大鼠逼尿肌肌源性变化与逼尿肌反射亢进及逼尿肌不稳定的关系  

Relationship between the myogenic change of detrusor and the detrusor hyperrflexia or the detrusor instability

作　　者：邱功阔[1] 宋波[1] 金锡御[1] 卢根生[1] 方强[1] 张庆华[1] 张水文[1] 唐伟[1] 赵谦[1] 

机构地区：[1]重庆市第三军医大学西南医院泌尿外科中心,400038

出　　处：《中国康复医学杂志》2006年第7期596-598,共3页Chinese Journal of Rehabilitation Medicine

摘　　要：目的观察骶髓上损伤或膀胱出口梗阻(BOO)后逼尿肌收缩功能的变化,探讨逼尿肌反射亢进(DH)及逼尿肌不稳定(DI)的发病机制。方法建立SD大鼠骶髓上损伤后4周及BOO4周动物模型,进行在体和离体膀胱充盈性测压及离体逼尿肌条机械牵拉试验。结果骶髓上损伤后DH的发生率为91.1%,BOO后DI的发生率为66.7%;正常对照组大鼠在体膀胱充盈至压力32.85±11.08cmH2O时尿液自导管周围溢出,在体及离体膀胱充盈测压全过程逼尿肌无节律性收缩反应,DH组和DI组在体及离体膀胱均于较低的膀胱内压下即出现节律性收缩反应,离体膀胱的收缩频率明显高于在体膀胱(P<0.05);DH组及DI组离体逼尿肌条机械牵拉致其出现收缩时的最小张力明显低于正常对照组,相同前负荷下的收缩频率明显高于正常对照组(P<0.05)。结论逼尿肌能够自发兴奋产生收缩,骶髓上损伤或膀胱出口梗阻后膀胱逼尿肌发生继发性改变,自动节律性增强,DH及DI的发生与逼尿肌自身的兴奋性增强密切相关,传统观念忽略了肌源性变化的作用。Objective： To observe the changes of detrusor contraction function after suprasacral cord injury or der outlet obstruction （BOO）,and to elucidate the pathogenesis of detrusor hyperreflexia （DH）and detrusor instability （DI）. Method：A animal models at 4 weeks after suprasacral cord injury or BOO were made in female SD rats.Cystometry in vivo and in vitro,mechanical pulling tests of isolated detrusor strips were performed.Result：The incidence rate of DH after suprasacral cord injury was 91.1%,and 66.7% for DI after BOO.No rhythmicity contraction occurred during the course of vivo and vitro cystometry in control group.Rhythmicity contraction occurred at lower pressure in DH and DI groups,regardless of in vivo or in vitro.The frequence of contraction in vitro was higher than in vivo significantly （P〈0.05）. The tension that induced isolated detrusor contraction by mechanical pulling in DH and DI groups was lower than the control group,and the contraction frequence at the same tension was higher than the control group（P〈0.05）.Conclusion：Detrusor has the capability of spontaneous contraction.The autorhythmicity of detrusor increases after suprasacral cord injury or BOO, the occurrence of DH and DI is related to the increase of detrusor excitability closely.

关 键 词：膀胱 脊髓损伤 梗阻 逼尿肌不稳定 逼尿肌反射亢进 

分 类 号：R694[医药卫生—泌尿科学]