电针中髎、次髎穴兴奋膀胱逼尿肌的效应规律和外周神经调控机制

Electroacupuncture (EA) at "Ciliao" (BL 32) and "zhongliao" (BL 33) can specifically excite detrusor, which is related with the state of bladder, depth of needling and EA parameters. Deep electroacupuncture of BL32 and BL33 can directly stimulate the anterior branches of the 2ndisui 3rd sacral nerve, exciting both afferent and efferent fibers of pelvic nerve, sacral parasympathetic nucleus, and thus to strengthen detrusor contraction. Using animal model of acute urinary retention, this study aims to evaluate differences of detrusor excitation induced by needling depth, acupoints, non-acupoints, and frequency and stimulus intensity of EA, by the means of urodynamics, electroneurophysiology techniques, and also aims to systematically study the effects and correlations of EA on bladder pressure, electric signal activity of afferent and efferent fibers of pelvic nerve and micturition center in the sacral cord. Doing these we can make clear the action law and key influencing fators of derusor excitation by EA at BL32 and BL33, thus to clarify its peripheral nerve regulation mechanism preliminary. Combined with our previous NSFC research named "The specific effect and afferent mechanism of electro-acupuncture at BL32 for overactive bladder", it is hoped that through this study we can preliminarily illuminate the mechanism of bidirectional regulation that EA does to detrusor and make clear its key influencing factors.

电针中髎和次髎穴有一定的特异兴奋逼尿肌效应，该效应与膀胱功能状态、针刺深浅、电针频率和电流强度等相关。电针深刺直接作用于骶2、3神经前支，可能通过兴奋盆神经传入、传出纤维及骶髓副交感核，加强逼尿肌收缩，达到治疗效应。本研究以急性尿潴留大鼠为模型，采用尿动力学、神经电生理技术等手段，评价不同电针深度、穴位、非穴位和电针频率及强度等兴奋膀胱效应的差异，系统研究电针对膀胱压力、盆神经传出和传入及骶髓中枢电信号活动的影响及相互关系，以期明确电针中髎和次髎穴兴奋膀胱的效应规律和关键影响因素，初步阐明其外周神经调控机制。结合前一个基金课题"电针次髎抑制膀胱过度活动的穴位特异和感觉调控机制"，可以初步阐明电针对逼尿肌既可以抑制又可以兴奋的针灸独有的双向调节机制及关键影响因素。

目的：1.明确电针深刺中髎/次髎穴促进膀胱逼尿肌(DSM)收缩效应和兴奋性的穴位特异性及关键影响因素；2.评价不同频率、不同强度电针深刺中髎/次髎穴促进DSM收缩效应及兴奋性的影响；3.探讨电针深刺中髎/次髎穴促进DSM收缩效应及兴奋性的外周神经调控机制。方法：1.以电针深刺中髎/次髎穴、浅刺中髎/次髎穴、中髎/次髎穴旁非穴点、三阴交穴（异经同节段穴）、委中穴（同经同节段穴）、合谷穴（异经非节段穴）干预急性尿潴留（AUR）模型大鼠，比较干预前后尿动力学、DSM放电变化情况，评价深刺中髎/次髎穴的相对穴位特异性效应及影响因素；2.以手针/2Hz/100Hz（不同频率）、0.1mA/0.5mA/1mA（不同强度）干预AUR大鼠，评价其对DSM收缩效应及兴奋性的影响；3.观察电针深刺中髎/次髎穴（2Hz、1mA）前后盆神经传入端、传出端、骶髓中枢端电信号变化，探讨电针深刺中髎/次髎穴增强DSM收缩效应及兴奋性的外周神经调控机制。结果：1.造模后，大鼠排尿期膀胱收缩时间增加，排尿间隔延长，收缩后膀胱内压增加（p＜0.05）。DSM放电频率降低，放电时间延长（p＜0.01）。电针深刺中髎/次髎穴可增加膀胱收缩时间（p＜0.01），效应优于浅刺、非穴点、三阴交、合谷、委中；可缩短排尿间隔（p＜0.05）、降低收缩后膀胱内压（p＜0.01），效应优于非穴点、合谷；可增加DSM放电频率，延长放电时间（p＜0.01），效应均优于浅刺、非穴点、三阴交、合谷、委中。2.手针/2Hz /100Hz（1mA）均可增加DSM收缩效应及兴奋性，组间比较无差异（p＞0.05）；0.1mA/0.5mA/1mA（2Hz）电针可增加DSM收缩效应及兴奋性，1mA效应优于0.1mA（p＜0.05）。3.电针深刺中髎/次髎穴可增强盆神经传出信号传导（p＜0.05）,增强传入信号传导（p＜0.01），增强骶髓中枢信号传导（p＜0.05）。结论：1.电针深刺中髎/次髎穴可相对特异性促进AUR模型大鼠DSM收缩效应、增强DSM兴奋性；2.2Hz、 1mA电针有最佳效应趋势；3.电针深刺中髎/次髎穴增强AUR大鼠盆神经传出信号、传入信号传导，增强骶髓中枢信号传导，从而增强DSM收缩效应和兴奋性。