中国儿童遗尿症疾病管理专家共识（2025年）

doi:10.12372/jcp.2025.25e0564

摘要/Abstract

摘要：

遗尿症是儿童期常见疾病，会对患儿的身心健康造成危害，规范化诊疗对遗尿症的疗效及改善预后非常重要。近年来，随着国内外临床研究证据的积累和新诊疗理念的临床应用，更新并完善遗尿症诊疗共识具有重要的临床意义。因此，中国医师协会儿科医师分会肾脏疾病学组中国儿童遗尿疾病管理协作组基于国内外最新循证依据，结合国内临床经验，对2014年版《中国儿童单症状性夜遗尿疾病管理专家共识》进行修订和更新。结合国际权威指南修订了遗尿症的定义，完善了遗尿症的诊断流程和标准化术语；更新了病史采集内容以强调鉴别其他疾病和共患病，修订了排尿日记的记录方式以提高依从性；对于单症状性遗尿症部分，增加了去氨加压素药物剂量调整及减停方案，完善了二线药物治疗的具体剂量推荐；新增了非单症状性遗尿症的治疗，包括治疗策略和药物治疗方案等。本共识按照临床问题为导向的方式提出了推荐意见，为遗尿症的管理提供了更全面的指导。

关键词: 遗尿症, 德尔菲法, 单症状, 非单症状, 儿童

Abstract:

Nocturnal enuresis is a common disease in childhood, which can be harmful to the children’s physical and psychological well-being. Standardized diagnosis and therapeutic approaches are very important for the efficacy and prognosis of enuresis. In recent years, with the accumulation of domestic and foreign clinical research evidence and the application of new diagnostic and therapeutic concepts, it is of great clinical significance to update and improve the consensus on the diagnosis and treatment of enuresis. Therefore, Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association has revised and updated the 2014 version of the "Expert Consensus on the Management of Monosymptomatic Nocturnal Enuresis in Chinese Children" based on the latest domestic and international evidence-based rationales and combined with clinical experience. The definition has been revised in accordance with international authoritative guidelines, and the diagnosis process and standardized terminology has been enhanced. The content of medical history collection has been updated to emphasize the differentiation of other diseases and comorbidities, and the recording method of the voiding diary has been revised to improve compliance. For monosymptomatic enuresis, the dosage adjustment and discontinuation plan of desmopressin have been added, and the specific dosage recommendations for second-line drug treatment have been refined. Additionally, a new section on non-monosymptomatic enuresis has been introduced, including treatment strategies and pharmacologic interventions. This consensus recommendations in a problem-oriented manner, delivering more comprehensive and structured guidance for the management of nocturnal enuresis.

Key words: nocturnal enuresis, delphi method, monosymptomatic, non-monosymptomatic, child

中图分类号:

中国医师协会儿科医师分会肾脏疾病学组中国儿童遗尿疾病管理协作组. 中国儿童遗尿症疾病管理专家共识（2025年）[J]. 临床儿科杂志, 2025, 43(7): 483-499.

Chinese Cooperative Group for the Management of Pediatric Enuresis Affiliated to Pediatric Nephrology Committee of Chinese Medical Doctor Association. Chinese expert consensus on management of nocturnal enuresis in children[J]. Journal of Clinical Pediatrics, 2025, 43(7): 483-499.

图/表 10

表1

图1

附表1

病史采集表"

病史	结果
儿童是否夜间睡眠中尿床（提示严重度、治疗方法及预后）	□是 □否
1. 每周尿床的夜晚数：	夜/周
2. 每晚尿床的次数：	次
3. 每晚尿床时间（大致时间）
4. 尿意-觉醒功能：①排尿完毕后仍未醒，②排尿完毕后立即觉醒，③排尿超过一半觉醒，④排尿开始即觉醒，⑤有尿意即觉醒）	选择： ①②③④⑤
5. 每晚遗尿量（可通过测量尿布增重进行计量）	g/ mL
日间下尿路症状（以下症状提示膀胱功能障碍）
1. 日间发生的漏尿（提示膀胱活动过度/非单症状性遗尿）	□是 □否
内裤上的尿渍
-排尿前	□是 □否
-排尿后	□是 □否
严重尿湿内裤（内裤非常湿）	□是 □否
漏尿频率（每日发生次数）：	次/天
每日间断或持续的漏尿	□是 □否
3岁半以后的日间尿失禁病史	□是 □否
2. 尿频（排尿次数每日≥8次）	□是 □否
3. 尿急，即突然和急迫的想要排尿（提示膀胱活动过度）	□是 □否
4. 日间排尿次数减少（<4次/日，提示排尿功能障碍）	□是 □否
5. 特殊憋尿姿势（如文森特氏屈膝礼-儿童突然停止活动，脚尖站立，双脚用力交叉或采取蹲位，脚后跟顶着会阴部) （提示排尿功能障碍）	□是 □否
6. 需按压以促进排尿	□是 □否
7. 尿流中断，或一次接一次的数次排尿（提示排尿功能障碍）	□是 □否
8. 泌尿道感染病史（常与潜在的膀胱功能障碍相关）	□是 □否
9. 疾病和/或畸形
泌尿道	□是 □否
脊髓/神经系统	□是 □否
合并症-可能预测治疗抵抗的因素
1.存在以下排便症状或病史（可预测治疗抵抗：便秘治愈可能致遗尿症的治愈）
便秘（每周排便≤3次）	□是 □否
内裤上的大便痕迹（大便失禁）	□是 □否
2.存在心理/行为/精神问题，如注意缺陷多动障碍（ADHD）、孤独症谱系障碍（ASD）的证据（可预测治疗抵抗）	□是 □否
注意力不易集中、注意短暂	□是 □否
活动过多	□是 □否
情绪易冲动	□是 □否
社会交往、交流障碍	□是 □否
兴趣狭窄	□是 □否
刻板重复的行为方式	□是 □否
3.运动障碍和/或学习障碍和/或精神运动发育障碍的病史(可能提示中枢神经系统病变)	□是 □否
4.睡眠问题
夜间睡眠时间
早上起床时间
是否有入睡困难，唤醒困难、多梦、白天嗜睡	□是 □否
是否有严重打鼾和/或睡眠呼吸暂停	□是 □否
饮水习惯
1. 是否常喝饮料	□是 □否摄入量及类型：
2. 晚间（睡前2~3小时内）是否饮水	□是 □否
3. 晚间（睡前2~3小时内）饮水量超过200 mL	□是 □否
4. 晚餐是否饮用牛奶或晚餐进食粥、汤类食物	□是 □否
5. 晚间是否食用有利尿作用或含水量多的水果（如西瓜等）	□是 □否
家族史和既往史
1. 遗尿家族史(包括父母、同胞及其他亲属)	□是 □否
2. 既往泌尿系感染史	□是 □否
3. 既往脊髓/泌尿系手术史	□是 □否
4. 服用影响排尿的药物（如螺内酯、呋塞米等）	□是 □否
5. 既往遗尿的治疗方式	无治疗有，治疗方式：

附表1

表2

附表2

附表3

表3

表4

图2

表5

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术语	定义
遗尿症（NE）	≥5岁，平均每月至少1次夜间不自主排尿，并持续3个月及以上
MNE	患儿仅有夜间遗尿，不伴有日间LUTS
NMNE	患儿不仅有夜间遗尿，还伴有日间LUTS
PNE	自幼遗尿，没有6个月以上的不尿床期，并除外器质性疾病
SNE	之前已经有长达6个月或更长不尿床期后又再次出现尿床
预期膀胱容量（EBC）	<12岁时计算公式为：[(年龄+1)×30]，单位mL；12~18岁为390 mL
最大排尿量（MVV）	24 h内出现的单次最大排尿量（早晨第1次排尿除外），该排尿量需在排尿日记中保持记录至少2天
夜间总尿量（TVV）	包括入睡后夜间自主或不自主的排尿量（尿布增重或夜间起床排尿量）与清晨第1次尿量之和
夜间多尿（NP）	夜间尿量超过同年龄段儿童预期膀胱容量130%
膀胱过度活动症（OAB）	一种以尿急症状为特征的症候群，可伴或不伴有急迫性尿失禁
日间LUTS	日间发生漏尿、尿频、尿急、排尿次数减少、排尿困难、尿线中断或排尿中断
漏尿	多指白天不自觉将尿液排出体外
尿频	日间排尿≥8次·d^-1
尿急	突然、意想不到和急迫的排尿
日间排尿次数减少	日间排尿<4次·d^-1
排尿困难	排尿踌躇（排尿犹豫、启动困难）、尿流速缓慢，排尿费力、需按压以促进排尿

年龄	EBC	MVV最小阈值^1）	TVV最大阈值^2）
5岁	180	117	234
6岁	210	137	273
7岁	240	156	312
8岁	270	176	351
9岁	300	195	390
10岁	330	215	429
11岁	360	234	468
12~18岁	390	254	507

年龄	女	男
4~8岁	1 000~1 400	1 000~1 400
9~13岁	1 200~2 100	1 400~2 300
14~18岁	1 400~2 500	2 100~3 200