去氨加压素（弥凝）联合阿米替林治疗儿童难治性夜遗尿的疗效分析

Clinical analysis of refractory nocturnal enuresis treated by amitriptyline and desmopressin

目的通过对去氨加压素（弥凝）联合阿米替林治疗小儿难治性遗尿症的临床观察，评价其疗效及不良反应。方法将72例难治性夜遗尿患儿随机分成两组，弥凝联合阿米替林组38例和弥凝增量组34例，所有患儿给予干床训练。观察治疗3个月和治疗结束停药3个月时患儿的治疗效果及不良反应。结果治疗3个月后进行疗效评估：弥凝联合阿米替林组在完全反应率（89．5％比61．8％）、有效率（97．4％比82．4％）上均明显高于弥凝增量组，差异有统计学意义（P〈0．05）；停药3个月后进行疗效评估：弥凝联合阿米替林组在完全反应率（81．6％比52．9％）、有效率（92．1％比73．5％）上均明显高于弥凝增量组，差异有统计学意义（P〈0．05）；随访6个月内未见严重不良反应。结论弥凝联合阿米替林治疗难治性夜遗尿临床疗效好，依从性高，不良反应少，值得临床应用。

Objective To observe the clinical efficacy and adverse reactions of amitriptyline combined with desmopressin in the treatment of refractory nocturnal enuresis. Methods 72 children with refractory nocturnal enuresis were randomly divided into two groups： 38 children were treated with amitriptyline and desmopressin; 34 children were treated with increased dosage of desmopressin. All children were given dry-bed training. The curative effect and adverse reactions of the children were observed after 3 months of treatment and 3 months after drug withdrawal. Results Efficacy evaluation after 3 months of treatment： the total reaction rate and the effective rate in amitriptyline combined with desmopressin group were significantly higher than those in desmopressin group （89.5% vs.61.8%, 97.4% vs.82.4%; P〈0.05）. Efficacy evaluation 3 months after drug withdrawal： the total reaction rate and the effective rate in amitriptyline combined with desmopressin group were significantly higher than those in desmopressin group （81.6% vs.52.9%, 92.1% vs.73.5%; P〈0.05）. No severe adverse reactions were observed during the 6 months. Conclusion Amitriptyline combined with desmopressin in the treatment of refractory nocturnal enuresis is effective, with high patient compliance and few adverse reactions, worthy of clinical application.