儿童遗尿症中西医结合临床实践指南（2025年）

doi:10.20274/j.cnki.1674-3865.2025.03.001

摘要/Abstract

摘要：

儿童遗尿症是指年龄≥5岁的儿童在夜间睡眠时发生间歇性尿失禁，是儿科临床常见疾病之一。持续存在的遗尿症状会影响患儿的身心健康和生活质量，加重社交焦虑及家庭照护负担。为规范遗尿症的中西医结合临床诊疗方案，由中华中医药学会儿童健康协同创新平台、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及中国中西医结合学会儿科专委会肾脏风湿内分泌协作组共同发起制定该指南。该指南从定义、临床分类、发病机制、病史采集、体格检查、辅助检查、中西医结合诊治策略等方面对遗尿症进行了系统梳理，尤其是针对遗尿症的不同临床分类分别给出了中西互参的结合点，以期为遗尿症的中西医诊断与治疗提供合理化建议和参考，并推动遗尿症中西医结合研究的发展。

关键词: 遗尿症, 临床实践指南, 中西医结合, 标准, 儿童

Abstract:

Childhood enuresis (also known as nocturnal enuresis, NE) is intermittent urinary incontinence that occurs at night during sleep in children ≥5 years of age, and is one of the common clinical disorders in pediatrics. The persistent symptoms of nocturnal enuresis affect children's physical and mental health and quality of life, which aggravates social anxiety and increases the burden of family care. In order to standardize the clinical diagnosis and treatment protocols of NE in integrative Chinese and western medicine, the Chinese Society of Traditional Chinese Medicine (CSTCM) Children's Health Collaborative Innovation Platform (CHCIP), the Chinese Children's Enuresis Disease Management Collaborative Group of Renal Disease Group of Pediatricians Branch of Chinese Medical Doctor Association (CMDA), and the Kidney Rheumatism Endocrinology Cooperative Group of Pediatric Special Committee of Chinese Association of Integrated Traditional Chinese and Western Medicine have jointly initiated the development of this guideline. The guideline systematically sorts out NE from the aspects of definition, clinical classification, pathogenesis, medical history collection, physical examination, auxiliary examination, and diagnosis and treatment strategies of integrative Chinese and western medicine. Especially, it puts forward the integrative points of Chinese and western medicine regarding different clinical classifications of NE, with the aim of providing rationalized suggestions and references for the diagnosis and treatment of NE in both Chinese and western medicines, and promoting the development of the research on the combination of Chinese and western medicines in NE.

Key words: Enuresis, Clinical practice guidelines, Integrative Chinese and western medicine, Criteria, Child

中图分类号:

R256.54

. 儿童遗尿症中西医结合临床实践指南（2025年）[J]. 中国中西医结合儿科学, 2025, 17(3): 185-198.

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分类	定义
原发/继发	原发性遗尿症：自幼遗尿，无6个月以上的不尿床期，并除外器质性疾病
原发/继发	继发性遗尿症：之前已有长达6个月或更长不尿床期后又再次出现尿床
单症状/非单症状	单症状性遗尿症：仅有夜间遗尿，不伴有日间下尿路症状^＊
单症状/非单症状	非单症状性遗尿症：不仅有夜间遗尿，还伴有日间下尿路症状
遗尿程度	轻度：2～3个夜晚/周
	中度：4～6个夜晚/周
	重度：7个夜晚/周

内容	询问要点
排尿情况	了解排尿的时间、频率、次数和排尿量，是否有尿急、尿失禁、排尿延迟、排尿困难、间断排尿及异常排尿姿势等，症状出现及加重、缓解因素。通过记录排尿日记可以更好地协助诊断，避免出现描述的主观差异
排便情况	有无便秘、腹泻和大便失禁
饮食习惯、液体摄入量	有无重盐、喜甜食，白天饮水量及睡前饮水习惯
用药史	是否使用抗胆碱能、镇静催眠药、利尿药、抗精神病药、肾上腺素能受体激动药、咖啡因等
心理行为表现	有无心理、行为和精神异常以及运动和学习障碍
手术史	是否有先天性巨结肠、尿道膀胱手术史等
家族史	一级、二级和三级亲属的遗尿史
其他	有无糖尿病、反复尿路感染、睡眠异常（睡眠通气不良、多梦乱动等）或神经系统疾病

分型	主症	次症	舌脉
肾气不足，开阖失司	睡中遗尿，熟睡不易醒，尿量多	面色淡白，精神不振	舌质淡、苔白、脉沉细
肝失疏泄，湿热下注	睡中遗尿，伴白天尿频、尿急和尿失禁	小便量少色黄，气味腥臊，性情急躁，目睛红赤，夜卧不安或梦语齘齿，口臭，大便黏或干	舌质红，苔黄腻，脉滑数
心肾不交，阴阳失衡	睡中小便自遗	伴有五心烦热，形体消瘦，活动过度，多动少静，冲动任性，注意力不集中，夜寐难醒，记忆力差，夜卧不安，多梦易惊，夜间多汗	舌质红，苔少，脉沉细数
脾胃积热，下移膀胱	睡中遗尿	夜卧不宁，烦渴易饥，口臭，大便黏或干	舌质红，苔黄燥，脉滑数
下元虚寒，气化失常	病程较长，睡中遗尿，甚者一夜数次	尿频尿清而长，神疲乏力，面白肢冷，腰腿酸软，或智力较差	舌质淡，苔薄白，脉沉迟无力

年龄（岁）	预计膀胱容量	日间最大排尿量^a	夜间总尿量^b
5	180	117	234
6	210	137	273
7	240	156	312
8	270	176	351
9	300	195	390
10	330	215	429
11	360	234	468
12~18	390	254	507