中国儿童单症状性夜遗尿疾病管理专家共识解读

1、The Second Xiangya Hospital,CSUCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South University膀胱膀胱脑干基底脑干基底神经节神经节尿液尿液感觉感觉冲动冲动骶髓骶髓中枢中枢大脑大脑皮层皮层初次初次尿意尿意膀胱高膀胱高容低压容低压最大膀最大膀胱容量胱容

2、量逼尿肌逼尿肌收缩收缩排尿排尿皮层解除脑干皮层解除脑干中枢抑制中枢抑制运动运动冲动冲动皮层下抑制皮层下抑制皮层抑制皮层抑制肾和输肾和输尿管尿管压力感受器压力感受器盆神经盆神经合适合适环境环境储尿储尿顺应性顺应性脊丘侧束脊丘侧束Central South UniversityCentral South University最大膀胱容量最大膀胱容量20-5020-50cmH2OcmH2O尿道阻力降低尿道阻力降低反射性反射性膀胱收缩膀胱收缩横隔下降横隔下降腹压腹压增高增高逼尿肌逼尿肌收缩收缩膀胱内膀胱内压升高压升高膀胱颈收膀胱颈收缩缩短缩缩短膀胱颈部膀胱颈部呈漏斗状呈漏斗状盆底肌及尿道盆底肌及尿道外

3、括约肌松弛外括约肌松弛尿液排出尿液排出Central South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South Uni

4、versityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentr

5、al South UniversityCentral South University模板 连续两个周末的日间日记Central South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South University诊断为

6、诊断为MNE治疗方案的建议：治疗方案的建议：基于意愿、动机和日记（如果完整）共同决策基于意愿、动机和日记（如果完整）共同决策尿床报警器尿床报警器去氨加压素去氨加压素Central South UniversityCentral South University日记信息日记信息给予警报器或去给予警报器或去氨加压素治疗氨加压素治疗对报警器疗法更对报警器疗法更敏感敏感对去氨加压素治对去氨加压素治疗更敏感疗更敏感联合去氨加压素联合去氨加压素及报警器治疗及报警器治疗夜间尿排量正常夜间尿排量正常且膀胱容量正常且膀胱容量正常小于年龄相应预小于年龄相应预计膀胱容量计膀胱容量患有患有NP且膀胱容且膀胱容量正常量

7、正常尿排量过高且膀尿排量过高且膀胱容量偏小胱容量偏小MNE亚型亚型Central South UniversityCentral South University去氨加压素受到去氨加压素受到2009年国际尿失禁咨年国际尿失禁咨询委员会（询委员会（ICI）的）的1级级A等推荐！等推荐！Central South UniversityCentral South University 仅在给药夜间仅在给药夜间有效，须每日有效，须每日给药，且需要给药，且需要全程坚持给药全程坚持给药以避免夜间尿以避免夜间尿床床 初始治疗初始治疗2 26 6周，改周，改善后持续治疗善后持续治疗3 3个月个月 睡 前睡 前

8、 1 h1 h 服 药服 药（0.20.20.6 mg0.6 mg），），能浓缩减少尿液，能浓缩减少尿液，给药前给药前1h1h和给药后和给药后8h8h减少饮水减少饮水初始治疗初始治疗26周周须每日给药须每日给药睡前睡前1小时服药小时服药Central South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South

9、University遗尿报警器同时也受到遗尿报警器同时也受到ICI的的1级级A等等推荐！推荐！Central South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South UniversityCentral South

10、 UniversityCentral South UniversityCentral South UniversityCentral South University排除以下情况：排除以下情况：u 依从性不佳依从性不佳u 睡前未排尿睡前未排尿u 睡前最后睡前最后1次排次排尿前尿前1h内服药内服药u 去氨加压素给去氨加压素给药前、后药前、后1h期期间饮水过多间饮水过多u 尿崩症尿崩症增加剂量增加剂量部分部分MNE患患者对去氨者对去氨加压素抗加压素抗性性无持续性无持续性NP持续性持续性NP具去氨加压素具去氨加压素抗性，转诊至抗性，转诊至专家处专家处通过夜间通过夜间尿量鉴别尿量鉴别仍未改善仍未改善Central South UniversityCentral South UniversityCentral South UniversityCentral South University便秘是遗尿症和治疗抗便秘是遗尿症和治疗抗性的风险因素，应在遗性的风险因素，应在遗尿症治疗计划