CAJ | 학술논문

目的:通过会阴超声显示的盆底肌肉运动、阴道内压力和盆底表面肌电的同步检测证实电针阴部神经刺激疗法确能兴奋阴部神经.方法:对骶部四个针刺点,采用长针(针灸针)深刺并加以电刺激直接兴奋阴部神经.在患者接受电针阴部神经刺激疗法的同时,使用带影像组件的Medtronic Duet Encompass尿动力仪同步显示会阴超声B模式下盆底肌肉运动和M模式下盆底肌运动曲线、阴道压变化曲线及盆底肌电波.同步检测亦在下列三种情况下进行:1)停止电刺激;2)减弱电刺激强度至原来的2/7左右;3)逐渐退出下两针使针尖离开原处1～2 cm.结果:35例女性压力性尿失禁患者(年龄54.9±9.8岁)接受了电针阴部神经刺激疗法和同步检测.当电针阴部神经刺激疗法正确实施时,患者有盆底肌以尿道为中心有节律地向头部方向收缩的感觉;同步检测显示超声B模式下盆底肌头尾方向运动,M模式下盆底肌运动曲线(振幅1 mm左右,n=31,14例≥1 mnl,17例＜1 mm),锯齿状阴道压变化曲线[变化幅度2.61±1.69(0.7～5.6)cmH2O2,n=34]和盆底肌电波[波幅23.9±25.3(5～96)μV,n=34].盆底肌运动曲线振幅大小与阴道压力变化幅度大小基本一致.当停止电刺激,减弱电刺激或针尖后退离开原处1～2厘米时,盆底肌运动及其运动曲线和锯齿状阴道压变化曲线消失.结论:电针阴部神经刺激疗法确能兴奋阴部神经,有效地收缩盆底肌.
목적:통과회음초성현시적분저기육운동、음도내압력화분저표면기전적동보검측증실전침음부신경자격요법학능흥강음부신경.방법:대저부사개침자점,채용장침(침구침)심자병가이전자격직접흥강음부신경.재환자접수전침음부신경자격요법적동시,사용대영상조건적Medtronic Duet Encompass뇨동력의동보현시회음초성B모식하분저기육운동화M모식하분저기운동곡선、음도압변화곡선급분저기전파.동보검측역재하렬삼충정황하진행:1)정지전자격;2)감약전자격강도지원래적2/7좌우;3)축점퇴출하량침사침첨리개원처1～2 cm.결과:35례녀성압력성뇨실금환자(년령54.9±9.8세)접수료전침음부신경자격요법화동보검측.당전침음부신경자격요법정학실시시,환자유분저기이뇨도위중심유절률지향두부방향수축적감각;동보검측현시초성B모식하분저기두미방향운동,M모식하분저기운동곡선(진폭1 mm좌우,n=31,14례≥1 mnl,17례＜1 mm),거치상음도압변화곡선[변화폭도2.61±1.69(0.7～5.6)cmH2O2,n=34]화분저기전파[파폭23.9±25.3(5～96)μV,n=34].분저기운동곡선진폭대소여음도압력변화폭도대소기본일치.당정지전자격,감약전자격혹침첨후퇴리개원처1～2전미시,분저기운동급기운동곡선화거치상음도압변화곡선소실.결론:전침음부신경자격요법학능흥강음부신경,유효지수축분저기.
Purpose:To prove that electroacupuncture pudendal nerve stimulation(EPNS)can exactly excites the pudendal nerve.by simultaneous measurements of pelvic floor muscle (PFM) movements(perineal ultrasound),vaginal pressure and pelvic floor surface myoelectricity.Methods:Long needles(acupuncture needles)were deeply inserted into four sacral points and electrifled to stimulate the Pudendal nerves.When EPNS Was performed.perineal ultrasound B-mode images of PFM movements(contractions),M-mode PFM movement curves;vaginal pressure and pelvic floor surface electromyogram were recorded simultaneously by use of an urodynamic instrument with video suite(Medtronic Duet Encompass).Simultaneous records were also obmined under three conditions in the process of the nerve stimulation:1) pausing electric stimulation;2)reducing the intensity of electric stimulation(to about 2/7 of the original);3)drawing back the two lower needles to make the tips 1-2 cm away from the original position.Results:Thirty-five female patients with stress incontinence(aged 54.9±9.81 received EPNS and the simultaneous measurements.When EPNS was performed correctly,the patient felt rhythmic and cephalad PFM contractions with the urethra as the center.Simultaneous records showed the following:1) cranio-caudal PFM movements on the B.mode image;2)the M-mode curves indicating the PFM contractions (amplitude:about 1 mm,n=31,14 cases≥1 mm and 17 cases＜1 mm);3)A sawtooth curve of changes in vaginal pressure[amplitude:2.61±1.69(0.7-5.6)cmH2O,n=34];4)pelvic floor myoelectric waves[amplitude:23.9±25.3(5-96)μV,n=34].The amplitude of a PFM movement curve conformed basically to that of a vaginal pressure curve.If the electric current was stopped or its intensity was reduced to about 2/7 of the original or during the process of the nerve stimulation the two lower needles were gradually drawn back until the tips were 1-2 cm away from the original positions,then B-mode PFM movements,M-mode curves and sawtooth changes in vaginal pressure disappeared.Conclusion:Electroacupuncture pudendal nerve stimulation can exactly excites the pudendal nerve and effectively contract the pelvic floor muscles.