帕金森病中的夜尿症：为何会发生以及如何处理？
Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?
作者信息
Batla Amit, Phé Véronique, De Min Lorenzo, Panicker Jalesh N
机构信息
Department of Motor neuroscience and Movement Disorders UCL Institute of Neurology London United Kingdom.
Department of Uro-Neurology The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology London United Kingdom.
出版信息
Mov Disord Clin Pract. 2016 Jun 7;3(5):443-451. doi: 10.1002/mdc3.12374. eCollection 2016 Sep-Oct.
BACKGROUND
Nocturia is one of the commonest nonmotor symptoms in Parkinson's disease (PD) and has a significant impact on quality of life both for patients and their carers. There exists a relation between nocturia and poor sleep quality, falls, and institutionalization. Nocturia may manifest as a result of reduced functional bladder capacity or nocturnal polyuria; however, most often the cause is multifactorial. Disorders of circadian rhythm regulation are known to occur with sleep disturbances in PD may also contribute to nocturia.
METHODS AND RESULTS
In this review, an overview of the assessment and management of nocturia in patients with PD is presented. History taking, medication review, and a bladder diary form the cornerstone of the evaluation. Urinalysis, ultrasonography, and urodynamic studies help to assess the cause for lower urinary tract symptoms and exclude concomitant pathologies, such as bladder outlet obstruction. Antimuscarinic medications are the first-line treatment for the overactive bladder; however, caution is needed when using these medications in individuals predisposed to cognitive impairment. Desmopressin is effective for managing nocturnal polyuria.
CONCLUSIONS
An individualized approach is recommended to optimize the management of nocturia in PD.
背景
夜尿症是帕金森病（PD）最常见的非运动症状之一，对患者及其照料者的生活质量有重大影响。夜尿症与睡眠质量差、跌倒及入住养老院存在关联。夜尿症可能是由于膀胱功能容量降低或夜间多尿所致；然而，其原因通常是多因素的。已知昼夜节律调节紊乱会伴随PD患者的睡眠障碍出现，这也可能导致夜尿症。
方法与结果
在本综述中，对PD患者夜尿症的评估与管理进行了概述。病史采集、药物审查和膀胱日记是评估的基石。尿液分析、超声检查和尿动力学研究有助于评估下尿路症状的原因，并排除诸如膀胱出口梗阻等伴随疾病。抗胆碱能药物是治疗膀胱过度活动症的一线药物；然而，在易发生认知障碍的个体中使用这些药物时需谨慎。去氨加压素对治疗夜间多尿有效。
结论
建议采用个体化方法优化PD患者夜尿症的管理。
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