儿童原发性夜间遗尿症生理心理治疗的疗效及随访评估

摘要 目的 应用生理心理治疗观察儿童原发性夜间遗尿症（PNE）的临床远期疗效，并探讨其治疗机制。 方法 对2004年9月至2006年1月在上海交通大学医学院附属上海儿童医学中心发育行为儿科应用生理心理治疗PNE患儿的资料进行回顾性分析，治疗中2周随访1次（随访观察6个月），治疗结束后1个月随访1次，家长每日记录患儿遗尿频率和夜间自行起床排尿次数。B超测定治疗前和治疗结束时最大憋尿状态下的膀胱容量。统计分析生理心理治疗的远期疗效，遗尿频率、膀胱容量以及夜间自行起床排尿次数的变化情况，采用Logistic回归分析影响生理心理治疗远期疗效的危险因素。结果 研究期间应用生理心理治疗的68例PNE患儿远期疗效为：治愈43例（63.2%），显效18例（26.5%），部分有效5例（7.4%），无效2例（2.9%）。治疗前平均遗尿频率为每周(6.12±1.32)次，停止治疗6个月后遗尿频率为每周（1.23±0.18）次(t= 2.65,P=0.011 )。治疗前平均夜间自行起床排尿次数为每周（0.72±0.15）次，停止治疗6个月后平均夜间自行起床排尿次数为每周（6.83±1.16）次(t= 2.25,P=0.026 )。治疗前患儿平均膀胱容量/体重为(4.13±0.98) mL·kg-1，治疗后平均膀胱容量/体重为(8.69±1.96) mL·kg-1(t= 2.58,P=0.016 )。Logistic回归分析显示有统计学意义：降低生理心理远期疗效的危险因素为年龄小［年龄<8岁（RR=3.24，95%CI：2.54～4.83）］、存在行为问题（RR=2.95，95%CI：1.33～4.16），膀胱容量小［膀胱容量/体重<5 mL·kg-1（RR=1.75，95%CI：1.03～2.67）］，治疗前从未夜间自行起床排尿（RR=1.25，95%CI：1.04～2.17）。结论 应用生理心理治疗PNE可较快发展患儿的夜间排尿控制能力，亦可增大患儿膀胱容量，远期疗效较好。

Evaluation of the efficacy of physio-psychological treatment for primary nocturnal enuresis and its follow-up in children

Abstract Objective To Study the clinical long term efficacy of physio psychological treatment in children with primary nocturnal enuresis(PNE) and analyze the mechanism of this treatment.Methods The study objects were 68 children who were diagnosed as primary nocturnal enuresis(PNE) and applied physio psychological treatment in the Department of Developmental and Behavioral Pediatrics of Shanghai Children's Medical Center from September 2003 to January 2006, including 41 boys and 27 girls; The age range was from 5 to 16 years, mean age was (8.28±2.01) years. PNE diagnosis strictly followed International Classification of Diseases, the 10th edition (ICD 10). The clinical data were analysed retrospectively including general conditions, clinical manifestations, clinical history, birth history, developmental and behavioral history, family history, psychological and social environments, outcomes of psychological tests(including Achenbach children behavioral checklist, Wechsler intelligence scale for children Revised, Wechsler preschool and primary scale of intelligence), ultrasonic graph of bladder capacity(before and after treatment), outcomes of laboratory tests(such as urine routine, nocturnal urine specific gravity, x-ray graph of lumbar and sacral vertebrae, ultrasonic graph of urinary system etc.), diagnosis, treatment procedure, the change in bed wetting frequency, frequency of getting up for urination by themselves at night just responding to the sense of full bladder. All patients were followed up 6 months after stopping treatment. During treatment period, they were followed up per 2 weeks. After stopping treatment, they were followed up every 1 month. The long term efficacy of physio psychological treatment was calculated. Logistic-multi-factor-analysis was applied to find out the risk factors that influenced clinical efficacy of physio-psychological treatment.Results The long term efficacy of physio psychological treatment in 68 children with PNE during this period was just as follows: 43（63.2%）were cured，18（26.5%）significantely improved，5（7.4%）partially improved，2（2.9%）not improved. The average frequency of enuretic onsets before treatment was (6.12±1.32) times per week，while the average frequency of enuretic onsets 6 months after treatment was (1.23±0.18) times per week (t= 2.65,P=0.011 )。The average frequency of getting up by themselves at night responding to the sense of full bladder before treatment was (0.72±0.15) times per week，while the average frequency of getting up by themselves at night responding to the sense of full bladder 6 months after treatment was (6.83±1.16) times per week (t= 2.25,P=0.026 ).The bladder capacity/body weight before treatment was (4.13±0.98) mL·kg-1，while the bladder capacity/body weight after treatment was (8.69±1.96) mL·kg-1(t= 2.58,P=0.016). Logistic regression analysis showed the risk factors that decreased long term efficacy of physio-psychological treatment were patients younger than 8 years（RR=3.24，95%CI：2.54-4.83）,comorbided other behavioral problems（RR=2.95，95%CI：1.33-4.16），less than 5 mL·kg-1 of the bladder capacity（RR=1.75，95%CI：1.03-2.67），never getting up by themselves at night responding to the sense of full bladderbefore treatment（RR=1.25，95%CI：1.04-2.17).Conclusions It could be relatively soon to develop children's ability to control the bladder at night when the physio-psychological treatment was applied to children with PNE. Moreover, the bladder capacity was increased during this treatment period. So the long term efficacy was ensured.