CAJ | 학술논문

目的：探讨阳极阻滞电刺激术刺激骶神经根对恢复脊髓损伤性神经源性膀胱功能的价值及机制。方法选取新西兰清洁级白兔54只，均经尿流动力学检查证实无异常。随机选择18只作为对照组（假手术），其余36只采用脊髓完全夹闭法造成脊髓损伤模型。造模后白兔按是否植入电极分成电刺激组18只与神经源性膀胱组18只。电刺激组予以长期电刺激，刺激时间为30 min／次，6次／d，刺激4周。检查3组尿动力学情况，评估膀胱功能。结果对照组术前术后未见逼尿肌收缩现象，尿动力参数各项指标比较差异均无统计学意义，且膀胱充盈期压力曲线较为平滑，无排尿期反射；神经源性膀胱组术后膀胱逼尿肌漏尿点压、静息压升高，逼尿肌活动亢进且收缩多为无效，在排尿过程中出现逼尿肌－括约肌失调，残余尿量增多且排尿量减少，膀胱体积明显减少，排尿效率与膀胱顺应性均下降；电刺激组膀胱静息压有所上升，膀胱充盈中逼尿肌收缩较佳，漏尿点压有所降低，且括约肌在排尿中肌电图十分稳定，排尿量有所增加，残余尿量相应减少，排尿效率以及膀胱顺应性均增高。结论阳极阻滞电刺激法可以明显减少残余尿量，增大膀胱体积，有助于排尿率的提升，可降低逼尿肌压、漏尿点压以及膀胱静息压，对恢复膀胱功能及重建有重要意义。
목적：탐토양겁조체전자격술자격저신경근대회복척수손상성신경원성방광공능적개치급궤제。방법선취신서란청길급백토54지，균경뇨류동역학검사증실무이상。수궤선택18지작위대조조（가수술），기여36지채용척수완전협폐법조성척수손상모형。조모후백토안시부식입전겁분성전자격조18지여신경원성방광조18지。전자격조여이장기전자격，자격시간위30 min／차，6차／d，자격4주。검사3조뇨동역학정황，평고방광공능。결과대조조술전술후미견핍뇨기수축현상，뇨동력삼수각항지표비교차이균무통계학의의，차방광충영기압력곡선교위평활，무배뇨기반사；신경원성방광조술후방광핍뇨기루뇨점압、정식압승고，핍뇨기활동항진차수축다위무효，재배뇨과정중출현핍뇨기－괄약기실조，잔여뇨량증다차배뇨량감소，방광체적명현감소，배뇨효솔여방광순응성균하강；전자격조방광정식압유소상승，방광충영중핍뇨기수축교가，루뇨점압유소강저，차괄약기재배뇨중기전도십분은정，배뇨량유소증가，잔여뇨량상응감소，배뇨효솔이급방광순응성균증고。결론양겁조체전자격법가이명현감소잔여뇨량，증대방광체적，유조우배뇨솔적제승，가강저핍뇨기압、루뇨점압이급방광정식압，대회복방광공능급중건유중요의의。
Objective It is to explore the value and mechanism of anodal block electrical stimulation at sacral nerve root on the recovery of spinal cord injury neurogenic bladder function .Methods 54 New Zealand rabbits of clean grade were select-ed and confirmed to be normal by urodynamics , in which 18 ones were randomly selected as control group (sham operation), the rest 36 ones were established as spinal cord injury models by completely spinal occlusion , and the injury animal models were divided into electrical stimulation group (n=18) and neurogenic bladder group (n=18) according to whether implanted electrodes .Electrical stimulation group was treated with long -term electrical stimulation for 4 weeks , the stimulation time was 30min per once and 6 times per day.Urine dynamics of the rabbits in the three groups were checked after 4 weeks to evaluate the function of bladder .Results No detrusor contraction phenomenon was found in the control group before and after surgery , and there was no difference in urodynamic parameters , and the bladder filling period of pressure curve was more smooth , with-out voiding reflex .In neurogenic bladder group , urinary bladder detrusor leak point pressure and resting pressure increased af-ter operation , detrusor overactivity and shrink much as invalid , urination disorders of detrusor sphincter appeared , residual u-rine volume increased and urine output decreased , bladder volume significantly reduced , and voiding efficiency and bladder compliance decreased .In electrical stimulation group , the bladder resting pressure increased , the filling of bladder detrusor contraction was better , leak point pressure decreased , the sphincter electromyography in micturition was very stable , urine out-put increased , a corresponding reduction in residual urine volume , voiding efficiency and bladder compliance were higher . Conclusion Anode block electrical stimulation can significantly reduce residual urine volume and increase bladder volume , which is helpful for the increase of urination rate , it can reduce detrusor pressure , leak point pressure and bladder resting pressure, and has an important significance for the recovery and reconstruction of bladder function .