【摘要】：正常的排尿反射是沿從腦、脊髓到膀胱、尿道平滑肌這樣一條協(xié)調(diào)完整的通路進(jìn)行。由交感、副交感、軀體周?chē)窠?jīng)共同參與,任何與排尿有關(guān)的神經(jīng)受到損害后,引起的排尿功能障礙稱(chēng)為神經(jīng)源性膀胱(neurogenic bladder,NB)。NB是一類(lèi)由神經(jīng)病變或損害引起的膀胱和(或)尿道的功能障礙性疾病,常同時(shí)伴有膀胱尿道功能的協(xié)調(diào)性失常�？僧a(chǎn)生復(fù)雜的排尿癥狀,而排尿不暢或尿潴留是其中最常見(jiàn)的癥狀之一。NB是脊髓損傷(spinal cord injury,SCI)后的常見(jiàn)并發(fā)癥,是SCI患者最常見(jiàn)的臨床問(wèn)題,癥狀根據(jù)脊髓損傷平面的不同可以分為不同類(lèi)型,常見(jiàn)為:①逼尿肌反射亢進(jìn);②逼尿肌無(wú)反射。而之后伴隨的腎功能衰竭、腎和膀胱結(jié)石、膀胱癌癥、尿路感染(UTI)和輸尿管返流(VUR)將增加患者死亡風(fēng)險(xiǎn)。因此,對(duì)于癱瘓的SCI患者,恢復(fù)膀胱功能甚至比恢復(fù)運(yùn)動(dòng)功能更加重要�，F(xiàn)代研究SCI后NB缺乏安全有效的治療方案,電針能阻止或減輕SCI后的繼發(fā)性的損害,促進(jìn)脊髓的修復(fù)和再生。但是電針刺激治療脊髓損傷的機(jī)理還未完全揭開(kāi),刺激強(qiáng)度也不好把握,而且電針不是上下神經(jīng)元的電生理恢復(fù)和傳導(dǎo)束的功能性重建,故還不能做到損傷部位的功能性替代,不能完全重建膀胱功能。SCI后NB屬中醫(yī)"癃閉"范疇。現(xiàn)代基礎(chǔ)研究證實(shí):濟(jì)生腎氣丸具有良性調(diào)節(jié)膀胱內(nèi)壓力及調(diào)節(jié)代謝、神經(jīng)和免疫的功能,因此我們選用電針刺激骶神經(jīng)治療SCI后NB的同時(shí),結(jié)合祖國(guó)醫(yī)學(xué)的優(yōu)勢(shì),辨證選用中藥濟(jì)生腎氣丸治療SCI后NB,旨在降低膀胱感染保護(hù)膀胱及腎功能,促進(jìn)膀胱功能的重建。本文通過(guò)SCI后NB的文獻(xiàn)研究、動(dòng)物實(shí)驗(yàn)及臨床尿動(dòng)力學(xué)分析三部分探討了 SCI后NB動(dòng)物模型的建立及評(píng)估、電針結(jié)合濟(jì)生腎氣丸濟(jì)生腎氣丸治療SCI后NB的療效及初步探討其改善SCI后NB大鼠膀胱功能的分子機(jī)制,為臨床治療SCI后NB提供新的方法和思路。1文獻(xiàn)綜述從西醫(yī)和中醫(yī)兩個(gè)方面對(duì)SCI后NB的流行病學(xué)、病理生理、分型、診斷和治療及中醫(yī)理論基礎(chǔ)、中藥治療、針灸治療和中醫(yī)其它療法等方面的現(xiàn)狀進(jìn)展進(jìn)行闡述,并總結(jié)SCI后NB的中西醫(yī)治療上的優(yōu)缺點(diǎn)。2實(shí)驗(yàn)研究2.1實(shí)驗(yàn)一目的:建立理想的脊髓損傷后神經(jīng)源性膀胱動(dòng)物模型并評(píng)估脊髓及膀胱狀態(tài)。方法:16只SD大鼠分為對(duì)照組(假手術(shù))6只,實(shí)驗(yàn)組(T9脊髓全橫斷損傷大鼠模型)10只,記錄每日實(shí)驗(yàn)組大鼠手法排尿量等情況以評(píng)估脊髓損傷后神經(jīng)源性膀胱恢復(fù)情況,術(shù)后2周使用尿流動(dòng)力學(xué)方法檢測(cè)并比較兩組大鼠膀胱內(nèi)壓以評(píng)估大鼠膀胱狀態(tài)。結(jié)果:術(shù)后一周內(nèi),大鼠手法輔助排尿量逐漸增加并達(dá)到最大。術(shù)后一周后,大鼠輔助排尿量逐漸減低并于兩周時(shí)漸漸穩(wěn)定。對(duì)照組及實(shí)驗(yàn)組大鼠在最大膀胱壓、膀胱基礎(chǔ)壓、排尿閾、收縮間隔、膀胱容量、排尿效率的參數(shù)值分別為(26.60±4.31)mmH2O、(21.66±2.56)mmH20;(11.66±1.33)mmH20、(14.72±2.65)mmH20;(20.46±0.52)mmH20、(16.99±0.81)mmH20;(1.36±1.58)min、(2.02±0.36)min;(0.82±0.15)ml、(2.20±0.24)ml;(92.67±1.97)%、(25.33±4.46)%。差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:采用T9水平脊髓全橫斷損傷制作的神經(jīng)源性膀胱大鼠模型可操作性強(qiáng),易量化、可重復(fù),在正確積極的術(shù)后護(hù)理下并發(fā)癥少、死亡率低。使用術(shù)后SCI大鼠手法排尿量的變化判斷脊髓恢復(fù)情況,并以尿流動(dòng)力學(xué)方法檢測(cè)大鼠在膀胱連續(xù)灌注下的膀胱壓力變化來(lái)評(píng)價(jià)其膀胱狀態(tài)客觀可行。2.2實(shí)驗(yàn)二目的:探討電針結(jié)合濟(jì)生腎氣丸對(duì)于SCI后NB大鼠膀胱功能、腎功能的干預(yù)作用及初步探討對(duì)損傷修復(fù)的分子機(jī)制。方法:SD雌性大鼠50只,隨機(jī)挑選8只作為A組(假手術(shù)組),其余42只大鼠進(jìn)行T9脊髓全橫斷損傷造模,2周后對(duì)確定神經(jīng)源性膀胱成模的存活大鼠39只隨機(jī)挑選8只作為B組(對(duì)照組),其余31只采用隨機(jī)數(shù)字表法分為:C組(中藥組)、D組(電針組)、E組(中藥+電針組)分別為11只、10只、10只。A組不予任何干預(yù)。B組造模后不予任何干預(yù)。C組給予自制濟(jì)生腎氣丸水煎劑灌胃和骶2神經(jīng)處體表肌肉電針。D組予蒸餾水灌胃和骼2神經(jīng)電針刺激。E組自制濟(jì)生腎氣丸水煎劑灌胃和骶2神經(jīng)電針刺激。實(shí)驗(yàn)期間觀察并記錄實(shí)驗(yàn)動(dòng)物的死亡情況;分別在造模前、干預(yù)4天后、干預(yù)2周后、干預(yù)4周后稱(chēng)取實(shí)驗(yàn)動(dòng)物的體重;在處死實(shí)驗(yàn)動(dòng)物后,稱(chēng)取膀胱重量。干預(yù)2周后,眼眶取血測(cè)定血肌酐、尿素氮、尿微量白蛋白。并取T8-T10脊髓及S2雙側(cè)神經(jīng)根用于Western blot 檢測(cè)。結(jié)果:動(dòng)物共死亡9只,其中造模過(guò)程死亡3只;干預(yù)及取標(biāo)本過(guò)程死亡6只,分別是C組3只、D組1只、E組2只。①一般情況:E組的電針結(jié)合濟(jì)生腎氣丸的干預(yù)方式能夠明顯改善SCI后大鼠的體重下降的情況,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)大鼠與對(duì)照組比較,在膀胱重量和最后一次手法排尿量方面差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。②血清肌酐、尿素氮和尿微量白蛋白檢查:血清肌酐各干預(yù)組同對(duì)照組比較差異不具有統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)2周后,E組電針結(jié)合濟(jì)生腎氣丸的干預(yù)方式能夠明顯降低SCI后大鼠尿素氮水平,與對(duì)照組比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);C組、D組、E組大鼠的尿微量白蛋白檢測(cè)結(jié)果較對(duì)照組均顯著降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。③膀胱HE染色:C組、D組、E組均能顯著改善SCI后NB大鼠的膀胱形態(tài):減輕膀胱壁肌層和黏膜層的水腫、充血及炎性細(xì)胞的浸潤(rùn),降低肌層增生的程度,而其中E組改善情況最明顯。④充盈性膀胱內(nèi)壓測(cè)定:D組、E組能夠顯著降低SCI后NB大鼠的膀胱容量,與對(duì)照組比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。⑤Western Blot檢測(cè)相關(guān)因子蛋白表達(dá):C組中藥治療以及E組電針結(jié)合中藥的治療方式能夠提高SCI后NB大鼠脊髓組織中神經(jīng)生長(zhǎng)因子NGF及其受體TrkA表達(dá)同時(shí)降低神經(jīng)根組織中神經(jīng)生長(zhǎng)因子NGF及其受體TrkA表達(dá),D組電針的方式能夠提高SCI后NB大鼠脊髓組織中TrkA表達(dá)同時(shí)降低神經(jīng)根組織中TrkA表達(dá),與對(duì)照組比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:①電針結(jié)合濟(jì)生腎氣丸治療能夠改善SCI后NB大鼠的體重下降情況、腎功能、膀胱組織病理學(xué)改變及膀胱容量。②電針結(jié)合濟(jì)生腎氣丸的治療方式能夠提高SCI后NB大鼠脊髓組織中神經(jīng)生長(zhǎng)因子NGF及其受體TrkA表達(dá)同時(shí)降低神經(jīng)根組織中神經(jīng)生長(zhǎng)因子NGF及其受體TrkA表達(dá),這可能是其改善SCI后NB大鼠膀胱功能的機(jī)制之一。3臨床分析目的:分析臨床不同損傷節(jié)段SCI后NB患者的尿動(dòng)力學(xué)檢查的特點(diǎn)。方法:收集2014年10月-2016年12月中國(guó)康復(fù)研究中心北京博愛(ài)醫(yī)院影像尿動(dòng)力學(xué)檢查中心檢查的門(mén)診或病房病人113例。根據(jù)患者損傷情況分為骶上脊髓損傷組和骶髓損傷組,分析比較兩組患者尿動(dòng)力檢查指標(biāo)最大膀胱容量、殘余尿量及通過(guò)影像尿動(dòng)力檢查觀測(cè)兩組患者逼尿肌無(wú)反射、逼尿肌過(guò)度活動(dòng)、順應(yīng)性增加、順應(yīng)性降低、膀胱感覺(jué)異常、膀胱-輸尿管返流的情況。結(jié)果:兩組患者尿動(dòng)力檢查指標(biāo)最大膀胱容量、殘余尿量比較均無(wú)明顯差異,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05);骶上脊髓損傷患者的逼尿肌無(wú)反射、逼尿肌過(guò)度活動(dòng)、膀胱順應(yīng)性增加、膀胱順應(yīng)性降低、膀胱感覺(jué)異常及膀胱-輸尿管返流的發(fā)生率分別是34.7%、36.8%、9.5%、44.2%、55.8%、63.2%,而骶髓損傷患者的發(fā)生率則分別是85.7%、21.4%、21.4%、35.7%、28.6%、71.4%。骶髓損傷患者比骶上脊髓損傷患者的逼尿肌無(wú)反射的表現(xiàn)較明顯,并且膀胱-輸尿管返流的發(fā)生率更高,但膀胱感覺(jué)異常的發(fā)生率明顯低于骶上脊髓損傷患者,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:骶上脊髓損傷患者主要表現(xiàn)為膀胱感覺(jué)異常,而骶髓損傷患者主要表現(xiàn)為逼尿肌無(wú)反射和膀胱-輸尿管返流。
[Abstract]:Normal urination reflex is a coordinated and complete pathway from the brain, the spinal cord to the bladder, and the smooth muscle of the urethra. It is involved in the sympathetic, parasympathetic, and peripheral nerves. After any injury to the urination, the urinary dysfunction (neurogenic bladder, NB).NB is a type of nerve. Dysfunction of the bladder and / or urethra caused by lesion or damage, often accompanied by a coordinated disorder of the urinary bladder and urethra, can produce complicated urination symptoms, and urinary retention or retention of urine is one of the most common symptoms,.NB is a common complication after spinal cord injury (SCI) and is the most common SCI patient. Clinical problems can be divided into different types according to the different plane of spinal cord injury, which are common as: (1) detrusor hyperreflexiism; (2) detrusor reflex; and subsequent renal failure, kidney and bladder stones, bladder cancer, urinary tract infection (UTI) and ureteral reflux (VUR) will increase the risk of death in patients. Therefore, for paralyzed SCI patients The restoration of bladder function is even more important than restoring the function of the motor. After the modern study of SCI, NB lacks a safe and effective treatment. Electroacupuncture can prevent or reduce secondary damage after SCI and promote the repair and regeneration of the spinal cord. However, the mechanism of electroacupuncture therapy for spinal cord injury has not been completely uncovered, and the intensity of stimulation is not well understood, and The electroacupuncture is not the electrophysiological recovery of the upper and lower neurons and the functional reconstruction of the conduction beam. Therefore, the functional replacement of the injured part can not be achieved, and the NB belongs to the category of "long closed" in Chinese medicine after the complete reconstruction of the bladder function.SCI. Modern basic research has confirmed that Jisan Shenqi Pill has a benign intravesical pressure regulating and regulating metabolism, nerve and immunity. Yes, so we choose the electroacupuncture stimulation of the sacral nerve to treat the NB after SCI, combined with the advantages of the Chinese medicine, and select the traditional Chinese medicine Jisan Shenqi Pill for the treatment of NB after SCI, in order to reduce the bladder and renal function of bladder infection and promote the reconstruction of the function of the bladder. This article through the literature study, animal experiment and clinical urodynamic analysis three after SCI. The establishment and evaluation of NB animal model after SCI, the effect of electroacupuncture combined with jiseng Shenqi Pill with Jisan Shenqi Pill in the treatment of NB after SCI and the molecular mechanism of improving the bladder function of NB rats after SCI, provide new methods and ideas for the clinical treatment of SCI after NB, and the.1 literature review from two aspects of Western medicine and traditional Chinese medicine to SCI NB flow The progress in the current status of disease, pathophysiology, typing, diagnosis and treatment and traditional Chinese medicine theory, traditional Chinese medicine treatment, acupuncture and moxibustion treatment and other therapies of traditional Chinese medicine were expounded, and the advantages and disadvantages of traditional Chinese medicine and Western medicine after SCI were summed up by the.2 experimental study 2.1 experiment: to establish an ideal model of neurogenic bladder animal after spinal cord injury and evaluate the neurogenic bladder animal model. Methods: 16 SD rats were divided into 6 rats in the control group (sham operation) and 10 rats in the experimental group (T9 spinal complete transection injury rat model). The urine volume of the rats in the experimental group was recorded in order to evaluate the recovery of neurogenic bladder after spinal cord injury. 2 weeks after the operation, the urine flow kinetics method was used to detect and compare the two groups of rats. Intravesical pressure was used to evaluate the bladder state of rats. Results: during the week after the operation, the amount of manual urination in rats increased gradually and reached the maximum. After one week, the amount of auxiliary urination decreased gradually and gradually stabilized at two weeks. The control and experimental group were in the maximum bladder pressure, bladder base pressure, urination threshold, contraction interval, bladder capacity, urination. The parameters of the efficiency were (26.60 + 4.31) mmH2O, (21.66 + 2.56) mmH20, (11.66 + 1.33) mmH20, (14.72 + 2.65) mmH20, (20.46 + 0.52) mmH20, (16.99 + 0.81) mmH20, (1.36 + 1.58) min, ML, ml; (P0.05 + +)%, (P0.05)%. (P0.05). Conclusion: T9 horizontal spinal cord was used. The neurogenic rat model of neurogenic bladder produced by total transection injury is highly operable, easy to quantify, repeatable, less complications and lower mortality in the correct and active postoperative care. The recovery of spinal cord is judged by the changes in the amount of manipulative urination of SCI rats after operation, and the bladder pressure of rats under continuous bladder perfusion by urinary flow dynamic method is detected. Objective: To evaluate the objective and feasible.2.2 experiment two objective: To explore the effect of the electroacupuncture combined with jisen Shenqi Pill on bladder function, renal function and the molecular mechanism of injury repair in NB rats after SCI. Methods: 50 SD female rats were randomly selected as A group (sham operation group), and the other 42 rats were treated with T9 spinal cord. After 2 weeks, 39 rats were randomly selected as B group (control group), and the other 31 were divided into group C (group of Chinese Medicine), group D (electroacupuncture group), group E (traditional Chinese medicine + acupuncture group) 11, 10 respectively, and 10 group of.A without any intervention in.B group without any interference in.C The group gave the self-made Jisan Shenqi Pill water decoction and the 2 nerve of the sacrum to the body surface muscle electroacupuncture.D group to give the distilled water to irrigate the stomach and the iliac 2 nerve electroacupuncture stimulation to stimulate the.E group with the water decoction of Jisheng Shenqi Pill and the 2 nerve needle stimulation of the sacral nerve. During the experiment, the death situation of the experimental animals was observed and recorded. Before the model, the intervention was 4 days after intervention, and after the intervention for 2 weeks, the dry matter was dried. After 4 weeks, the body weight of the animal was weighed. After the experimental animals were killed, the weight of the bladder was weighed. After 2 weeks of intervention, blood creatinine, urea nitrogen and urine microalbumin were measured in the orbit. The T8-T10 spinal cord and S2 bilateral nerve roots were used for Western blot detection. Results: 9 animals died in the animal model process, and 3 of them died in the process of modeling; the intervention and sample process were taken. There were 6 deaths in group C, 3 in group C, 1 in group D and 2 in group E. (1) the interference of electroacupuncture combined with jiseng kidney qi pill in group E could obviously improve the weight decline of rats after SCI, and the difference was statistically significant (P0.05). Statistical significance (P0.05). (2) serum creatinine, urea nitrogen and urine microalbumin examination: serum creatinine intervention group was not significantly different from the control group (P0.05). After 2 weeks of intervention, the intervention of electroacupuncture combined with jiseng kidney qi pill in group E could significantly reduce the level of urea nitrogen in rats after SCI, and there was a statistical difference between the control group and the control group. The results of urinary microalbuminuria in group C, group D, and group E were significantly lower than those in the control group. The difference was statistically significant (P0.05). (P0.05) bladder HE staining: C group, D group and E group could significantly improve the bladder morphology of NB rats after SCI: reducing the edema of the muscularis and mucous layer of the bladder wall, congestion and infiltration of inflammatory cells, and reducing the muscle layer The degree of proliferation, and the most obvious improvement in group E. (4) filling bladder pressure measurement: group D, E group can significantly reduce the volume of bladder in NB rats after SCI, the difference has statistical significance (P0.05). 5. Western Blot detection related factor protein expression: C group of traditional Chinese medicine treatment and E group electroacupuncture combined with traditional Chinese medicine treatment The expression of nerve growth factor NGF and its receptor TrkA in spinal cord tissue of NB rats can be increased and the expression of nerve growth factor NGF and its receptor TrkA in the nerve root tissue is reduced. The D group electroacupuncture can increase TrkA expression in spinal cord tissue of NB rats after SCI and reduce TrkA expression in the nerve root group. The difference is compared with the control group. The difference is compared with the control group. Statistical significance (P0.05). Conclusion: (1) electroacupuncture combined with Jisan Shenqi Pill can improve the weight loss of NB rats after SCI, renal function, bladder histopathological changes and bladder capacity. 2. The treatment of electroacupuncture combined with jiseng kidney qi pill can improve the neural growth factor NGF and its receptor TrkA in spinal cord of NB rats after SCI To reduce the expression of nerve growth factor NGF and its receptor TrkA in nerve root tissue, which may be one of the mechanisms for improving the bladder function of NB rats after SCI,.3 clinical analysis: the characteristics of urodynamic examination of NB patients after SCI in different segments of the segmental SCI. Methods: to collect the Chinese rehabilitation research center in December -2016 year October 2014 113 patients in the clinic or ward were examined by the imaging urodynamic examination center in Beijing Bo'ai Hospital. The patients were divided into sacral spinal cord injury group and sacromedullary injury group according to the damage of the patients. The maximum bladder capacity, the residual urine volume and the detrusor inreflex in the two groups were observed and compared in the two groups. Excessive activity of detrusor, increased compliance, decreased compliance, abnormality of bladder sensation, bladder ureteral reflux. Results: there was no significant difference in the residual urine volume between the two groups, and the difference was not statistically significant (P0.05); the detrusor was not reflected in the sacral spinal cord injury and detrusor. The incidence of bladder compliance, bladder compliance and bladder ureteral reflux was 34.7%, 36.8%, 9.5%, 44.2%, 55.8%, 63.2%, respectively, while the incidence of sacral injury was 85.7%, 21.4%, 21.4%, 35.7%, 28.6%, respectively, and the 71.4%. sacral injury patients were less detrusor than those with sacral spinal cord injury. The incidence of bladder and ureteral reflux was higher, but the incidence of abnormal bladder sensation was significantly lower than that of the sacral spinal cord injury patients. The difference was statistically significant (P0.05). Conclusion: the patients with upper sacral spinal cord injury were mainly characterized by abnormal bladder sensation, and the main manifestations of sacral injury were detrusor inreflexity. Bladder ureteral reflux.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R651.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳勇;赤仁杰;;β-七葉皂甙鈉對(duì)脊髓損傷大鼠脊髓組織水通道蛋白4與水通道蛋白9表達(dá)的影響[J];中國(guó)醫(yī)科大學(xué)學(xué)報(bào);2016年12期

2 鄭利強(qiáng);伍亞民;石永江;江瓊;;黃芪多糖對(duì)大鼠脊髓損傷后運(yùn)動(dòng)功能和脊髓病理的效果[J];中國(guó)康復(fù)理論與實(shí)踐;2016年11期

3 楊永棟;俞興;熊洋;趙赫;;丹參酮ⅡA對(duì)骶上脊髓損傷后神經(jīng)源性膀胱大鼠尿動(dòng)力學(xué)的影響[J];中國(guó)脊柱脊髓雜志;2016年11期

4 楊梟雄;于前進(jìn);秦江;李忠海;宋科冉;任東風(fēng);唐家廣;;脊髓損傷住院患者1027例流行病學(xué)分析[J];脊柱外科雜志;2016年05期

5 張海明;彭偉雄;李華南;;補(bǔ)陽(yáng)還五湯對(duì)胸腰椎骨折伴脊髓損傷術(shù)后康復(fù)的臨床觀察[J];世界最新醫(yī)學(xué)信息文摘;2016年65期

6 陳愛(ài)連;胡振江;符文君;艾坤;;臍灸聯(lián)合膀胱功能訓(xùn)練治療脊髓損傷后神經(jīng)源性膀胱的臨床觀察[J];中國(guó)中醫(yī)急癥;2016年06期

7 李春梅;郭珊珊;李敏;;艾灸結(jié)合吳茱萸熱熨治療脊髓損傷神經(jīng)源性膀胱的效果觀察[J];全科護(hù)理;2016年12期

8 牛寶寶;趙斌;張文艷;;互動(dòng)式針刺法治療脊髓損傷后神經(jīng)源性膀胱的療效觀察[J];世界最新醫(yī)學(xué)信息文摘;2016年20期

9 李雪;董調(diào)紅;劉曉瑞;黃彬洋;熊興娟;陳燕;王舒敏;劉浩;陳洋;熊德啟;;強(qiáng)腎灸聯(lián)合運(yùn)動(dòng)想象療法治療脊髓損傷后神經(jīng)源性膀胱尿潴留隨機(jī)平行對(duì)照研究[J];實(shí)用中醫(yī)內(nèi)科雜志;2016年01期

10 鄧周武;楊梓華;鄭南翅;;補(bǔ)陽(yáng)還五湯加減輔助治療胸腰椎骨折伴脊髓損傷的可行性研究[J];首都食品與醫(yī)藥;2016年02期

，

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