本文選題：下尿路 + 膀胱功能��； 參考：《北京中醫(yī)藥大學》2015年博士論文

【摘要】：背景下尿路由膀胱和尿道組成,是一個完整的功能單位。排尿活動除受周圍神經(jīng)的控制之外,還受到低位中樞(骶髓)高位中樞(腦干和大腦皮層)的共同控制。近年來的針刺基礎研究顯示：針刺S,部位的骨膜時,OAB大鼠的排尿間隔得到顯著增加；電針中膂俞可降低膀胱機能亢進大鼠的排尿頻率；針刺OAB大鼠的次可使其排尿頻率顯著下降。而另外一些研究提示：針刺正常家貓的次 ,可觀察到膀胱收縮及膀胱內壓升高現(xiàn)象；針刺次、三陰交、腎俞可明顯提高尿潴留家兔的膀胱內壓、減少殘余尿量；亦有研究從延髓排尿中樞入手,提示針刺膀胱俞后延髓排尿中樞的電活動增加。針刺對膀胱可能存在抑制和興奮的雙向調節(jié),這種“雙向性”調節(jié)是否與機體的不同狀態(tài)有關,以及“雙向性”調節(jié)的神經(jīng)通路如何?這些問題尚需進一步的研究。目的評價針刺對膀胱是否存在“雙向調節(jié)”效應,即在膀胱抑制狀態(tài)下,針刺使其興奮；在膀胱興奮狀態(tài)下,針刺使其抑制；并探索針刺調節(jié)膀胱功能的神經(jīng)機制。研究內容和方法1.在麻醉大鼠正常生理狀態(tài),選取膀胱同神經(jīng)節(jié)段腧穴中毼/次毼、三陰交、異神經(jīng)節(jié)段腧穴合谷進行針刺刺激(手針、電針2Hz、電針15Hz,穴位針刺順序隨機選擇,)同步記錄膀胱收縮時的尿動力學指標和逼尿肌肌電活動與盆神經(jīng)電活動,觀察針刺對其影響及相關性。2.在麻醉大鼠急性尿潴留(AUR)狀態(tài),選取膀胱同神經(jīng)節(jié)段腧穴中/次、三陰交、異神經(jīng)節(jié)段腧穴合谷進行針刺刺激(手針、電針2Hz、電針15Hz,穴位針刺順序隨機選擇,)同步記錄膀胱收縮時的尿動力學指標和逼尿肌肌電活動與盆神電活動,觀察針刺對其影響及相關性。3.在麻醉大鼠膀胱過度活動(OAB)狀態(tài),選取膀胱同神經(jīng)節(jié)段腧穴中/次 三陰交、異神經(jīng)節(jié)段腧穴合谷進行針刺刺激(手針、電針2Hz、電針15Hz,穴位針刺順序隨機選擇,)同步記錄膀胱收縮時的尿動力學指標和逼尿肌肌電活動與盆神電活動,觀察針刺對其影響及相關性。結果1. 無論何種針刺刺激(手針、電針2Hz、電針15Hz)“三陰交”穴或“中毼/次毼”穴,都延長麻醉大鼠正常生理狀態(tài)下的排尿間隔時間；但針刺(手針、電針2Hz、電針15Hz)“合谷”穴對麻醉大鼠正常生理狀態(tài)下的膀胱各尿動力學指標無明顯影響,說明針刺調節(jié)正常生理狀態(tài)下膀胱活動期處于偏抑制,并與腧穴所處神經(jīng)節(jié)段相關。2. 無論何種針刺刺激(手針、電針2Hz、電針15Hz) “三陰交”穴或“中毼/次毼”穴,都增加麻醉大鼠AUR狀態(tài)下的大鼠膀胱收縮時間與最大逼尿肌收縮壓,降低排尿頻率時間和收縮后膀胱內壓,促進AUR大鼠的排尿,減少膀胱殘余尿,同時增加逼尿肌膀胱收縮時放電次數(shù),從而對過度的抑制對膀胱起到興奮作用,且近端腧穴中毼/次毼的逼尿肌膀胱收縮時放電次數(shù)(7.19±1.47)優(yōu)于遠端腧穴三陰交(5.84±1.61 )(P0.05；)但針刺(手針、電針2Hz、電針15Hz)“合谷”穴對麻醉大鼠AUR狀態(tài)下的膀胱各尿動力學指標及逼尿肌無明顯影響；說明針刺興奮膀胱功能效應與腧穴所處神經(jīng)節(jié)段相關。3. 無論何種針刺刺激(手針、電針2Hz、電針15Hz)“三陰交”穴或“中毼/次毼”穴,都增加麻醉大鼠OAB狀態(tài)下膀胱收縮時間和逼尿肌最大收縮壓,延長排尿間隔時間,減少了收縮后膀胱內壓,促進OAB大鼠的排尿,降低排尿頻率,同時減少膀胱收縮時逼尿肌放電頻率,從而對過度興奮的膀胱起到抑制作用,且近端腧穴中毼/次毼的最大逼尿肌收縮壓(41.14±1.27)排尿間隔(165.22±21.85)優(yōu)于遠端腧穴三陰交(38.97±1.70)(128.80±22.99 )(P0.01；)但針刺(手針、電針2Hz、電針15Hz)“合谷”穴對麻醉大鼠OAB狀態(tài)下的膀胱各尿動力學指標及逼尿肌電活動無明顯影響；說明針刺抑制膀胱功能效應與腧穴所處神經(jīng)節(jié)段相關。結論研究表明,在不同病理模型大鼠中,針刺對膀胱同神經(jīng)節(jié)段的腧穴對膀胱存在“雙向調節(jié)”,這種雙向效應取決于不同的疾病模型所處的狀態(tài)。也即在尿潴留時的膀胱抑制狀態(tài)下,針刺有興奮性效應；在膀胱刺激癥的興奮狀態(tài)下,針刺有抑制性效應。針刺效應與穴位所處的節(jié)段和膀胱神經(jīng)支配的節(jié)段遠近相關：近端腧穴如中毼/次毼效應優(yōu)于遠端腧穴如三陰交,遠離膀胱神經(jīng)節(jié)段的腧穴合谷效應不明顯,說明這種“雙向調節(jié)”是通過影響支配膀胱的神經(jīng)活動實現(xiàn)的。針刺對膀胱的“雙向調節(jié)”機制是通過興奮或抑制逼尿肌肌電活動來興奮或抑制膀胱收縮。生理狀態(tài)下于排尿期針刺膀胱同神經(jīng)節(jié)段的腧穴三陰交或中毼/次毼可延長其排尿間隔,以抑制排尿效應為主,是否存在興奮性效應有待于進一步實驗證實。
[Abstract]:The urinary bladder and urethra composition in the background is a complete functional unit. The urination activity is controlled by the peripheral nerve in addition to the peripheral nerve, and is also controlled by the high center (the brain stem and the cerebral cortex) in the lower center (the sacral pulp). In recent years, the basic acupuncture study showed that when the S, the periosteum of the part of the OAB rats were puncturing, the interval of urination was remarkable. The frequency of urination in rats with hyperactivity of bladder can be reduced by Electroacupuncture at Zhong lshu, and the frequency of urination in OAB rats can be reduced significantly. In addition, some other studies suggest that the phenomenon of bladder contraction and elevated bladder pressure can be observed in normal domestic cats; acupuncture, Sanyinjiao and Shenshu can obviously improve the retention of urine in rabbits. The internal pressure of the bladder reduces the amount of residual urine; there is also a study from the medullary urination center, which suggests that the electrical activity of the medullary micturition center is increased after the acupuncture of the bladder, and that there may be a two-way regulation of inhibition and excitement to the bladder. These questions still need further study. Objective to evaluate the "two-way regulation" effect of acupuncture on the bladder, that is, in the state of bladder suppression, acupuncture makes it exciting; under the excitation of bladder, acupuncture makes it inhibit; and explore the nerve mechanism of acupuncture regulating bladder function. Research contents and methods 1. in normal anesthetic rats. The urodynamic indexes of the bladder contraction and the electric activity of the detrusor and the electric activity of the detrusor muscle and the electrical activity of the pelvic nerve were recorded simultaneously, and the influence and phase of the acupuncture on it were observed. .2. in the state of acute urinary retention (AUR) in anesthetized rats, select the acupuncture stimulation (hand, electroacupuncture 2Hz, electroacupuncture 15Hz, acupoint acupuncture sequence random selection,) synchronously record the urodynamic index of bladder contraction and the electromyography of detrusor and pelvic God electrical activity in the bladder of the same ganglion segment acupoints of the ganglion segment of the bladder. The influence and correlation of acupuncture on the state of bladder overactivity (OAB) in anesthetized rats and the selection of acupuncture stimulation (hand acupuncture, electroacupuncture 2Hz, electroacupuncture 15Hz, acupuncture point sequence of acupoints) to synchronize urodynamic indexes and compel urine in the bladder contraction of the bladder at the acupoints of the same ganglion at the acupoints of the ganglia of the anaesthetized rats and the acupoints of the ganglion segment of the bladder (.3.). Results 1. acupuncture stimulation (hand acupuncture, electroacupuncture 2Hz, electroacupuncture 15Hz), "Three Yin Jiao" points or "Zhong Yin" point, can prolong the interval time of urination in normal physiological state of anesthetized rats, but acupuncture (hand needle, electroacupuncture 2Hz, electroacupuncture 15Hz) "Hegu" point The urinary kinetic indexes of the bladder in the normal physiological state of the anesthetized rats were not significantly affected, indicating that the bladder active period under the regulation of normal physiological state was partial inhibition, and it was related to the ganglion segment of the acupoint of.2. no matter what acupuncture stimulation (hand needle, electroacupuncture 2Hz, electroacupuncture 15Hz) "Three Yin" points or "middle of Yin" point, all increased anesthesia. The bladder contraction time and the maximum detrusor systolic pressure in the AUR state of rats, lower urinary frequency time and intravesical pressure after contraction, promote urination of AUR rats, reduce urinary bladder residual urine, and increase the number of discharge times of detrusor bladder contraction. The number of discharges (7.19 + 1.47) of the detrusor contractile bladder (7.19 + 1.47) was superior to that of the distal acupoint (5.84 + 1.61) (5.84 + 1.61), but the acupuncture (hand, electroacupuncture 2Hz, electroacupuncture 15Hz) had no significant influence on the urinary kinetic indexes and detrusor of the bladder in the AUR state of the anesthetized rats. No matter what kind of acupuncture stimulation (hand acupuncture, electroacupuncture 2Hz, electroacupuncture 15Hz) "Three Yin Jiao" points or "middle.3." acupoints, all of them increase the time of bladder contraction and the maximum systolic pressure of detrusor, prolong the interval of urination, reduce the internal pressure of the bladder after contraction, promote the urination of the OAB rats and reduce the frequency of urination. The frequency of detrusor discharge during bladder contraction was reduced and the excessively excited bladder was inhibited, and the maximum detrusor systolic pressure (41.14 + 1.27) in the proximal acupoints (165.22 + 21.85) was superior to that of the distal acupoint (38.97 + 1.70) (128.80 + 22.99) (P0.01;) but acupuncture (hand, electroacupuncture 2Hz, electroacupuncture 15Hz) " The effect of acupuncture on bladder function is related to the ganglion segment of acupoints in the OAB state of the anaesthetized rats. Conclusion the study shows that the acupuncture on the acupoints of the bladder and the segment of the deity segment has a two-way regulation of the bladder in different pathological model rats. "The two way effect depends on the state of the different disease models. That is, the acupuncture has the excitatory effect under the bladder suppression state of urinary retention; in the excitatory state of the bladder irritation, acupuncture has the inhibitory effect. The acupuncture effect is closely related to the segment of the acupoint and the segment of the innervation of the bladder: the proximal acupoints such as The effect of the intermediate effect is superior to the distal acupoint such as the triple yin, and the acupoint of the acupoint far away from the ganglia of the bladder is not obvious. It shows that this "bidirectional regulation" is realized by affecting the nerve activity that dominates the bladder. The mechanism of "bidirectional regulation" of the bladder is to excite or inhibit the bladder by stimulating or inhibiting the electromyography of detrusor. In the physiological state, the acupoints of the bladder of the same ganglion at the stage of urination can prolong the interval of urination, in order to inhibit the effect of urination, and whether there is the effect of excitability remains to be confirmed by further experiments.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R245

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