倍芪脐贴联合行为干预治疗儿童夜间遗尿症疗效观察

Efficacy of Bei Qi umbilical patch combined with behavioral intervention on nocturnal enuresis in children

目的探讨倍芪脐贴联合行为干预治疗儿童夜间遗尿症的疗效及对儿童脑-膀胱功能轴的影响。方法选取2023年2—8月于上海儿童医学中心发育行为儿科就诊且主诉为夜间遗尿的患儿60例,随机分为治疗组和对照组各30例。治疗组给予倍芪脐贴联合行为干预治疗,对照组给予单纯行为干预治疗,2组均治疗8周。比较2组治疗前、治疗4周、治疗8周后的每周遗尿次数及治疗8周后的遗尿好转率,观察2组治疗前后脑-膀胱功能轴指标(尿意觉醒程度评分、最大日/夜间膀胱容量、最小日/夜间膀胱容量、平均日/夜间膀胱容量、次日清晨第一次尿量、单位体表面积的饮水总量、日间排尿量、夜间排尿量)及最大排尿量(MVV)/年龄预期膀胱容量(EBC)、夜间总尿量(TVV)/EBC的变化。结果2组治疗4周后每周遗尿次数均明显低于治疗前,治疗8周后明显低于治疗4周后,且治疗组治疗4周、8周后的每周遗尿次数均明显低于同期对照组,差异均有统计学意义(P均<0.05)。治疗组总有效率为63.4%(19/30),对照组总有效率为30.0%,治疗组总有效率明显高于对照组(2=6.698,P<0.05,Cohen’s d=0.70)。治疗8周后,治疗组尿意觉醒程度评分明显低于对照组(t=2.808,P<0.05,Cohen’d=0.73);2组最大和最小日间膀胱容量、日间平均膀胱容量、最大和最小夜间膀胱容量、夜间平均膀胱容量和次日清晨第一次尿量组内及组间比较差异均无统计学意义(P均>0.05);治疗组单位体表面积日间排尿量较治疗前明显增加(t=2.672,P<0.05,Cohen’s d=0.51),单位体表面积夜间排尿量较治疗前明显减少(t=2.543,P<0.05,Cohen’s d=0.67);对照组单位体表面积夜间排尿量较治疗前明显减少(t=2.238,P<0.05,Cohen’s d=0.36),日间排尿量与治疗前比较无明显变化(P>0.05)。治疗8周后,2组的MVV/EBC均较治疗前升高,但组内及组间比较差异均无统计学意义(P均>0.05);2组TVV/EBC均较治疗前明显降低(P均<0.05)。结论积极的行为干预可改善夜间遗尿症患儿脑-膀胱功能轴指标,联合倍芪脐贴治疗后可进一步改善患儿遗尿症状,主要是提高尿意-觉醒功能。

Objective It is to investigate the efficacy of Bei Qi umbilical patch combined with behavioral intervention in the treatment of nocturnal enuresis and its effect on the brain-bladder function axis in children.Methods Sixty children with chief complaints of nocturnal enuresis who attended the Department of Developmental and Behavioral Pediatrics of Shanghai Children’s Medical Center from February to August 2023 were randomly divided into 30 cases in the treatment group and 30 cases in the control group.The treatment group was treated with Bei Qi umbilical patch combined with behavioral intervention,and the control group was treated with behavioral intervention alone,and both groups were treated for 8 weeks.The times of urine loss per week and the improvement rate of urine loss after 8 weeks of treatment were compared between the two groups before treatment,after 4 weeks and after 8 weeks of treatment,the changes in the brain-bladder function axis indexes(urinary arousal score,maximum day/night bladder capacity,minimum day/night bladder capacity,average day/night bladder capacity,first urine volume in the next morning,total water consumption per unit of body surface area,daytime urinary output,nighttime urinary output)and maximum voided volume(MVV)/age expected bladder capacity(EBC),total voided volume(TVV)/EBC before and after the treatment were observed in the two groups.Results The times of urine loss per week after 4 weeks of treatment were significantly lower than those before treatment,while the times after 8 weeks of treatment were significantly lower than those after 4 weeks of treatment in the two groups,and the times of urine loss per week after 4 and 8 weeks of treatment in the treatment group were significantly lower than those in the control group at the same time period,the differences were all statistically significant(all P<0.05).The total effective rate of the treatment group was 63.4%(19/30),and that of the control group was 30.0%,the total effective rate of the treatment group was significantly higher than that of the control group(2=6.698,P<0.05,Cohen’s d=0.70).After 8 weeks of treatment,the urinary arousal score of the treatment group was significantly lower than that of the control group(t=2.808,P<0.05,Cohen’s d=0.73);there were no statistically significant differences in the maximum and minimum daytime bladder capacity,average daytime bladder capacity,maximum and minimum night bladder capacity,average night bladder capacity,and the first urine volume in the next morning between the two groups and between before and after treatment in each group(all P>0.05);the daytime urinary output per unit of body surface area was significantly increased(t=2.672,P<0.05,Cohen’s d=0.51),and nighttime urinary output per unit of body surface area was significantly decreased compared with those before treatment in the treatment group(t=2.543,P<0.05 Cohen’s d=0.67);the nighttime urinary output per unit of body surface area was significantly decreased compared with that before treatment in the control group(t=2.238,P<0.05,Cohen’s d=0.36),and there was no significant change in daytime urine output compared with the before treatment(P>0.05).After 8 weeks of treatment,MVV/EBC was significantly increased compared with before treatment in both groups,but the differences were not statistically significant between the two groups and between before and after treatment in each group(all P>0.05);TVV/EBC was significantly decreased compared with before treatment in both groups(both P<0.05).Conclusion Active behavioral intervention can improve the indexes of brain-bladder function axis in children with nocturnal enuresis,and the combined treatment with Bei Qi umbilical patch can further improve the enuresis symptoms of the children,mainly to improve the urinary-arousal function.