针刺对膀胱的“双向调节”效应及神经机制研究

发布时间：2018-06-06 22:59

本文选题：下尿路 + 膀胱功能　；参考：《北京中医药大学》2015年博士论文

【摘要】：背景下尿路由膀胱和尿道组成,是一个完整的功能单位。排尿活动除受周围神经的控制之外,还受到低位中枢(骶髓)高位中枢(脑干和大脑皮层)的共同控制。近年来的针刺基础研究显示：针刺S,部位的骨膜时,OAB大鼠的排尿间隔得到显著增加；电针中膂俞可降低膀胱机能亢进大鼠的排尿频率；针刺OAB大鼠的次可使其排尿频率显著下降。而另外一些研究提示：针刺正常家猫的次 ,可观察到膀胱收缩及膀胱内压升高现象；针刺次、三阴交、肾俞可明显提高尿潴留家兔的膀胱内压、减少残余尿量；亦有研究从延髓排尿中枢入手,提示针刺膀胱俞后延髓排尿中枢的电活动增加。针刺对膀胱可能存在抑制和兴奋的双向调节,这种“双向性”调节是否与机体的不同状态有关,以及“双向性”调节的神经通路如何?这些问题尚需进一步的研究。目的评价针刺对膀胱是否存在“双向调节”效应,即在膀胱抑制状态下,针刺使其兴奋；在膀胱兴奋状态下,针刺使其抑制；并探索针刺调节膀胱功能的神经机制。研究内容和方法1.在麻醉大鼠正常生理状态,选取膀胱同神经节段腧穴中毼/次毼、三阴交、异神经节段腧穴合谷进行针刺刺激(手针、电针2Hz、电针15Hz,穴位针刺顺序随机选择,)同步记录膀胱收缩时的尿动力学指标和逼尿肌肌电活动与盆神经电活动,观察针刺对其影响及相关性。2.在麻醉大鼠急性尿潴留(AUR)状态,选取膀胱同神经节段腧穴中/次、三阴交、异神经节段腧穴合谷进行针刺刺激(手针、电针2Hz、电针15Hz,穴位针刺顺序随机选择,)同步记录膀胱收缩时的尿动力学指标和逼尿肌肌电活动与盆神电活动,观察针刺对其影响及相关性。3.在麻醉大鼠膀胱过度活动(OAB)状态,选取膀胱同神经节段腧穴中/次三阴交、异神经节段腧穴合谷进行针刺刺激(手针、电针2Hz、电针15Hz,穴位针刺顺序随机选择,)同步记录膀胱收缩时的尿动力学指标和逼尿肌肌电活动与盆神电活动,观察针刺对其影响及相关性。结果1. 无论何种针刺刺激(手针、电针2Hz、电针15Hz)“三阴交”穴或“中毼/次毼”穴,都延长麻醉大鼠正常生理状态下的排尿间隔时间；但针刺(手针、电针2Hz、电针15Hz)“合谷”穴对麻醉大鼠正常生理状态下的膀胱各尿动力学指标无明显影响,说明针刺调节正常生理状态下膀胱活动期处于偏抑制,并与腧穴所处神经节段相关。2. 无论何种针刺刺激(手针、电针2Hz、电针15Hz) “三阴交”穴或“中毼/次毼”穴,都增加麻醉大鼠AUR状态下的大鼠膀胱收缩时间与最大逼尿肌收缩压,降低排尿频率时间和收缩后膀胱内压,促进AUR大鼠的排尿,减少膀胱残余尿,同时增加逼尿肌膀胱收缩时放电次数,从而对过度的抑制对膀胱起到兴奋作用,且近端腧穴中毼/次毼的逼尿肌膀胱收缩时放电次数(7.19±1.47)优于远端腧穴三阴交(5.84±1.61 )(P0.05；)但针刺(手针、电针2Hz、电针15Hz)“合谷”穴对麻醉大鼠AUR状态下的膀胱各尿动力学指标及逼尿肌无明显影响；说明针刺兴奋膀胱功能效应与腧穴所处神经节段相关。3. 无论何种针刺刺激(手针、电针2Hz、电针15Hz)“三阴交”穴或“中毼/次毼”穴,都增加麻醉大鼠OAB状态下膀胱收缩时间和逼尿肌最大收缩压,延长排尿间隔时间,减少了收缩后膀胱内压,促进OAB大鼠的排尿,降低排尿频率,同时减少膀胱收缩时逼尿肌放电频率,从而对过度兴奋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缩压(41.14±1.27)排尿间隔(165.22±21.85)优于远端腧穴三阴交(38.97±1.70)(128.80±22.99 )(P0.01；)但针刺(手针、电针2Hz、电针15Hz)“合谷”穴对麻醉大鼠OAB状态下的膀胱各尿动力学指标及逼尿肌电活动无明显影响；说明针刺抑制膀胱功能效应与腧穴所处神经节段相关。结论研究表明,在不同病理模型大鼠中,针刺对膀胱同神经节段的腧穴对膀胱存在“双向调节”,这种双向效应取决于不同的疾病模型所处的状态。也即在尿潴留时的膀胱抑制状态下,针刺有兴奋性效应；在膀胱刺激症的兴奋状态下,针刺有抑制性效应。针刺效应与穴位所处的节段和膀胱神经支配的节段远近相关：近端腧穴如中毼/次毼效应优于远端腧穴如三阴交,远离膀胱神经节段的腧穴合谷效应不明显,说明这种“双向调节”是通过影响支配膀胱的神经活动实现的。针刺对膀胱的“双向调节”机制是通过兴奋或抑制逼尿肌肌电活动来兴奋或抑制膀胱收缩。生理状态下于排尿期针刺膀胱同神经节段的腧穴三阴交或中毼/次毼可延长其排尿间隔,以抑制排尿效应为主,是否存在兴奋性效应有待于进一步实验证实。
[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.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R245

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