托特罗定联合醋酸去氨加压素治疗膀胱过度活动症并白天尿失禁患儿疗效分析

Analysis of curative effects of Tolterodine combined with Desmopressin acetate in the treatment of overactive bladder in children with diurnal urinary incontinence

目的探讨托特罗定联合醋酸去氨加压素治疗膀胱过度活动症并白天尿失禁患儿的临床疗效及安全性。方法收集2016年1月至2018年12月华中科技大学同济医学院附属武汉儿童医院收治的伴白天尿失禁的膀胱过度活动症患儿55例的临床资料。所有患儿均接受了尿动力学检查,并排除了神经源性膀胱、脊髓外伤等因素所致尿失禁。28例患儿接受托特罗定+醋酸去氨加压素治疗,27例患儿接受托特罗定治疗,服药疗程依患儿临床症状有无消失来定。治疗开始后根据膀胱过度活动症症状评分评价患儿症状改善情况,分为完全改善、明显改善和未改善或改善极少,完全改善和明显改善定义为有效,未改善或改善极少定义为无效。同时观察有无口干、脸红、便秘等不良反应发生。结果托特罗定+醋酸去氨加压素组完全改善15例(53.6%,15/28例),明显改善11例(39.3%,11/28例),未改善或改善极少2例(7.1%,2/28例),有效率为92.9%(26/28例);托特罗定组中完全改善9例(33.3%,9/27例),明显改善11例(40.7%,11/27例),未改善或改善极少7例(25.9%,7/27例),有效率为74.1%(20/27例),2组有效率比较差异有统计学意义(χ2=9.16,P<0.05)。托特罗定+醋酸去氨加压素组出现不良反应6例(21.4%,6/28例),托特罗定组出现不良反应5例(18.5%,5/27例),2组不良事件发生比例比较差异无统计学意义(χ2=0.073,P>0.05)。结论托特罗定联合醋酸去氨加压素治疗膀胱过度活动症并白天尿失禁患儿,能显著改善症状及尿失禁事件,并且安全性及耐受性好,疗效优于托特罗定单药治疗,推荐作为治疗膀胱过度活动症并白天尿失禁患儿的一种新方案。

Objective To evaluate the efficacy and safety of Tolterodine combined with Desmopressin acetate in the treatment of overactive bladder in children with diurnal urinary incontinence.Methods Clinical data of 55 overactive bladder children with diurnal urinary incontinence in Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2016 to December 2018 were collected.The urodynamic examination on all patients excluded factors such as neurogenic bladder and spinal cord trauma from the causes of urinary incontinence.Twenty-eight patients underwent Tolterodine plus Desmopressin acetate,and the remaining 27 patients were treated with Tolterodine alone.The course of medication was determined according to whether the clinical symptoms disappeared or not.According to the ratings of overactive bladder,the treatment effects of all children were evaluated and divided into complete improvement,obvious improvement,and little or no improvement.The effectivity was defined as complete and obvious improvement,while the ineffectiveness was defined as little or no improvement.Meanwhile,adverse effects like dry mouth,blushing and constipation were observed.Results In the Tolterodine+Desmopressin acetate group,15 cases were improved completely(53.6%,15/28 cases),11 cases were obviously improved(39.3%,11/28 cases),2 cases were slightly or not improved(7.1%,2/28 cases).The effective rate was 92.9%(26/28 cases).In the Tolterodine group,9 cases were improved completely(33.3%,9/27 cases),11 cases were obviously improved(40.7%,11/27 cases),and 7 cases(25.9%,7/27 cases)were not or slightly improved.The effective rate was 74.1%(20/27 cases).The difference of the effective rate between the 2 groups was statistically significant(χ2=9.61,P<0.05).Six cases(21.4%,6/28 cases)in the Tolterodine+Desmopressin acetate group presented adverse reactions,and that number was 5(18.5%,5/27 cases)in the Tolterodine group.There was no significant difference in the proportion of adverse reaction events between the 2 groups.Conclusions Tolterodine combined with Desmopressin acetate can significantly improve symptoms and reduce urinary incontinence events in children with overactive bladder and diurnal urinary incontinence.The combined use of Tolterodine and Desmopressin acetate is safe and well tolerated,with better efficacy than Tolterodine alone.Therefore,it is recommended as a new treatment for overactive bladder in children with diurnal urinary incontinence.