儿童隐性脊柱裂对单症状性夜遗尿治疗及复发的影响

Impact of spina bifida occulta in children on recurrence and treatment of monosymptomatic nocturnal enuresis

目的探讨隐性脊柱裂对儿童单症状性夜遗尿治疗及其复发的影响。方法选择2018年9月至2019年9月单症状性夜遗尿患儿186例,从中筛选出伴隐性脊柱裂患儿98例,随机分为对照组(醋酸去氨加压素组)41例和观察组(醋酸去氨加压素联合奥昔布宁组)57例,所有患儿均给予干床训练。观察患儿治疗6个月和停药3个月的治疗效果、复发率及不良反应。结果治疗6个月后,对照组完全效应率61.0%,总有效率68.3%;观察组完全效应率80.7%,总有效率91.2%。两组间完全效应率和总有效率的差异均有统计学意义(χ^(2)=4.65、8.37,P均<0.05)。停药3个月后,41例对照组患儿复发11例(26.8%),57例观察组患儿复发6例(10.5%),两组间差异有统计学意义(χ^(2)=4.42,P=0.036)。结论隐性脊柱裂在单症状性夜遗尿患儿中发现率高,治疗后遗尿容易复发。醋酸去氨加压素联合奥昔布宁治疗遗尿,可提高完全反应率及有效率,并可降低复发率,依从性好,安全性高。

Objective To investigate the effect of spina bifida occulta on the recurrence of monosymptomatic nocturnal enuresis in children and its treatment.Methods A total of 186 children with monosymptomatic nocturnal enuresis from September 2018 to September 2019 were selected,of them 98 children with spina bifida occulta were selected and randomly grouped into a control group(desmopressin group,n=41)and an observation group(desmopressin combined with oxybutynin group,n=57),and all children were given dry bed training.The treatment effect and adverse effects of the children were observed after 6 months of treatment and 3 months of drug withdrawal.Results After 6 months of treatment,the control group had a complete effect rate of 61.0%and a total effective rate of 68.3%;the observation group had a complete effect rate of 80.7%and a total effective rate of 91.2%.The differences in the complete effect rate(χ^(2)=4.65,P=0.031)and the total effective rate(χ2=8.37,P=0.004)between the two groups were statistically significant.Three months after discontinuation of the drug,11(26.8%)of the 41 control children relapsed and 6(10.5%)of the 57 observed children relapsed,with a statistically significant difference between the two groups(χ^(2)=4.42,P=0.036).Conclusion Spina bifida occulta was found to be highly prevalent in children with monosymptomatic nocturnal enuresis and to be prone to recurrence of enuresis during treatment.The combination of desmopressin with oxybutynin for the treatment was effective on increasing the complete response rate and efficiency,decreasing the recurrence rate,and on providing good compliance and safety.