夜间遗尿与上颌扩弓：一项叙述性综述。

文献信息

中文摘要

背景： 夜间遗尿（NE）可能发生于因潜在睡眠障碍（如阻塞性睡眠呼吸暂停）而睡眠不佳的儿童。已有研究提示潜在睡眠障碍与NE之间存在因果联系。上颌扩弓已被提出用于改善鼻气道通畅性和气流，目的是减少或解决受影响儿童的NE。

所审查的研究类型： 作者考察了历史上和当代使用上颌扩弓管理NE的方法。本综述的原始材料主要来自以PubMed为主要数据库的文献检索；使用了各种检索词并结合布尔运算符（AND/OR），以及在适用时使用医学主题词。确定了3项关于该主题的系统综述，但其中仅2项纳入了一项随机安慰剂对照试验。该单一项随机对照试验使用了安慰剂对照，并放置了假上颌扩弓器。其余可获得的证据来自临床研究。总体而言，有足够的证据可供批判性评价。

结果： 基于文献、NE的病理生理学以及诊断和管理该疾病的医学标准，可以明确上颌扩弓并非NE的循证治疗方法。

结论与实践意义： 没有证据支持对NE儿童常规进行上颌扩弓。在不存在横向差异的情况下进行扩弓在文献中缺乏依据。牙科保健专业人员应充分了解NE诊断和管理的循证方法，引导家庭从相关医疗保健专业人员（如儿科医生或小儿泌尿科医生）处获得正确的诊疗。

英文摘要

BACKGROUND: Nocturnal enuresis (NE) may occur in children experiencing poor sleep secondary to an underlying sleep disorder such as obstructive sleep apnea. A causal link between an underlying sleep disorder and NE has been suggested. Maxillary expansion has been proposed to improve nasal airway patency and airflow, with the aim of reducing or resolving NE in affected children.
TYPES OF STUDIES REVIEWED: The authors examined the historical and contemporary approaches to managing NE with maxillary expansion. The source material for this review came mainly from literature searches using PubMed as the primary database; various search terms combined with Boolean operators (AND/OR) were used as well as Medical Subject Heading terms, when applicable. Three systematic reviews on this topic were identified, although only 2 included a single randomized placebo-controlled trial. The single randomized controlled trial used a placebo control with a sham maxillary expander in place. The remaining available evidence came from clinical studies. Overall, sufficient evidence was available for critical appraisal.
RESULTS: Based on the literature, the pathophysiology of NE, and the medical standards for diagnosing and managing this condition, it is clear that maxillary expansion is not an evidence-based treatment for NE.
CONCLUSIONS AND PRACTICAL IMPLICATIONS: There is no evidence to support routine maxillary expansion for children with NE. Expanding in the absence of a transverse discrepancy is unsubstantiated in the literature. Dental care professionals should be well informed about the evidence-based approaches for the diagnosis and management of NE, guiding families to access the right care from the relevant health care professionals such as pediatricians or pediatric urologists.