儿童原发性夜间遗尿症治疗的临床随机对照研究

A randomized controlled clinical trial for treatment of children with primary nocturnal enuresis

目的对3种遗尿症治疗方法进行临床随机对照研究,比较各种治疗方法的特点以及对原发性夜间遗尿症儿童的疗效。方法以138例确诊为原发性单一症状性夜间遗尿症的患儿为研究对象,在家长和患儿同意进行4个月的治疗并坚持随访情况下,将其随机分为3组:(1)生理-心理治疗组52例,使用报警器的条件反射训练与其他心理行为治疗整合的一体化方法;(2)药物治疗组46例,口服去氨加压素片剂;(3)综合治疗组40例,同时应用前两种方法治疗。家长和患儿决定暂不治疗或延期治疗的45例患儿归为对照组,并定期随访。对4组患儿4个月治疗结束时,和停止治疗3个月后遗尿的缓解情况进行比较分析。结果生理-心理治疗组的近期和远期治愈率分别为75.0%、71.2%;药物治疗组的近期和远期治愈率分别为47.8%、28.3%;综合治疗组的近期和远期治愈率分别为85.0%、80.0%。生理-心理治疗组与综合治疗组的近期、远期疗效均显著优于药物治疗组(P<0.01),生理-心理治疗组与综合治疗组的近期远期疗效差异无统计学意义(P>0.05)。生理-心理治疗组起效慢、疗效巩固;药物治疗组起效快,停药后复发率高。结论生理-心理治疗和药物去氨加压素治疗对我国儿童具有良好疗效。生理-心理治疗立足于发展儿童的夜间排尿控制能力,较药物治疗疗效更好,且复发率明显低于药物治疗,值得在国内遗尿症治疗中推广应用。

Objective Applying three treatment methods for enuresis in children with primary nocturnal enuresis （PNE） in a randomized controlled clinical trial （RCT） to compare the curative effects and characteristics of the three methods. Methods If the parents and children consented to accept the treatment for 4 months and to keep on follow-up, the children diagnosed as primary nocturnal enuresis in the department of developmental and behavioral pediatrics in Shanghai Children＇s Medical Center from April 2003 to August 2004 were randomized into three groups ： 52 children were in physio-psychological treatment group and were treated by utilizing the conditioning training role of alarm and other psychological and behavioral training programs; 46 children were in drug treatment group and were treated by taking DDAVP tablets orally; 40 children were in combined treatment group who were treated by applying the former two methods simultaneously. If the parents and children did not accept treatment, they were enrolled into the control group and were followed-up. Then, the curative effects of the four groups were compared statistically when the 4-month treatment was over and compared again 3 months later. Results Applying the physiopsychological treatment for 4 months, the short-term cure rate of children with enuresis was 75.0%. Three months after the end of the treatment, the long-term cure rate was 71.2%. As for drug treatment group, the short-term cure rate of children with enuresis was 47. 8%, the long-term cure rate was 28.3% ; As for combined treatment group, the short-term cure rate of children with enuresis was 85.0%, the long-term cure rate was 80. 0%. The short-term and long-term curative effects of physio-psychological treatment group and combined treatment group were better than that of drug treatment group（P 〈0. 01 ）. However, the short-term and long-term curative effects were not significantly different between physio-psychological treatment and combined treatment group （ P 〉 0. 05 ）. Physio-psychological treatment exerts effects slowly, but showed sustained curative effects. While Drug treatment exerts effects rapidly, but the relapse rate was very high after discontinuation of the medication. Condusions Physio-psychological treatment and drug treatment are currently generally recognized the best ways to treat enuresis, beth of them are suitable for Chinese enuresis children, beth of them showed good curative effects. Physio-psychological treatment develops children＇s ability to control nocturnal micturition, its curative effects were better than that of the drug treatment whilst its relapse rate is lower as compared to drug treatment. So, physio-psychological treatment is more suitable for widespread use to treat PNE in China.