Cendron M, Klauber G
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Br J Urol. 1998 May;81 Suppl 3:26-8. doi: 10.1046/j.1464-410x.1998.00003.x.
To evaluate, in a retrospective study, the response rate of older children to combination therapy using a sustained-release anticholinergic agent, hyoscyamine, and a synthetic analogue of antidiuretic hormone, desmopressin acetate.
Twenty-eight patients (20 males and eight females, aged 9-18 years) diagnosed with nocturnal enuresis were evaluated using a questionnaire, history and physical examination. None had success with single-agent pharmacological therapy. All were begun on 0.375 mg of hyoscyamine and 20 microg of desmopressin intranasally at bedtime. The response rate was monitored at 2 and 4 weeks, and then every 3 months by recording dry nights on a calendar. To improve efficacy, the dosage of medication was adjusted up to 0.750 mg of hyoscyamine and 60 microg of desmopressin. Upon achieving dryness and spontaneous awakening to void, medication doses were tapered.
Within 6 months 16 (57%) patients were completely dry and six (21%) were dry at least 80% of nights. Nine patients relapsed during dose tapering and therapy was reinstituted. Presently, 17 (60%) patients are off medication (after a mean of 8 months of medication). Eight patients are still on medication and are dry at least 80% of nights. Combination therapy failed in three patients and they have transferred to a different regimen. None experienced untoward side-effects from the medications.
Most older children with nocturnal enuresis responded to combination therapy. These children require long-term follow-up and may need medication for up to 6 months because the relapse rate is fairly high. Combination therapy appears safe and reliable in treating nocturnal enuresis in older children who have had no success with other treatment modalities.
在一项回顾性研究中，评估大龄儿童使用缓释抗胆碱能药物莨菪碱以及抗利尿激素的合成类似物醋酸去氨加压素进行联合治疗的有效率。
对28例诊断为夜间遗尿症的患者（20例男性，8例女性，年龄9 - 18岁）采用问卷调查、病史及体格检查进行评估。所有患者单药药物治疗均未成功。所有患者于睡前开始鼻内给予0.375 mg莨菪碱和20 μg醋酸去氨加压素。在第2周和第4周监测有效率，之后每3个月通过在日历上记录无尿床夜数进行监测。为提高疗效，将药物剂量调整至0.750 mg莨菪碱和60 μg醋酸去氨加压素。在实现无尿床且能自发醒来排尿后，逐渐减少药物剂量。
6个月内，16例（57%）患者完全无尿床，6例（21%）患者至少80%的夜晚无尿床。9例患者在逐渐减药过程中复发，重新开始治疗。目前，17例（60%）患者已停药（平均用药8个月后）。8例患者仍在用药，至少80%的夜晚无尿床。联合治疗对3例患者无效，他们已改用其他治疗方案。无一例患者出现药物不良反应。
大多数大龄夜间遗尿症儿童对联合治疗有反应。这些儿童需要长期随访，可能需要用药长达6个月，因为复发率相当高。联合治疗在治疗对其他治疗方式无效的大龄儿童夜间遗尿症方面似乎安全可靠。
