夜尿症的诊治

The diagnosis and treatment of nocturia

夜间1次起床排尿即可称为夜尿症,但是临床发现只有1次夜尿对患者生活质量影响较小,2次以上的夜尿更具备治疗的意义。中国成人(40岁以上人群)1次以上的夜尿症患病率为55%,2次以上的夜尿达22.8%。53.4%的夜尿症患者承认夜尿症导致的睡眠障碍干扰了他们正常的工作和社交。根据成因及临床表现差异,夜尿症可分为4大类:多尿症、夜间多尿、夜间膀胱容量下降、混合型。排尿日记是夜尿症最重要的诊断手段。改变生活方式和行为方式一直是治疗夜尿的一线治疗。去氨加压素能显著减少夜间尿量,提高患者生活质量。药物相关的唯一严重并发症—低钠血症的风险随着年龄的增加而增大,多数发生在65岁以上老年人。目前尚没有确切证据证明抗毒蕈碱剂能减少膀胱过度活动症患者的夜尿次数。国内一项多中心前瞻性随机实验证明,多沙唑嗪4mg与坦索罗辛0.2mg均能够缓解男性下尿路症状患者的夜尿症。

Nocturia is defined by the International Continence Society （ICS） as the complaint that the individual has to wake at night one or more times to void and each void is preceded and followed by sleep. The prevalence of nocturia in China, if defined as 2 or more voiding episodes nightly, is 22.8% in adults older than 40 years 01d. There are many possible causes of nocturia, depending on the types, such as polyuria, nocturnal polyuria, low nocturnal bladder capacity and mixed nocturia. Bladder diary is essential for the diagnosis of nocturia. Treatment depends on the type and cause of nocturia, including restrict fluids in the evening （especially coffee, caffeinated beverages, and alcohol）, anticholinergics and a-blockers to reduce symp- toms of overactive bladder and bladder outlet obstruction, desmopressin （DDAVP） to help the kidneys produce less urine at night so as to alleviate nocturnal polyuria.