急迫性尿失禁

急迫性尿失禁第1頁Urgeurinaryincontinence(UUI)isdefinedasinvoluntarylossofurineassociatedwithasudden,strongdesiretovoid.Ithappensinbothmenandwomenandmoreinthelatter.急迫性尿失禁是指伴有強烈尿意不自主漏尿。男、女均可發(fā)病，女性多于男性，第2頁Itsincidenceincreaseswithage.ItcomesunderthecategoryofenuresisinTCM.發(fā)病率隨年紀增加而增加。屬中醫(yī)學遺尿范圍。第3頁Overactivebladder&

Urgeincontinence

第4頁EtiologyandPathogenesisUUIcanbeofneurologicalornon-neurologicalorigin.Theformerincludestroke,Parkinson'sdisease,Alzheimer'sdisease,multiplesclerosis,braininjuryandspinalinjury.一.

病因和發(fā)病機理引發(fā)急迫性尿失禁原因能夠是神經(jīng)原性或非神經(jīng)原性。前者多由中風、帕金森氏病、老年癡呆、多發(fā)性硬化、腦損傷和脊髓損傷等疾病引發(fā)。第5頁第6頁EtiologyandPathogenesisThelatterincludeurethralobstruction(chronicprostatehyperplasia),vesicalinflammation(calculus,tumor)andstressurinaryincontinence.UUIcanalsobeofidiopathicorigin.Alltheabovecausescanproducedetrusoroveractivitytoresultinurgeurinaryincontinence.后者由尿道梗阻（慢性前列腺增生）、膀胱炎癥（結石、腫瘤）、壓力性尿失禁等原因所致，另有些原因不明（特發(fā)性）。上述原因都可引發(fā)逼尿肌功能亢進，造成急迫性尿失禁。第7頁Clinicalmanifestations1.

SymptomInvoluntarylossofurineassociatedwithasudden,strongdesiretovoid.二.

臨床體現(xiàn)1.

癥狀有突然、強烈尿意時或之后尿液不自主地從尿道口流出。第8頁Clinicalmanifestations2.

SignsTheobservationofinvoluntaryurinarylossfromtheurethrasynchronouswithanuncontrollableurgetovoid.Positivepadtest.Perinealanesthesia.Abnormalbulbocavernosusreflex.2.

體征有不能控制尿急時觀測到尿液不自主地從尿道口流出。護墊試驗陽性。會陰區(qū)感覺消失、球海綿體肌反射異常。

第9頁Laboratoryexamination1.Urinalysis,vesicourethralX-rayandendoscopyShowingthenon-neurologicalorigins:inflammation,calculus,tumorandurethralobstruction.三.

試驗室檢查1.

尿液檢查、膀胱尿道X線和內(nèi)窺鏡檢查可發(fā)覺急迫性尿失禁非神經(jīng)原性原因，如炎癥、結石、腫瘤、尿道梗阻等。第10頁Laboratoryexamination2.UrodynamicstudyInvoluntarydetrusorcontraction(detrusoroveractivity).Adecreaseinbladdercapacityatthefirstdesireforurination.Adecreaseinmaximumbladdercapacity(incontinencewithanuncontrollabledesiretovoid).Lowbladdercompliance.2.尿動力檢查可見無抑制性逼尿肌收縮（逼尿肌功能亢進）、初始尿意時膀胱容量減小、最大膀胱容量減少（有不能忍受強烈尿意時出現(xiàn)尿失禁）、

低順應性膀胱。第11頁OveractiveBladder:UrodynamicsNormalCystometrogramCystometrograminpatientwithdetrusorinstability:AKAOveractiveBladderPves(cmH20)Pves(cmH20)Volume(mL)MCC—MaximumCystometricCapacityMaxPdet—MaximumDetrusorPressureVolume(mL)TwononvoidinvoluntarycontractionsthatresultedinvoidInvoluntarycontractionsthatresultedinvoid第12頁DetrusorLeakPointPressure第13頁DagnosisBasedonThesymptom(history)ofurgeincotinencePositivepadtest.Theresultsofimagingurodynamicstudy.四.

診斷根據(jù)：1.急迫性尿失禁癥狀（病史）。2.護墊試驗陽性。3.尿動力檢查成果。

第14頁TreatmentAcupuncturetreatment1.TherapeuticprincipleAccordingtoTCMtheory,itiscausedbydeficiencyofkidneyqiandfailureofthebladderinrestrainingtheurinedischarge,五.治療中醫(yī)針刺治療1.治療標準中醫(yī)以為，尿失禁是由于腎氣不足，膀胱不固引發(fā)，第15頁TreatmentAcupuncturetreatment1.Therapeuticprinciplesothetherapeuticprincipleisreinforcingkidneyqiandimprovingvesicalrestrainingfunction.因此治療標準是補益腎氣，固脬止遺。第16頁2.PointselectionTheBack-ShuandFront-Mupointsofthekidneyandbladderareselectedasthemainacupoints2.穴位選擇主穴是腎和膀胱背俞穴和募穴。第17頁2.PointselectionTheacupointsoftenselectedareShenshu(B23),Pangguangshu(B28),Zhongji(Ren3),Guanyuan(Ren4),Mingmen(Du4),Huiyang(B35),Sanyinjiao(Sp6)andZusanli(S36).常用穴位有：腎俞，膀胱俞，中極，關元，命門，會陽，三陰交，足三里。第18頁2.PointselectionThekidneyisexteriorly-interiorlyrelatedtothebladder,sotheBack-Shupointsofthekidneyandbladderareapplied.Zhongji(Ren3)istheFront-Mupointsofthebladder.Thecombineduseoftheabovethreeacupointscontributestoreinforcekidneyqiandimprovevesicalrestrainingfunction.腎和膀胱相表里，故選腎和膀胱背俞穴。中極是膀胱募穴。三穴適用有助于補益腎氣，固脬止遺。第19頁2.PointselectionGuanyuan(Ren4)andMingmen(Du4)arethesourcesofprimordialqiandacupunctureofthemcantonifyprimordialyang(kidney-yang).Huiyang(B35)istheacupointofthefoot-taiyangmeridianandacupuinctureofitcaninvigoratethemeridionalqiofthebladder.關元、命門是元氣之源，針之能補腎益元。會陽是足太陽經(jīng)穴位，針之能振奮膀胱之經(jīng)氣。第20頁2.PointselectionSanyinjiao(Sp6)isthecrossingpointofthethreefoot-yinmeridiansandacupunctureofitcanregulatetheqiofthethreefoot-yinmeridians.Zusanli(S36)belongstotheyangmingmeridian,whichisfullofqiandblood,acupunctureofitcantonifyqitostopincontinence.三陰交是足三陰經(jīng)交會穴，針之能調(diào)整足三陰經(jīng)氣。足三里屬陽明經(jīng)，陽明經(jīng)多氣多血，針之能補氣止遺。第21頁Electroacupunctureneurostimulation

電針神經(jīng)刺激療法AcombinationofacupunctureintraditionalChinesemedicineandelectricalnervestimulationinwesternmedicine(includingpudendalnervestimulation,suprapubictranscutaneouselectricalnersestimulationandpercutaneoustibialnervestimulation).中醫(yī)針刺療法和西醫(yī)神經(jīng)電刺激療法（陰部神經(jīng)刺激，恥骨上經(jīng)皮神經(jīng)電刺激和經(jīng)皮脛神經(jīng)刺激）結合。第22頁1.AcupointselectionAccordingtoTCMtheoryandmodernanatomyincombinationwithclinicalpractice,wesiftouttwogroupsofacupoints:(1)Fourabdominalpoints(empirical)and(2)Foursacralpoints(empirical).1.穴位選擇根據(jù)中醫(yī)理論和西醫(yī)解剖學，結合臨床實踐，篩選出二組穴位：（1）“腹四穴”（經(jīng)驗穴）；（2）“骶四穴”（經(jīng)驗穴）。第23頁Foursacralpoints

骶四穴2Acupuncturemethods1)Foursacralpoints(1)Theuppertwopoints:locatedbythetwoedgesofthesacrumonalevelwiththefourthsacralforamina;2針刺辦法1）骶四穴（1）上兩針刺點：骶骨邊緣旁，平第4骶后孔水平處（雙側）。第24頁Foursacralpoints

骶四穴2Acupuncturemethods1)Foursacralpoints(1)Theuppertwopoints:usealongneedleof4cun(100mm);punctureperpendicularly3~3.5cunindepth;maketheneedlingsensationreachtheurethraoranus.使用4寸長針直刺，針刺深度為3-3.5寸，使針感達尿道或肛門。第25頁Foursacralpoints

骶四穴2Acupuncturemethods1)Foursacralpoints(2)Thelowertwopoints:0.5cunbilateraltothetipofthecoccyx;usealongneedleof4or5cun(100or125mm);（2）下兩針刺點：尾骨旁開0.5寸（雙側），使用4寸或5寸長針，第26頁Foursacralpoints

骶四穴2Acupuncturemethods1)Foursacralpoints(2)Thelowertwopoints:punctureobliquely(laterally)towardstheischiorectalfossa,3~4.5cunindepth;maketheneedlingsensationreachtheurethra.向外側（坐骨直腸窩）斜刺，3-4.5寸深，使針感達尿道。第27頁第28頁第29頁第30頁第31頁第32頁第33頁Fourabdominalpoints

腹四穴2Acupuncturemethods2)Fourabdominalpoints(1)Thetwoupperpoints:2.5cunbilateraltoGuanyuan(Ren4);2針刺辦法2）腹四穴（1）上兩針刺點：關元旁開2.5寸（雙側）。第34頁Fourabdominalpoints

腹四穴2Acupuncturemethods2)Fourabdominalpoints(1)Thetwoupperpoints:usealongneedleof4cun(100mm);punctureobliquely1~2cunindepth;maketheneedlingsensationreachtheurethraorvulva.使用4寸長針，斜刺，1-2寸深，使針感達尿道或外陰部。第35頁Fourabdominalpoints

腹四穴2Acupuncturemethods2)Fourabdominalpoints(2)Thetwolowerpoints:1.5cunbilateraltoZhongji(Ren3);（2）下兩針刺點：中極旁開1.5寸（雙側）。第36頁Fourabdominalpoints

腹四穴2Acupuncturemethods2)Fourabdominalpoints(2)Thetwolowerpoints:usealongneedleof4cun(100mm);punctureobliquely1~2cunindepth;maketheneedlingsensationreachtheurethraorv