The child is more than 5 years old and also frequently urinate the bed. One article summarizes the treatment method ...

*For medical professionals for reading reference

Adjust your lifestyle, develop good urination, defecation habits, etc., are first -line treatment, and run through the entire treatment process.

According to the recommendation of the 2019 version of "The Diagnosis and Treatment Expert of Children's Rasal", children aged 5-6 years old occurred at least twice a month in the night sleep. For more than 3 consecutive months, there is no obvious spiritual and nerve abnormalities, and it can be defined as children's enuresis (NE).

NE can be divided into primary enuresis (PNE) and secondary enuresis (SNE). PNE refers to the immersion period that does not have more than 6 months since childhood, and excludes organic diseases; SNE refers to the urine bed again after the previous period of 6 months or longer. According to statistics, about 75 % of children with enuresis belong to PNE.

NE can also be divided into single -symptomatic libidic urine (MNE) and non -single -symptomatic nightpi urine (NMNE). MNE refers to only night enuresis, and children have no symptoms of dysfunctional dysfunction, and the urine volume is usually within the normal range; NMNE refers to not only at night, but also with different symptoms of urinary tract, such as urinary incontinence, such as urinary incontinence , Urgency, frequent urination, delay in urination, incomplete urination function, etc.

The NE treatment method mainly includes basic therapy (adjusting lifestyle habits, developing good urination, defecation habits, etc., is a first -line treatment method, penetrating the entire treatment process), alarm therapy (also alarm bell therapy, which is currently the first choice treatment for the treatment of enuresis. Methods) and drug therapy. All patients must be treated with basic therapy. Children who fail to treat the treatment of alarm or not abide by the therapy of the urine alarm can consider drug therapy or add drug therapy.

one

Ammonia

Actinoplastin is an artificial synthetic antidic urine hormone. The main effect is to reduce the amount of urine at night. It is a first -line treatment drug recommended by the International Pediatric Pediatrics Association (ICCS). It is the preferred drug for MNE treatment [1]. The effective rate of ammonia isolymin is 60 % to 70 %, of which about 30 % of the children have the effect of responding completely, and 40 % are part of the response [2]. For ammonia, the treatment of mne patients can significantly improve the symptoms of MNE children and improve their sleep quality.

▎ Usage Dosage:

Take 1 hour before going to bed, and the effect lasts 8 to 10 hours after taking. It is recommended to start with a small dose (0.2 mg / d), and adjust the dose according to the efficacy and physical condition of the child. Initial treatment is evaluated every two weeks of efficacy. If no improvement can gradually increase the dose under the guidance of doctors, but the maximum does not exceed 0.6 mg / d. If recurrence after treatment, you can continue to administration within 3 months.

This medicine is a relatively safe drug. Its side effects are hydrosis and hyponatromia. Adverse reactions are mainly headache, nausea, vomiting and convulsions. During the medication period, try to control the amount of liquid intraday at night. It is recommended that the drugs are given a small amount of water to serve, and 8H restricted drinking water after taking the medicine 1h before taking the medicine. Once a child requires a large amount of liquid supplementation such as fever, diarrhea, etc., the use of ammonia deprotin should be suspended to avoid causing water poisoning.

Antimetamin has three dosage types: oral frozen dry agent, solid tablets and nasal spray agents. Among them, oral frost drying agents and food have low interaction, and the efficacy is better than ordinary tablets, and it can improve the reaction and compliance of patients with enuresis. Because nasal spray agents can cause higher percentage hyponiasis, it is not recommended.

two

Plortonal hydrochloride

Plutinine hydrochloride is suitable for NE children with difficulty in awakening at night. This medicine can promote the oxidation and restore metabolism of brain cells, increase the use of sugars, remove the excess oxygen free radicals in the body, and play a role in awakening, inspiring the spirit, and excitement of breathing; it can improve the sensitivity of the cerebral cortex to urination and reflection. This medicine used for NE for the treatment of NE in the 60th century. Due to the obvious clinical effects of the drug, low toxic and side effects, and the safety of medication, the treatment of enuresis in pediatrics in hospitals is still the main drug.

▎ Usage Dosage:

The therapeutic dose is 100mg and takes half an hour before bedtime.

three

Anti -cholecoscopic drug

The M receptor antagonist is suitable for the treatment of ammonia deprotin, and the urine diary indicates that the bladder capacity or urinary dynamics test indicates that there are children with excessive urine muscles [3]. Divided into non -selective and selective categories. Non -selective M receptor antagonists mainly include Tot Rodor, Ogobinin, and Anti -Mountain Randoline; selective M receptor antagonists are mainly Somina New.

▎ Usage Dosage:

When used, it should be used for children's dosage, and each course of treatment takes 3 to 6 months.

During the treatment, we need to pay attention to non -performing reactions such as constipation, urinary retention, dry mouth, headache, blurred vision, and emotional changes, and use and pay attention to monitoring the residual urine capacity under the guidance of a specialist.

Four

Antidepressant

1

Olezine

Protrazine has anti -choline energy effects, can enlarge the bladder capacity, and has a effect on the central nervous system, making it easy for children to wake up and get up to urinate; effect. It is used to treat children with an aging NE who are invalid for the treatment of alarm bell therapy, ammonia and Mi receptor antagonist.

▎ Usage Dosage:

The dose of NE is administered for a single time before bedtime, and the use of M receptor antagonists can improve the treatment effect [4].

The most serious but rare adverse reactions in this medicine include cardiac toxicity and liver toxicity. Before use, the ECG should be checked whether the ECG has arrhythmia. The medicine is no longer used as a first -line drug for the treatment of NE. Pyrazine is effective for nearly 40 % of patients, but the recurrence rate is high after stopping the drug, about 75 % [5]. In the application, you need to pay close attention to the changes in heart and liver function. 2

Sertraline

During the treatment of adolescent PNE, there are common cases of removal of ammonia decoacin therapy. Shequlin is a selective 5-HT re-intake inhibitor, which is a newer night-end urine treatment drug. Clinical Shequarin Treatment 25 patients with PNE children who failed ammonia for ammonia, 18 cases (72 %) were relieved, of which 12 were completely relieved, and 6 cases were partially relieved. After 6 months of follow -up, 16 % of children with children were followed up. Reproduction, and bad events related to drugs are rare. Its adverse reactions include sleep disorders, headache, tremor, restlessness and gastrointestinal discomfort. Therefore, it is necessary to further study the effectiveness and safety of Shequlin to patients with NE.

3

Reboxetine

In recent years, it has been discovered that antidepressants renegentine reinforcement intake inhibitors Ripple Setin has a certain effect in the treatment of refractory enuresis. It is an alternative of cardiac toxicity, but further clinical control research is still needed.

4

Chloropami

Shimapumin is a third ring -ring antidepressant drug, exciting adrenaline receptor and reducing the deep phenomenon of night sleep to achieve the purpose of treating enuresis. Clinically, the enuresis caused by chloropato (nitrogen is blocked by the adrenaline receptor, causing the sphincter in the bladder to relax, causing the patients with end urine and daytime urinary incontinence) (16-48 years old) After that, the healing rate was 90 %, and the total effective rate was 100 % [6]. Whether this product has good effects to have a good effect still needs to be studied in depth.

five

Combined therapy

Frequent night urine combines the bladder capacity to decrease or use alerter to treat children, and can be used to combine ammonia ancestin combined with the alarm. This therapy can fully alleviate most children (76 %), and only 46 % of children treated with enuresis alerts are completely alleviated, but the recurrence rate of the two groups is similar.

For children with suspected merging bladder surgery or too many night urination, after eliminating organic diseases, consider using anti -cholecoskine drugs and ammonia deprotamin to effectively inhibit the excessive urine muscle activity of the bladder, reduce the child's end urine at the night frequency.

The mechanism of the enuresis of patients with ammonia miralin may be related to excessive amount of prostaglandin at night, so a few children with poor response to the treatment plan for ammonia or enuresis alarm can try to combine non -steroidal anti -inflammatory drugs (such as such as such as 7 Meixin) Treatment [7].

Profizine has limited effects of enuresis alone. Pigrazine can be used with small doses of atoro, which can increase the amount of urine in the bladder at night and improve the control capacity of the bladder sphincter.

Usage and dosage: Children <7 -year -old propyzine dosage is 12.5mg; ＞ 7 years old is 12.5mg to 25mg, and the dosage of Atropine is 0.01mg / kg, all QD, orally 1 to 2 hours before bedtime.

Because it is easy to relapse after stopping the medicine, it should be taken to consolidate for a period of time after seeing the effect, and gradually reduces the amount until the drug is stopped. However, because it has a certain adverse reaction, it is advisable to take the medicine treatment for not more than 8 weeks. [8]

references:

[1] Lu Lei, Wang Yizi. Ammonia removal has effects on symptoms and sleep quality in children with single symptoms [J]. Clinical pediatric magazine, 2022, 40 (4): 294-299.

[2] Neveus T, Eggert P, Evans J, ET A1. Evaluation of and Treatment for Monosymptomatic Enures: A Standardization Document from the International Children ‘s Continence Society [J]. J urel, 2010.183 (2): 441-447. Doh 10.1016, i. juro. 2009.10.043.

[3] Adam A, Classen F, CoOvadia A, Et Al.The South African Guidelines on ENURESIS — 2017 [J] .Afr J UROL, 2018,24 (1): 1⁃13.doi: 10.1016/J.AFJU. 2017.07.002.

[4] Caldwell PH, SURESHKUMAR P, WONG WC.tricyClic and Related Drugs for Nocturnal Enuresis in Children [J] .cochrane database syv, 2016,1: CD002117.DOI: 10.1002/146518585858585858585858585858585858585858585858585858585858585851858518585185851858518518518585.

[5] Caldwell PH, SURESHKUMAR P, wong wc.TricyClic and Related Drugs for NOCTURNAL Enuresis in Children [J].Cochrane database Syst Rev.2016.(I): CD0021 17.Doi: 10.1002 / 14651858.CD0021 17.pUB2.[6] Cheng Lin, Zhou Fangzhen. Small dose of chloropamin the treatment of clinical analysis of lunurohrinity of chloroplastin [J]. Clinical heart and body disease magazine, 2013, 19 (5): 461-462.

[7] Kamperis K, Rittig S, BOWER W, ET Al.effect of Indomethacin on Desmopressin Resistant NocTurnal Polyuria Ang Nocturnal Enuresis [J] .j urol, 2012,188 (5): 1915 = 1922222222222222222222222222222222222222222222222222222

[8] Sun Hairong, Duan Zhiheng. Bing Mizine plus small dose of atropine to treat children's enuresis 96 curative effect observations [J]. Chinese community physician, 2010, 12 (22): 127.

[9] Chinese Medical Society's Pediatric Surgery Branch Pediatric Urine Power and Pot Foundation Group and Urban Science Group. Children's urine diagnosis and treatment of Chinese expert consensus [J]. Chinese Medical Journal, 2019,99 (21): 1615-1620.Doi: 10.3760/CMA.ISSN.0376-2491.2019.21.005.

This article is the first: pediatric channel in the medical community

Author of this article: Yao Liao Zhai · Chang Yiyong

Editor in charge: Xiang Yu

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