小剂量口服醋酸去氨加压素治疗老年女性夜间尿量增多型夜尿的临床分析

Clinical analysis of low does oral Desmopressin in treatment of nocturia in elder women

目的观察小剂量口服醋酸去氨加压素治疗老年女性夜间尿量增多型夜尿的疗效和安全性。方法2009年8月至2011年6月女性夜间尿量增多型夜尿患者97例。年龄60—86岁，平均（72±7）岁。随机分为2组，实验组49例，夜间排尿量为（590±70）m1，平均夜尿次数为2．9次，每天睡前服用0．1mg醋酸去氨加压素片，同时限制夜间饮水量〈100ml；对照组48例，夜间排尿量为（6004-90）ml，平均夜尿次数为2．8次，仪限制夜间饮水量〈100ml。疗程8周。患者在治疗过程中持续记录排尿日记。治疗4、8周后分别测量平均夜间排尿量、平均夜尿次数、平均第一睡眠周期时间及睡眠质量。治疗前所有患者的血清钠、肝肾功能指标均在正常范围，治疗4、8周后，均复查血生化。结果治疗4周后，实验组夜尿次数〈2次者28例（57．1％），对照组15例（31．3％），组间比较差异有统计学意义（P〈0．05）。治疗8周后，实验组夜尿次数〈2次者35例（71．4％），对照组16例（33．3％），组间比较差异有统计学意义（P〈0．05）。治疗8周后，实验组夜间排尿量为（376±50）ml，平均夜尿次数为1．6次，与治疗前比较差异均有统计学意义（P〈0．05）；对照组夜间排尿量为（550±60）ml，平均夜尿次数为2．3次，与治疗前比较差异均无统计学意义（P〉0．05）；平均第一睡眠周期时间实验组由2．2h增至3．8h，对照组由2．1h增至2．5h，两组比较差异有统计学意义（P〈0．05）。治疗8周后，实验组39例（79．6％）睡眠质量评分≤2分，财照组15例（31．3％），两组比较差异有统计学意义（P〈0．05）。治疗过程中所有患者的血清钠、肝。肾功能指标均在正常范围。实验组3例发生轻度头痛、恶心、呕吐等药物相关不良反应，未停药自行缓解。对照组除夜间口渴外，无其他不良反应报告。结论小剂量口服醋酸去氨加压素治疗老年女性夜间尿量增多型夜尿安全有效。

Objective To investigate the efficacy and safety of low dose of oral desmopressin in eld- erly women with nocturia. Methods Eligible female patients with nocturia older than 60 years were included in this study. A total of 97 patients were randomly divided into 2 groups. Care was taken to match the patients of the two groups by age and clinical criteria. Control group （ n = 48） received liquid restriction dur- ing nighttime. Experimental group （n = 49） received 0.1 mg desmoprcssin at bedtime and liquid restriction for 8 weeks. Patients were required to visit the outpatient clinic from the first visit, and after 4 and 8 weeks of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. At each visit, all patients were evaluated by blood biochemical routine test, mean nocturnal urine volume, mean number of nocturia, mean duration of the first sleep period and sleep quality. At baseline, all the patient＇s blood sodium, liver and kidney function were normal. Results After 4 weeks of treatment with desmopressin, 28 patients （57.1%） had less than 2 voids. 15 patients （31.3%） in the control group had less than 2 voids. After 8 weeks, 35 patients （71.4%） with desmopressin had less than 2 voids. 16 patients （33.3%） in the control group had less than 2 voids. Compared with control group, nocturia cure rate in experimental group was significantly higher after 4 weeks and 8 weeks （ P 〈 0.05 ）. After 8weeks, desmopressin significantly decreased mean nocturnal urine output from 590 ± 70 ml to 376 ± 50 ml （ P 〈 0.05 ）. Mean nocturnal urine output in the control group was not significantly decreased from 600± 90 ml to 550 ± 60 ml （ P 〉 0.05 ） ; Mean number of nocturia before and after receiving desmopressin were 2.9 and 1.6 respectively which differed significantly （P 〈 0.05 ）. Mean number of nocturia before and after in control group were 2.8 and 2.3 respectively with no significant difference （ P 〉 0.05）. The mean duration of the first sleep period increased by 73% （ from 2.2 to 3.8 h） in the desmopressin group, compared with an increase of 19% （from 2. I to 2.5 h） in the control group （P 〈 0.05）. 39 （79.6%） patients in demopressin group were satisfied with sleep quality compared with only 15 （31.3%） patients in control group were satisfied （P 〈 0.05）. No serious complications were found during the medication. All the patient＇s blood sodium, liver and kidney function remained normal during treatment. Conclusions Low does oral administration of desmopressin could be an effective and well-tolerated treatment for nocturnal polyuria in elderly women.