托特罗定联合清洁间歇导尿和夜间留置导尿治疗儿童神经源性逼尿肌过度活动疗效分析*
Assessment of tolterodine combined with clean intermittent catheterization and catheterization during night in children with neurogenic detrusor overactivity

目的:评估托特罗定联合清洁间歇导尿(CIC)和夜间留置导尿(CDN)治疗儿童神经源性逼尿肌过度活动(NDO)临床疗效。方法:选取(7.9±2.5)岁NDO患儿44例,按单盲、随机法分为观察组24例(托特罗定联合CIC和CDN治疗)和对照组20例(安慰剂联合CIC和CDN治疗),疗程4周。服药前和治疗4周后分别行尿动力学检查和记录3 d排尿日记。结果:共41例患儿完成4周治疗。观察组治疗后首次逼尿肌收缩时容量、膀胱安全容量、膀胱顺应性及每次导尿量较治疗前增大,24 h尿失禁次数减少(P<0.05); 对照组治疗后膀胱安全容量、膀胱顺应性较治疗前增大(P<0.05); 治疗后观察组首次逼尿肌收缩时容量、膀胱安全容量、膀胱顺应性、每次导尿量及24 h尿失禁次数的改善情况均好于对照组,差异有统计学意义(P<0.05)。结论:托特罗定联合CIC和CDN治疗儿童NDO安全有效,可明显减少患儿尿失禁次数,改善患儿生活质量。
Aim: To investigate the effect of tolterodine combined with clean intermittent catheterization(CIC)and catheterization during night(CDN)in children with neurogenic detrusor overactivity(NDO).Methods: A total of 44 children with NDO were enrolled and randomly allocated into observation group(n=24)and control group(n=20). The observation group underwent tolterodine combined with CIC and CDN while the control group accepted placebo combined with CIC and CDN for 4 weeks. Urodynamic data and 3-day bladder diaries were obtained before and after 4 weeks.Results: Forty-one patients successfully completed this study. The first detrusor contraction capacity, the safety bladder capacity, the detrusor compliance and the per catheterization in volume of the observation group increased significantly after treatment, while the number of incontinence episodes per 24 h decreased(P<0.05). The safety bladder capacity and the bladder compliance of control group increased after treatment(P<0.05). All these parameters in the observation group improved compared with those in control group after treatment(P<0.05).Conclusion: Tolterodine combined with CIC and CDN is safe and effective in treatment of children with NDO, which can significantly decrease the number of incontinence episodes and improve the quality of life