电刺激脊髓损伤模型兔肛周皮肤调控神经源性膀胱内压

Electrical stimulation of the perianal skin regulates neurogenic intravesical pressure in rabbit models of spinal cord injury

背景:以往研究表明通过不同频率电刺激阴部神经及其分支会抑制膀胱逼尿肌的过度活动,从而治疗神经源性膀胱,基于此,能否通过电刺激阴部神经分支来抑制逼尿肌过度活动呢?目的:探讨电刺激脊髓损伤兔肛周皮肤调控神经源性膀胱内压可行性。方法:选择成年雌性兔10只,在T_9-T_(10)水平横断脊髓,饲养4周后开始进行实验,电刺激采用一对钩状电极刺激肛门周围的皮肤,在膀胱内插入双腔球囊导管注入生理盐水,测量膀胱内压力。结果与结论:当膀胱灌注量高于排尿容积阈值时,以低于10 Hz的频率电刺激肛周,会显著抑制膀胱逼尿肌过度活动;当膀胱灌注量低于排尿容积阈值时,刺激频率在20-50 Hz时,会引起膀胱收缩。最佳抑制刺激(6 Hz)能显著增加膀胱容积(30±10)%,最佳的兴奋刺激(25 Hz)能引起大幅度(超过25 cm H_2O即24.5 k Pa)、长时间(20 s)的膀胱收缩。结果表明电刺激脊髓损伤兔肛周皮肤可以有效调控神经源性膀胱压力。

BACKGROUND： Previous studies have shown that different frequencies of electrical stimulation of pudendal nerve and its branches can inhibit detrusor overactivity, thereby treating neurogenic bladder. Based on this, is it possible to inhibit detrusor overactivity through electrical stimulation of pudendal nerve branches？ OBJECTIVE： To investigate the feasibility of electrical stimulation of the perianal skin regulating neurogenic intravesical pressure in rabbit models of spinal cord injury.METHODS： Ten adult female rabbits were selected and subjected to spinal cord transection at T_9-T_（10） level. After 4 weeks of feeding, the experiment began. The skin around the anus was stimulated using a pair of hook-shaped electrodes. A double-lumen balloon catheter was inserted into the bladder. Normal saline was infused into the double-lumen balloon catheter. Intravesical pressure was measured. RESULTS AND CONCLUSION： When the perfusion volume of the bladder was higher than the threshold of voiding volume, detrusor overactivity was significantly inhibited after perianal electrical stimulations at frequencies below 10 Hz. When the perfusion volume of bladder was lower than the threshold of voiding volume, bladder contractions were induced by electrical stimulations at frequencies between 20 and 50 Hz. The optimal inhibitorystimulation（6 Hz） could significantly increase the bladder capacity of（30±10）%. The optimal excitatory stimulation（25 Hz） could induce large amplitude（greater than 25 cm H2O, i.e. 24.5 k Pa）, long duration（greater than 20 seconds） of bladder contractions. These results demonstrate that electrical stimulation of the perianal skin can effectively regulate neurogenic intravesical pressure in rabbit models of spinal cord injury.