适合长学制医学生开展的尿动力学实验

Urodynamic experiments suitable for medical students in a long-term curriculum

目的探索适合长学制医学生的尿动力学实验教学方法和技术。方法通过大鼠实验,使用直接电极检测膀胱平滑肌肌电活动,包括电信号脉冲串的频率(个/s)和波幅(μV),同时监测膀胱内压(cmH2O),找出膀胱肌电特征;通过膀胱逼尿肌兴奋剂乙酰胆碱与阻断剂阿托品作用前后的膀胱肌电变化情况,进一步证明膀胱平滑肌肌电来源的真实性。结果膀胱肌贮尿期无电活动表现,而膀胱平滑肌肌电信号出现伴随着膀胱内压的升高,随着膀胱内压的升高达到峰值时,膀胱肌电活动也随之达到峰值,出现排尿后,电活动减弱伴随着膀胱内压降低,进入下一个膀胱贮尿期。进一步分别对膀胱使用M受体阻断剂阿托品和兴奋剂乙酰胆碱,阿托品作用后膀胱排尿期的膀胱肌电强度减弱和膀胱内压下降,差异有统计学意义(P<0.05),乙酰胆碱作用后膀胱排尿期的膀胱肌电强度增强,膀胱内压增加,差异均有统计学意义(P<0.05)。结论尿动力学实验所记录的膀胱肌电信号真实、可靠并具有可重复性,适合在长学制医学生机能学实验中开展。

Objective To explore urodynamic experimental teaching methods and techniques suitable for long-term medical students.Methods In this study,direct electrodes were used to measure the electrical activity of the bladder smooth muscle,specifically the frequency(units/s)and amplitude(μV)of the electrical signal pulse train.Intravesical pressure(cmH2O)was monitored to investigate the characteristics of bladder myoelectricity.The changes in bladder myoelectricity before and after administering bladder detrusor stimulant acetylcholine and blocker atropine were analyzed to verify the origin of bladder smooth muscle myoelectricity.Results There were no electrical activities in the bladder muscle during urine storage period.The emergence of bladder smooth muscle electrical signals was accompanied by an increase in intravesical pressure.As the intravesical pressure increased and reached its peak value,the electrical activity of the bladder muscle also reached its peak value.After urination,the electrical activity weakened and the intravesical pressure decreased,entering the next bladder storage period.To further investigate,M-receptor blocker atropine and stimulant acetylcholine were separately used on the bladder.Atropine weakened the bladder myoelectric intensity during micturition phase and decreased the intravesical pressure.The difference was statistically significant(P<0.05).On the other hand,acetylcholine increased the bladder myoelectric intensity during bladder voiding period and increased the intravesical pressure.These differences were also statistically significant(P<0.05).Conclusion The bladder electromyographic signals recorded in the urodynamic experiment are authentic,reliable and repeatable,and are suitable for carrying out functional experiments for long-term medical students.