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。

The effect of enuresis treatment on self-concept in children with primary nocturnal enuresis

Objective Primary nocturnal enuresis (PNE) is one of the common diseases in childhood. It is not only a disease of the body but also has an impact on children's mentality and behavior development. Because PNE imposed the burden of cost and psychology on the patients and their families, more and more attention of families and society is paid to it. In several studies PNE was proved to depress the self concept of the patients. But only a few oversea studies discussed the change of the self concept after the enuresis treatment. There were few data about the Chinese PNE children. In this study, we will preliminarity discuss the impact of PNE on mentality and also discuss the effect of enuresis treatment on self concept in 8-16 years old patients through observing the change of Piers Harris children self concept scale scores. Methods 8-16 years old children who were diagnosed as PNE in enuresis center of Children′s Hospital of Fudan University from July 2005 to January 2006 were enrolled. The patients were excluded if they had hypertension, other diseases that could cause bedwetting or other factors which maybe had an impact on children's mentality such as divorced parents, chronic diseases, and so on. Before treating enuresis all the patients would finish the first Piers Harris children′s self concept scale under the doctor's guidance. Then the patients were divided into three groups to accept one month treatment. One was biofeedback group, one was desmopressin acetate group, another was Chinese traditional medicine group. After finishing the treatment the patients underwent follow up. Three months later patients were required to answer the Piers Harris children's self concept scale again. Special software was used for psychology analysis. Then the patients′ self concept were evaluated in respects of behavior, intellectual and school status, physical appearance and attributes, anxiety, popularity, happiness and satisfaction. Results There were 54 PNE patients included 29 boys and 25 girls, whose mean age was (10.0±0.6) years. 15 patients had mild enuresis, 20 had moderate enuresis and 19 had serious enuresis. As for self concept before treatment, the average score of anxiety of the 54 patients was significantly lower than normal (P<0.01) and there was no significant difference between the mild, moderate and serious groups. Then 12 patients underwent biofeedback therapy, 14 accepted desmopressin acetate and 28 took Chinese traditional medicine. After treatment 44 patients were followed up and were found that the score of anxiety increased significantly (P<0.05). Compared with pre treatment, score of anxiety was increased obviously in desmopressin acetate group (P<0.05). In addition, the score of relieved patients increased significantly after treatment (P<0.05). Conclusions Before treatment the self concept score of anxiety of PNE children was decreased. After treating enuresis it could be improved, which was significant in patients who had good curative effects.