中西医结合治疗小儿原发性遗尿症的临床研究

目的观察弥凝加中药敷脐治疗小儿原发性遗尿症的临床疗效及复发率。方法将临床诊断为原发性遗尿症的儿童121例随机分成观察组和对照组,观察组用弥凝加中药敷脐治疗,对照组单纯应用弥凝治疗,比较两组的治疗总有效率和复发率。结果对照组总有效率为86.67%,观察组总有效率为96.72%,两组相比在统计学上无显著性差异(χ2=2.816,P>0.05),但观察组复发率明显低于对照组,两者相比在统计学上有显著性差异(χ2=6.258,P<0.05)。结论中西医结合治疗小儿原发性遗尿症疗效显著且复发率低,临床用药简单,易被广大遗尿患儿接受,值得临床推广应用。     

生物反馈疗法联合电刺激治疗儿童原发性遗尿症的疗效观察

目的 观察生物反馈联合电刺激治疗儿童原发性遗尿症(PNE)的临床效果.方法 PNE患儿60例,均分为生物反馈治疗组(A组)和生物反馈联合电刺激治疗组(B组),疗程1个月,治疗结束后随访1个月,比较治疗前后遗尿频率的变化,判断疗效.结果 随访1个月,A组治愈率33.3％,有效率86.7％,B组治愈率60.0％,有效率96.7％,两组治愈率比较差异有统计学意义(P＜0.05),有效率无统计学差异(P＞0.05).结论 生物反馈联合电刺激治疗儿童PNE优于单独使用生物反馈疗法.     

去氨加压素治疗小儿遗尿症的临床研究

目的 研究应用去氨加压素治疗小儿原发性遗尿症临床疗效.方法 原发性遗尿症患儿112例,实验组（56例）口服去氨加压素片剂联合心理治疗,对照组（56）心理行为治疗.结果 对照组的总有效率明显低于实验组,两组比较差异有统计学意义,两组复发率比较差异无统计学意义.结论 去氨加压素治疗小儿原发性遗尿症,疗效显著,易被广大患儿接受,值得临床推广应用.     

醒脾养儿颗粒结合心理行为疗法治疗小儿原发性夜间遗尿症的临床研究

目的观察苗药醒脾养儿颗粒结合心理行为疗法治疗小儿原发性夜间遗尿症的临床疗效及复发率。方法 157例确诊为原发性单一症状性夜间遗尿症的患儿,在家长和患儿同意进行2个月的治疗并坚持随访情况下,将其随机分为2组:①单纯心理行为治疗组70例;②联合治疗组87例,醒脾养儿颗粒口服结合心理行为疗法治疗。家长和患儿决定暂不治疗或延期治疗的64例患儿归为对照组,并定期随访。对3组患儿2个月治疗结束时,和停止治疗3个月后遗尿症的缓解情况进行比较分析。结果联合治疗组总有效率为72.09%,单纯心理行为治疗组总有效率为46.37%,两组比较差异有统计学意义,联合治疗组复发率为12.79%,明显低于单纯心理行为治疗组的26.47%,两者比较差异有统计学意义。结论醒脾养儿颗粒结合心理行为疗法治疗小儿原发性遗尿症疗效显著且复发率低,临床用药简单,无明显不良反应,易被广大遗尿症患儿接受,值得临床推广应用。     

醒脾养儿颗粒治疗小儿原发性夜间遗尿症的临床观察

目的:观察醒脾养儿颗粒治疗小儿原发性夜间遗尿症的疗效和安全性。方法:97例原发性夜间遗尿症患儿随机分为对照组(46例)和观察组(51例)。对照组患儿给予消旋山莨菪碱片0.5 mg/(kg·d),口服,每日1次+维生素B1片10 mg,口服,每日3次+谷维素片10 mg,口服,每日3次+睡前30 min口服盐酸甲氯芬酯胶囊0.1 g,口服,每日1次。观察组患儿在对照组治疗的基础上加服醒脾养儿颗粒5~6岁0.4 g,7~14岁0.6 g,每日3次。两组均连续治疗4周。观察两组患儿的临床疗效,治疗前后肾阳虚症状积分、唤醒阈、膀胱容量、膀胱容量壁厚指数(BVWI)、遗尿频率、血清精氨酸加压素(AVP)、环磷酸腺苷(c AMP)、环磷酸鸟苷(c GMP)、c AMP/c GMP,复发率及不良反应发生情况。结果:观察组患儿总有效率显著高于对照组,差异有统计学意义(P<0.01)。治疗后,两组患儿肾阳虚症状积分、唤醒阈、BVWI、遗尿频率、血清c GMP均显著低于同组治疗前,且观察组显著低于对照组;两组患儿膀胱容量、血清AVP、c AMP、c AMP/c GMP均显著高于同组治疗前,且观察组显著高于对照组,差异均有统计学意义(P<0.01)。治疗3个月后,两组总有效患儿复发率比较,差异无统计学意义(P>0.05);治疗6个月后,观察组总有效患儿复发率显著低于对照组,差异有统计学意义(P<0.01)。两组患儿不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在常规治疗的基础上,醒脾养儿颗粒治疗小儿原发性夜间遗尿症的疗效和安全性均较好,可改善患儿肾阳虚症状及唤醒阈,提高患儿的膀胱容量和血清AVP。     

中药熏蒸配合敷脐治疗小儿遗尿症62例疗效观察

目的观察中药熏蒸配合敷脐治疗小儿遗尿症的临床疗效。方法将118例遗尿症患儿随机分为治疗组62例与对照组56例,治疗组予中药遗尿散熏蒸配合敷脐,对照组予盐酸甲氯芬酯胶囊口服,治疗28d后比较2组的临床疗效。结果治疗组总有效率为90．3％,对照组为80．3％,2组总有效率经统计学分析,差异有统计意义（P〈0．05）,说明治疗组疗效优于对照组。结论中药熏蒸配合敷脐治疗小儿遗尿症具有良好的疗效,值得临床推广应用。     

自拟遗尿方治疗小儿遗尿症脾肾两虚型30例临床观察

目的观察自拟遗尿方治疗小儿遗尿症脾肾两虚型的临床疗效。方法将60例遗尿症脾肾两虚型患儿随机分为治疗组和对照组,各30例。对照组给予基础行为治疗,治疗组在对照组治疗方法的基础上加服自拟遗尿方。治疗4周后,比较2组的主症和次症的变化、中医症候积分及临床疗效。结果治疗组总有效率为96.7%,对照组为73.3%,2组比较差异有统计意义(P0.05);治疗后2组中医症候积分比较,差异有统计意义(P0.05)。结论遗尿方治疗遗尿症脾肾两虚型患儿,能明显减少遗尿次数,改善睡眠深度及临床症状,充分证实了温补脾肾法治疗小儿遗尿症脾肾两虚型的有效性。     

自拟醒脑止遗汤治疗儿童遗尿症33例临床观察

目的观察自拟醒脑止遗汤治疗儿童遗尿症的临床疗效。方法选取2018年6月至2019年3月南通大学附属常州儿童医院儿童遗尿症专科门诊就诊的遗尿症患儿64例,按随机数字表法分为对照组31例和治疗组33例。2组均予以生活训练指导,对照组在生活训练指导的基础上予去氨加压素口服治疗,治疗组在生活训练指导的基础上口服自拟醒脑止遗汤,2组均连续治疗4周并观察1个月后统计疗效。结果治疗组总有效率为87.9%(29/33),明显高于对照组的71.0%(22/31),2组比较,差异有统计学意义(P0.05)。治疗前2组的中医证候积分比较,差异无统计学意义(P0.05),具有可比性。治疗后,对照组仅1周遗尿次数较同组治疗前明显下降,差异有统计学意义(P0.05);治疗组1周遗尿次数及觉醒程度较同组治疗前明显下降(P0.05),且与对照组治疗后比较,差异均有统计学意义(P0.05)。结论自拟醒脑止遗汤治疗儿童遗尿症临床疗效确切,可有效改善遗尿症患儿的遗尿次数及觉醒程度,值得临床推广应用。     

醋酸去氨加压素治疗小儿遗尿症46例

目的探讨醋酸去氨加压素（弥凝）治疗小儿遗尿症的疗效。方法将78例遗尿症患儿随机分成两组,对照组32例予谷维素、维生素B6等常规治疗,治疗组46例在常规治疗基础上加用弥凝0．1mg,睡前半小时顿服。疗程均为2个月,疗程结束后随访3个月。结果治疗组总有效率为93．48％,对照组为21．88％,两组相比有显著性差异（P〈0．01）。结论醋酸去氨加压素治疗小儿遗尿症疗效肯定,且相对安全,但停药后有一定的复发。     

缩泉丸联合托特罗定治疗小儿遗尿病的疗效观察

目的探讨缩泉丸联合酒石酸托特罗定片治疗小儿遗尿病的临床疗效。方法 2016年2月—2018年7月天津市蓟州区人民医院收治的190例小儿遗尿病患儿为研究对象,根据患者接受治疗方法的不同将其分为对照组和治疗组,每组各95例。对照组患儿口服酒石酸托特罗定片,2 mg/次,2次/d。治疗组患儿在对照组的基础上口服缩泉丸,3～6岁:3 g/次,6～12岁:6 g/次,2次/d。两组患儿连续治疗3个月。观察两组的临床疗效,比较两组的夜间遗尿次数、复发率。结果治疗后,对照组和治疗组的总有效率分别为70.53%、90.53%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组患儿夜间遗尿次数明显少于对照组,两组比较差异有统计学意义(P0.05)。治疗后,对照组和治疗组复发率分别为30.53%、8.42%,两组比较差异有统计学意义(P0.05)。结论缩泉丸联合酒石酸托特罗定片治疗小儿遗尿病具有较好的临床疗效,可减少夜间遗尿次数,降低复发率,安全性较好,具有一定的临床推广应用价值。     

Drug therapy for nocturnal enuresis. Current treatment recommendations.

It is estimated that enuresis occurs in 5 to 7 million children in the United States. The treatment approach for enuresis is controversial, in large part due to a lack of consensus as to the exact cause of enuresis. Several factors either alone or together may contribute to this syndrome. In addition, there is strong evidence of a genetic component to enuresis. Pharmacotherapy continues to be the preferred treatment for both physicians and families. The most widely used drugs include antidepressants, anticholinergics, and desmopressin. The tricyclic antidepressant imipramine has been used extensively since the 1960s. The exact mechanism of action in enuresis is unknown although it appears to be related to the anticholinergic and antispasmodic effects of the drug. The most common adverse effects reported with imipramine include personality changes, insomnia, anorexia and anxiety. There has been renewed interest in antidiuretic treatment of enuresis. Researchers have found that enuretic children do not have the ability to reduce urine volume at night or concentrate the urine they produce during the night. Clinical trials with desmopressin administered by nasal inhalation report a marked reduction in enuretic episodes. Adverse effects were limited to nasal complaints, rhinitis, or epistaxis. Additional long term studies are needed to delineate desmopressin's role in therapy. Although the number of options for treatment of enuresis is expanding, criteria to predict patient response need to be defined.     

Comparative tolerability of drug treatment for nocturnal enuresis in children.

Primary nocturnal enuresis is one of the most frequent complaints in paediatric and urologic practice. Physicians face the dilemma of whether or not to treat primary nocturnal enuresis since the trend towards spontaneous remission is countered by social disadvantages and reduced self esteem of the children affected and their families. We reviewed randomised, controlled trials investigating efficacy and adverse effects of current medical treatment for primary nocturnal enuresis. Only desmopressin and imipramine displayed significant effects in reducing wet nights: when compared with baseline bedwetting or placebo controls, 30-70% of the studied children achieved therapeutic success. For drugs such as indometacin or oxybutynin, convincing studies displaying a significant positive effect are still needed. However, considering the adverse effects profiles of desmopressin and imipramine it can be seen that imipramine is associated with about twice as many unwanted reactions. More importantly, a serious adverse effect of imipramine is sudden cardiac arrest. In general, adverse effects with desmopressin are rare and mild, but there have been a number of case reports of hyponatraemic hypervolaemia associated with coma and seizures. Of these, many cases were attributed to excess water intake before taking the drug and all children recovered fully. In summary, if medical treatment is considered, preference should be given to desmopressin.     

Intranasal Desmopressin-Induced Hyponatremia

Desmopressin is a commonly used, well-tolerated agent for the treatment of primary nocturnal enuresis and central diabetes insipidus. Intranasal desmopressin provides symptomatic relief with few serious complications. A 29-year-old woman with a long history of primary nocturnal enuresis began treatment with intranasal desmopressin. Although the enuresis ceased, she developed throbbing headaches, nausea, vomiting, paresthesia, lethargy, fatigue, and altered mental status over the next 7 days. When she came to the emergency room her sodium concentration was 127 mmol/L. The history of desmopressin use was not obtained at that time. She was treated with intravenous fluids and discharged. The symptoms returned and worsened over the next 4 days, and she returned to the emergency room stuporous. A repeat sodium was 124 mmol/L, and she was admitted. The history of desmopressin use was still not available. Medical evaluations included computerized tomography, lumbar puncture, complete blood counts, serum chemistries, and serologies. The next morning the woman was improved and informed clinicians of her desmopressin use. Without other causes for the hyponatremia, she was diagnosed with the syndrome of inappropriate antidiuretic hormone, presumably caused by desmopressin. Within 24 hours of fluid restriction and cessation of desmopressin, her symptoms and hyponatremia resolved. A review of the literature found 11 children and 2 adults in whom intranasal desmopressin was associated with hyponatremia, all of whom experienced seizures or altered mental status. Our patient illustrates the importance of early recognition and treatment of hyponatremia before the onset of seizures. When vague symptoms develop during desmopressin therapy, hyponatremia must be considered as part of the differential diagnosis. It may also be prudent to screen for electrolyte abnormalities in patients taking this agent to prevent serious iatrogenic complications.     

The influence of clinical and pharmacological factors on enuresis treatment with imipramine.

1. The aim of this study has been to evaluate the response to imipramine treatment in enuretic children through the use of a series of clinical and pharmacological variables and by applying a multivariate (principal components) analysis technique. 2. The study was carried out on 146 children whose ages ranged from 5 to 14 years, and who received variable doses of imipramine (12.5 to 100 mg day-1). 3. The quantitative variables analyzed were: drug dosage, serum levels of imipramine and its metabolite desipramine, the relationship between them both, the duration of treatment, age and weight. 4. The qualitative variables were: compliance, presence of side-effects, enuretic and/or psychiatric antecedents, intelligence quotient (I.Q.), the existence (or absence) of related pathologies, sex, and the type of enuresis. 5. The response to treatment was quantified by means of the percentage of decrease in frequency of enuresis as compared with the initial frequency. 6. The results obtained show that the variables which are most associated with the reduction of enuresis are, in decreasing order: the dosage of imipramine administered, the duration of treatment, compliance and the level/dose ratio for the sum of the drug and metabolite levels.     

Mode of action and relative value of imipramine and similar drugs in the treatment of nocturnal enuresis

Summary The present study was partly a clinical pharmacological analysis of the action of imipramine in nocturnal enuresis and partly an attempt to select children who would benefit most from this treatment. 61 fairly severe cases of nocturnal enuresis were studied as out-patients, divided by the criteria primary/secondary enuresis and with/without associated behavioural disturbances. The patients received imipramine, imipramine-N-oxide, emepronium, and a placebo in random sequence in a double-blind cross-over trial. There was no difference in effect between placebo and emepronium; after imipramine the frequency of enuresis fell to 58% of the figure during placebo treatment, i.e. 31% of the children became dry; imipramine-N-oxide reduced the number of wet nights only to 78% of the number on placebo, 18% of the children became dry. When the patients were classified into groups imipramine and imipramine-N-oxide were found to have had the greatest effect in cases of presumed psychogenic aetiology, a 65% reduction of the frequency of wet nights whilst taking the placebo. The most favourable results were in children with combined nocturnal and diurnal enuresis and in those with urinary frequency and imperative urgency. The effect was maintained during treatment for 3 months with the most suitable drug. The dose was 50 mg regardless of the body weight of the patient. There were no serious side effects. It was concluded that the psychopharmacological actions of imipramine and imipramine-N-oxide appear to be important in their effects on enuresis. Imipramine might have been the best drug because success may require the combination of antidepressant and anticholinergic activity. It was not possible to assess in detail its presumed effect on the level of sleep. Thus many children can be treated successfully and the final cure of enuresis may be hastened by breaking a vicious circle of psychological phenomena.     

Plasma pharmacokinetics of desmopressin following sublingual administration: an exploratory dose-escalation study in healthy male volunteers

OBJECTIVE: Desmopressin is usually administered intranasally in the treatment of central diabetes insipidus or nocturnal enuresis. The sublingual administration of desmopressin is expected to be an alternative to the intranasal route with advantages to children and to patients with allergic rhinitis or chronic rhinosinusitis. Therefore, the present study was carried out to explore the time-versus-concentration profile of desmopressin in plasma after sublingual administration to healthy volunteers. SUBJECTS AND METHODS: A total of 16 healthy male volunteers were enrolled in this open, exploratory, 1-period, randomized, dose-escalation study. Volunteers received a single sublingual dose of either 20, 40, 80, 160, 240 or 320 microg of desmopressin acetate. Desmopressin plasma concentrations were measured over a 12-hour period using a validated radioimmunoassay method. Safety and tolerability were assessed simultaneously. RESULTS: Plasma concentrations of desmopressin were below the lower limit of quantification (LLOQ) of 5 pg/ml for doses lower than 80 microg. For the doses of 160 - 320 microg the time-versus-concentration profiles were higher than the LLOQ. The area under the curve from 0 - 12 h (AUC0-12h) was 54.66 +/- 25.92 pg x h/ml after the 160 microg dose, 104.38 +/- 79.10 pg x h/ml following the 240 microg dose and 133.18 +/- 181.84 pg x h/ml following the 320 microg dose. Given the data from previous experiments, the time-versus-concentration profile of desmopressin in plasma after a sublingual dose of 240 microg appeared to be in the range of previously published data on an intranasal dose of 20 microg. Sublingual administration of desmopressin proved to be safe and was well tolerated by all volunteers. CONCLUSION: A very high inter-individual variability in desmopressin plasma concentrations was detected after sublingual administration. A sublingual dose of 240 microg of desmopressin appeared to result in a pharmacokinetic profile comparable to 20 microg administered intranasally. These data, however, need to be verified in a separate well-designed prospective clinical study.     

Medical management of nocturnal enuresis

Nocturnal enuresis, or bedwetting, is the most common cause of urinary incontinence in children. It is known to have a significant psychosocial impact on the child as well as the family. Nocturnal enuresis typically presents as failure to become dry at night after successful daytime toilet training. It can be primary or secondary (developing after being successfully dry at night for at least 6 months). Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal and/or reduced bladder capacity. Alarm therapy is the recommended first-line therapy, with treatment choices being influenced by the presence or absence of the abnormalities mentioned above. Children with nocturnal enuresis may also have daytime urinary urgency, frequency or incontinence of urine. This group (non-monosymptomatic nocturnal enuresis) requires a different clinical approach, with a focus on treating daytime bladder symptoms, which commonly involves pharmacotherapy with anticholinergic medications and urotherapy (including addressing bowel problems). This review discusses the current management of nocturnal enuresis using the terminologies recommended by the International Children's Continence Society.     

Synthesis of a quaternary bis derivative of imipramine as a novel compound with potential anti‐enuretic effect

Objectives Imipramine has been used for over four decades (early reports in 1960s) for the treatment of nocturnal enuresis, although the reason for its effect is not clear. Imipramine is a tertiary amine, which may act both in the periphery and/or pass through the blood‐brain barrier (BBB) in unionized form and exhibit a central effect. Since imipramine has anti‐cholinergic properties, some believe it may exert its anti‐enuretic effect by affecting peripheral cholinergic receptors, i.e. its anti‐enuretic effect may be due to peripheral anti‐cholinergic properties, whereas others think it can pass through the BBB and interact with central nervous system (CNS) receptors. If the anti‐enuretic effect of imipramine is due to its peripheral anti‐cholinergic effects, its entrance into the CNS is unnecessary. Therefore, the synthesis of a form of imipramine that can exhibit peripheral anti‐cholinergic effects but does not have CNS adverse effects would have a safer drug profile in this case. On the other hand, if the anti‐enuretic effect of imipramine is primarily due to its action on the CNS, a form of imipramine that cannot pass through the BBB has no effect on nocturnal enuresis treatment and thus may help to clarify the mechanism of action of imipramine in nocturnal enuresis treatment. Methods This article describes the synthesis and evaluation of the anti‐cholinergic effect of a new bis derivative of imipramine, which contains two imipramine units in its structure. Key findings The compound exhibited anti‐cholinergic activity comparable with that of imipramine on isolated guinea pig ileum. Conclusions Being a quaternary ammonium, this compound is not expected to be able to cross the BBB and thus would cause fewer CNS side effects.     

Seizure with hyponatremia in a child prescribed desmopressin for nocturnal enuresis.

We report a case of hyponatremia associated with a grand mal seizure in a 28 month-old child after intra-nasal desmopressin administration for high fluid intake with nocturnal enuresis. In view of the temporary symptomatic action and the seriousness of certain side-effects of desmopressin we recommend that desmopressin be used with caution in childhood enuresis.