次髎对SUI膀胱尿道功能穴位特异性及外周传出神经研究

Stress urinary incontinence is one of the urinary system common disease types, occurs in middle-aged and old women after menopause, mostly due to bladder urethra dysfunction and pelvic floor muscle system dysfunction induced by, because of its high incidence, but symptoms affects women's daily life, seriously affecting the quality of life of women. Currently, there is no specific treatment or medication for SUI.In recent years, there have been literature reports that acupuncture treatment of stress urinary incontinence is good, and the side effects are small, and there are some studies that show that the main point of intake is the lumbar sacral meridian and small abdominal cavity.This research will/time liao from acupuncture, three vaginal intercourse, valley, this paper studies of acupuncture depth with aperture at different positions of the nerve segments, bladder, bladder different nerve segments of SUI acupoints effect law of rat bladder urethra function, and its working mechanism is by influencing the pudendal nerve efferent electrical activity and electrical activity, urethral sphincter from peripheral efferent nerve preliminary in this paper, the neural mechanism of acupuncture in the treatment of stress urinary incontinence.

压力性尿失禁（Stress Urinary Incontinence，SUI）是泌尿系统常见的一种疾病类型，好发于绝经期后的中老年妇女，多数是由于膀胱尿道出现功能紊乱以及盆底肌肉系统功能失调等所诱发，由于其发病率高、难以启齿的症状困扰着女性的日常生活，严重影响着女性的生活质量。目前，针对SUI 临床上并无特效的治疗方法或药物。近年来有文献报道针灸治疗压力性尿失禁疗效好，且副作用小，有研究表明纳入取穴主要以腰骶部经穴和小腹部经穴为主。故本研究将从针刺中/次髎、三阴交、合谷入手，研究针刺深浅、膀胱同神经节段不同部位腧穴、膀胱异神经节段腧穴对SUI大鼠膀胱尿道功能的效应规律，及其起效机制是否是通过影响阴部神经传出电活动及尿道外括约肌电活动来实现，试图从外周传出神经初步阐述针灸治疗压力性尿失禁的神经机制。

压力性尿失禁是女性泌尿系统常见的一种排尿功能障碍的疾病之一，由膀胱尿道出现功能紊乱、盆底肌肉系统功能失调、阴部神经损伤等为主要原因诱发。针刺（电针）治疗是一种安全持久有效的治疗手段，通过腧穴的特异性，能良性地调节压力性尿失禁膀胱尿道功能及修复外周传出神经失神经化。本次实验研究针刺（电针）膀胱同神经节段近端“次髎”穴、非膀胱同神经节段“非经”穴、膀胱同神经节段远端“三阴交”穴，观察膀胱尿道功能运动、尿道括约肌肌电、阴部神经电信号，并结合免疫组织化学等研究方法，系统阐述“次髎”穴在针刺（电针）调节下的穴位特异性效应以及对外周传出神经（阴部神经）机制的影响。.实验研究发现针刺（电针）SUI模型大鼠调节后，“次髎”组大鼠的最大膀胱容量（1.05±0.27ml）、腹压漏尿点压（15.06±1.31cmH2O）、尿道闭合压（15.60±2.30cmH2O）明显优于 “非经”穴组和“三阴交”组；并且“次髎”组大鼠尿道括约肌肌电信号振幅和频率（0.43±0.3μV ，380.00±91.46Ηz）和外周传出神经（阴部神经）电信号振幅和频率（0.84±0.28μV，382.80±61.44Ηz）明显增强；免疫组化分析中发现：“次髎”组PGP9.5、CollagenI、CTGF、NPY、TGF-β1含量高于模型组大鼠；HE染色中发现：次髎组大鼠组织损伤后修复痕迹，神经纤维及组织大部分愈合，尿周肌肉恢复，胶原纤维含量改善。这主要是通过针刺（电针）膀胱同神经节段近端“次髎”穴，影响了SUI大鼠S2深处支配膀胱的神经纤维，调节躯体神经中的阴部神经的电活动，从而达到改善膀胱尿道功能。因此，我们在临床选择治疗与膀胱相关的疾病时，应选择膀胱同神经节段近端腧穴为佳。