电针调控自主神经电活动抑制膀胱过度活动症的机制

Mechanism of regulating autonomic nerve electrical activity by electroacupuncture to inhibit over active bladder

目的:探讨电针调控自主神经电活动抑制膀胱过度活动症的机制。方法:将40只SD雄性大鼠随机分为正常组、OAB模型组、OAB+盆神经离断组、OAB+腹下神经离断组、OAB+盆神经+腹下神经离断组,每组8只。造模成功后,实验分3部分进行:实验一(正常组和OAB模型组)不予电针干预;实验二(OAB模型组)分别予电针中髎(次髎)、三阴交、合谷、中极;实验三(OAB+盆神经离断组、OAB+腹下神经离断组、OAB+盆神经和腹下神经离断组)予电针中髎(次髎),电针强度1 mA,频率2 Hz,连续波,持续刺激5 min。记录膀胱排尿周期,观察大鼠基础膀胱内压等尿动力学指标、逼尿肌肌电及盆神经放电信号。结果:(1)与正常组比较,OAB大鼠膀胱收缩时间缩短,最大逼尿肌收缩压显著下降(P<0.01),排尿间隔缩短,基础膀胱内压,收缩后膀胱内压增高(P<0.01),提示OAB造模成功;且OAB逼尿肌肌电和盆神经信号增加(P<0.01)。(2)电针中髎/次髎后,较针刺前,OAB大鼠尿动力学参数明显改善;电针中髎(次髎)或三阴交后,大鼠逼尿肌膀胱收缩时放电次数减少(P<0.05),盆神经膀胱收缩时放电次数显著减少(P<0.05)。(3)电针前,与离断神经前OAB模型组比较,OAB+盆神经离断组及OAB+盆神经+腹下神经离断组的膀胱收缩时间及排尿间隔时间变长、最大逼尿肌收缩压增加、排尿阈值压降低、收缩后膀胱内压降低(P<0.05);电针干预后,与离断神经OAB组比较,OAB+腹下神经离断组的膀胱收缩时间变长、最大逼尿肌收缩压增加、排尿间隔时间延长、排尿阈值压降低、收缩后膀胱内压降低(P<0.05)。电针干预前,OAB+盆神经离断组、OAB+离断盆神经+腹下神经组的逼尿肌膀胱收缩时放电降低、膀胱收缩时放电降低(P<0.05);电针干预后,与离断神经OAB组比较,OAB+腹下神经离断组的逼尿肌膀胱收缩时放电降低、盆神经膀胱收缩时放电降低(P<0.05)。结论:针刺抑制OAB主要是通过针刺与膀胱同神经节段的腧穴,抑制自主神经的盆神经异常放电。

Objective:To explore the mechanism of regulating autonomic nerve activity by electroacupuncture to inhibit over active bladder.Methods:Forty SD male rats were randomly divided into normal group,OAB+pelvic nerve dissociation group,OAB+hypogastric nerve dissociation group,OAB+pelvic nerve and hypogastric nerve dissociation group,with 8 rats in each group.After successful modeling,the experiment is conducted in three parts.No electroacupuncture intervention was given in experiment 1(normal group and OAB model group).In experiment 2(OAB model group),Zhongliao(BL33)Ciliao(BL32),Sanyinjiao(SP6),Hegu and Zhongji Point selection were respectively electrocuted.In experiment 3(OAB+pelvic nerve dissociation group,OAB+hypogastric nerve dissociation group,OAB+pelvic nerve and hypogastric nerve dissociation group)electricacupuncture Zhongliao(Ciliao),electric acupuncture intensity 1 mA,frequency 2 Hz,continuous wave,continuous stimulation for 5 min.The urinary cycle of the bladder was recorded,the basic bladder pressure,and other urodynamic indexes,the discharge signals of the detrusor muscle and the pelvic nerve.Results:(1)Compared with the normal group,the bladder contraction time of OAB rats was shortened,and the maximum detrusor systolic blood pressure was significantly decreased(P<0.01),the urination interval was shortened,the basal bladder pressure was increased after contraction(P<0.01),indicating that OAB molding success.OAB detrusor muscle and pelvic nerve signals increased(P<0.01).(2)Urinary dynamics parameters of OAB rats were significantly improved after electricacupuncture Zhongliao(Ciliao)compared with before acupuncture,the discharge times of the detrusor muscle during bladder contraction decreased after Zhongliao(Ciliao)or Sanyinjiao(P<0.05),the discharge times of pelvic nerve during bladder contraction were significantly decreased(P<0.05),but the Zhongliao(Ciliao)of electroacupuncture was significantly less than that of Sanyinjiao.(3)Before electroacupuncture intervention,compared with the OAB model group before the severed nerve,the bladder contraction time and voiding interval of the dissociation pelvic nerve group and the dissociation pelvic nerve+hypogastric nerve group were longer,the maximum detrusor systolic pressure was increased,the voiding threshold pressure was decreased,and the bladder pressure after contraction was decreased(P<0.05).After electroacupuncture intervention,the bladder contraction time was longer,the maximum detrusor systolic pressure was increased,the urination interval was prolonged,the urination threshold pressure was decreased,and the bladder pressure after contraction was decreased(P<0.05).Before electroacupuncture intervention,compared with OAB model group before dissociated nerve,detrusor discharge in dissociated pelvic nerve group and dissociated pelvic nerve+hypogastric nerve group decreased during bladder contraction and discharge during bladder contraction(P<0.05).After the electroacupuncture intervention,detrusor discharge decreased during bladder contraction and pelvic nerve discharge decreased during bladder contraction in the dissociated hypogastric nerve group(P<0.05).Conclusion:The purpose of inhibiting OAB by acupuncture is to inhibit the abnormal discharge of the pelvic nerve of the autonomic nerve through acupuncture points in the same ganglion segment with the bladder.