有不同程度夜间缺氧血症的阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome,OSAS)患者血浆血管内皮生因子(Vascular endothelial growth factor,VEGF)浓度的变化.方法40例经多导睡眠图(polysomnography,PSG)检查诊断为OSAS的患者,根据夜间缺氧程度分为2组(重度夜间缺氧组和非重度夜间缺氧组),每组各20例.清晨空腹采用检测血浆VEGF浓度.结果重度夜间缺氧组血浆VEGF浓度为(125.96±99.04)pg/ml,而非重度夜间缺氧组血浆VEGF浓度为(49.83±17.16)pg/mi,二者之间有显著差异.血浆VEGF浓度与夜间缺氧程度呈正相关(r=0.743,P＜0.01).结论重度夜间缺氧的OSAS患者血浆VEGF浓度明显升高,OSAS患者夜间缺氧的严重程度呈血浆VEGF浓度正相关.     

OS和OSAS患者夜间缺氧和睡眠结构的分析

目的 探讨重叠综合征(overlap syndrome,OS)和阻塞性睡眠呼吸暂停综合征(obstrucfive sleep apnea syn-drome,OSAS)患者夜间缺氧和睡眠结构的分析。方法 对19例OS和25例OSAS患者进行肺功能和全夜多导睡眠(PSG)检查。结果 OS组SLT90%、S1+2显著高于OSAS组(P<0.01),睡眠效率显著低于OSAS组(P<0.01)。结论 OS患者较OSAS患者夜间缺氧更严重,睡眠结构改变明显。     

冠心病与阻塞性睡眠呼吸暂停综合征的相关性研究

目的探讨冠心病与阻塞性睡眠呼吸暂停综合征（OSAS）的相关性。方法选取2009年1月～2010年12月心血管内科的冠心病患者共100例,其中冠心病合并OSAS组患者33例,冠心病组患者67例,均进行一般情况与各指标的观察和测量。结果两组患者的体重指数、腰臀比、夜间胸痛、夜尿增多、晨起口干与嗜睡评分,GLU、INS、TC、SO2、AHI、SO2〈90%时间百分比和夜间出现ST压低于0.05mV,差异均具有统计学意义（P〈0.05）。结论冠心病合并OSAS发病率高,因此应详细询问冠心病患者的病史与体检,特别是夜尿多、夜间胸痛及肥胖患者,极易合并OSAS,要及时进行睡眠检测诊断,早期治疗将显著改变预后,从而降低冠心病风险。     

阻塞性睡眠呼吸暂停综合征患者心律失常的临床分析

目的 :探讨阻塞性睡眠呼吸暂停综合征 (obstructivesleepapneasyndrome ,OSAS)与心律失常的关系。方法 :对经多导睡眠仪监测 (Polysomnography ,PSG)确诊的OSAS 4 9例行 2 4h动态心电图 (Holter)观察 ,同时选择 2 0例单纯鼾症患者作为对照组。结果 :OSAS组患者体重、呼吸暂停低通气指数 (apneahypopneaindex ,AHI)和最低血氧饱和度 (lowestsaturation ,LSaO2 )与对照组差异有显著性 (P<0 .0 5 ,P <0 .0 1) ;OSAS组心律失常发生率为 5 1.11% ,并且随OSAS病情加重 ,心律失常发生率升高。结论 :OSAS患者心律失常的发生与呼吸暂停低通气指数及低氧血症密切相关     

补中益气汤配合针刺疗法对遗尿症患儿睡眠觉醒水平的影响

目的：观察补中益气汤配合针刺治疗对遗尿症患儿睡眠觉醒水平的影响,以便为中医药治疗小儿遗尿症提供科学依据。方法：选择2006年10月～2010年10月在我院门诊治疗的遗尿症患儿180例,随机将其分为治疗组（60例）、对照组I（60例）和对照组Ⅱ（60例）,治疗组采用补中益气汤配合针刺治疗,对照组I采用补中益气汤治疗,对照组Ⅱ采用口服醋酸去氨加压素治疗,并观察三组治疗效果。结果：治疗组总有效率为96．7％,对照组I总有效率为76．7％,对照组Ⅱ总有效率为63．3％,治疗组临床疗效明显高于对照组I和对照组Ⅱ（P〈0．05）,对照组I和对照组Ⅱ临床疗效相比,差异无统计学意义（P〉O．05）。结论：补中益气汤配合针刺疗法可明显提高遗尿症患儿的睡眠觉醒水平,治疗小儿遗尿症效果显著,临床上值得推广应用。