电刺激治疗失禁的研究

发布时间：2019-03-28 18:29

【摘要】：失禁是临床上常见的一种功能性疾病，其人群平均患病率高达2%，60岁以上老年人的人群患病率达7%。它不仅给病人带来了痛苦与不便，严重影响其参与正常社交生活和工作，也给社会造成了巨大的损失。直肠功能障碍、肛门括约肌损伤或者相关神经的损伤都可能导致失禁的发生。功能电刺激治疗失禁是通过电刺激作用于神经或肌肉并使之产生目的动作而抑制失禁的一种治疗手段。功能电刺激与化学药物治疗、薄股肌原位形成术、植入式人工肛门相比较，在失禁治疗中具有无创伤感染、操作简单、容易重复、人体适应性好、安全性高等特点。根据作用对象的不同，功能电刺激分为针对神经的骶神经电刺激和针对肌肉的直接电刺激。其中不依赖于神经完整的直接电刺激由于控制简单且安全可靠而具有巨大的发展潜力。另一方面，国内目前尚没有自主知识产权的针对失禁治疗的相关功能电刺激医疗设备，因此安全有效的电刺激方法具有重要的科研与临床应用价值。本课题即是进行关于低频电刺激直接作用于肛门直肠角以抑制失禁的可行性探讨。作为本课题的基础研究内容，本文首先在理论上分析了肛门直肠角在人体排便节制机制中作用原理和神经肌肉兴奋调制的相关机制，以及人体肌肉组织在外加电信号刺激下的电场分布规律；接下来运用有限元方法对肛门直肠角进行物理建模，，借助COMSOL Multiphysics多物理场耦合分析软件分析了肛门直肠角模型在三种不同形状结构的电极刺激下组织内电场的空间分布，并通过结合组织电场分布理论得出了直肠角电刺激效果的评价标准，通过三种电极作用下组织电场分布的分析比较探讨了直肠电刺激电极的优化设计。直肠角电场仿真结果显示模型在三种电极在同样的电刺激作用下，环状电极相比于普通电极和条型电极在直肠肛门角部位产生了更高的电场强度，而带状电极在特定方向刺激强度较高。仿真结果证明通过改变电极的形状及位置，能够提高方向刺激的效能，有助于增强肛门直肠角控制排便的能力，从而为电刺激探头优化设计提供理论指导。另外，本文设计调装了一种电刺激器并通过了试验验证。
[Abstract]:Incontinence is a common clinical functional disease. The average prevalence rate of incontinence is as high as 2%. The prevalence of incontinence is 7% in people over 60 years of age. It not only brings pain and inconvenience to patients, seriously affects their participation in normal social life and work, but also causes great losses to society. Rectal dysfunction, anal sphincter injury, or related nerve damage may lead to incontinence. Functional electrical stimulation therapy for incontinence is a treatment that inhibits incontinence by stimulating nerves or muscles and causing them to produce target movements. Compared with chemotherapy, thin femoral muscle in situ formation and implanted artificial anus, functional electrical stimulation has the characteristics of non-invasive infection, simple operation, easy repetition, good adaptability and high safety in the treatment of incontinence. According to the object of action, functional electrical stimulation is divided into sacral nerve electrical stimulation and muscle direct electrical stimulation. Direct electrical stimulation, which does not depend on the integrity of the nerve, has great potential for development because of its simple control and safe and reliable control. On the other hand, at present, there is no independent intellectual property right for incontinence treatment related functional electrical stimulation medical equipment, so safe and effective electrical stimulation method has important scientific research and clinical application value. The purpose of this paper is to discuss the feasibility of low frequency electrical stimulation directly acting on anal rectum angle to inhibit incontinence. As the basic research content of this subject, this paper firstly analyzes the function principle of anal rectum angle in human defecation control mechanism and the related mechanism of neuromuscular excitation modulation. And the electric field distribution of human muscle under the stimulation of external electrical signals; Then the finite element method is used to model the anal rectum angle, and the spatial distribution of the electric field in the tissue under the stimulation of three different shapes of electrodes is analyzed by means of COMSOL Multiphysics multi-physical field coupling analysis software. According to the theory of tissue electric field distribution, the criterion for evaluating the effect of rectum angle electrical stimulation was obtained, and the optimal design of rectal electrical stimulation electrode was discussed by analyzing and comparing the distribution of tissue electric field under three kinds of electrodes. The simulation results show that the electric field intensity of the ring electrode is higher than that of the ordinary electrode and the strip electrode in the rectum anal angle under the same electric stimulation of the three kinds of electrodes, and the simulation results show that the model has higher electric field intensity than the ordinary electrode and the strip electrode under the same electric stimulation. The stimulation intensity of the ribbon electrode is higher in a certain direction. The simulation results show that by changing the shape and position of the electrode, the efficiency of directional stimulation can be improved and the ability of anus and rectum angle to control defecation can be enhanced, thus providing theoretical guidance for the optimal design of electrical stimulation probe. In addition, this paper designs and installs a kind of electrical stimulator and passes the experiment verification.
【学位授予单位】：重庆理工大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R246

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