Simultaneous perineal ultrasound and vaginal pressure measurement proves electroacupuncture pudendal nerve stimulation

摘要

目的

通过会阴超声显示的盆底肌肉运动、 阴道内压力和盆底表面肌电的同步检测证实电针阴部神经刺激疗法确能兴奋阴部神经。

方法

对骶部四个针刺点, 采用长针(针灸针)深刺并加以电刺激直接兴奋阴部神经。 在患者接受电针阴部神经刺激疗法的同时, 使用带影像组件的Medtronic Duet Encompass尿动力仪同步显示会阴超声B模式下盆底肌肉运动和M模式下盆底肌运动曲线、 阴道压变化曲线及盆底肌电波。 同步检测亦在下列三种情况下进行: 1) 停止电刺激; 2) 减弱电刺激强度至原来的2/7 左右; 3) 逐渐退出下两针使针尖离开原处1∼2cm。

结果

35例女性压力性尿失禁患者 (年龄54.9 ± 9.8岁)接受了电针阴部神经刺激疗法和同步检测。 当电针阴部神经刺激疗法正确实施时, 患者有盆底肌以尿道为中心有节律地向头部方向收缩的感觉; 同步检测显示 超声B模式下盆底肌头尾方向运动, M模式下盆底肌运动曲线(振幅1 mm左右, n=31, 14例 ⩾ 1 mm, 17 例<1 mm), 锯齿状阴道压变化曲线[变化幅度2.61 ± 1.69 (0.7∼5.6) cmH₂O, n=34]和盆底肌电波[波幅23.9 ± 25.3 (5∼96) μV, n=34]。 盆底肌运动曲线 振幅大小与阴道压力变化幅度大小基本一致。 当停止电刺激, 减弱电刺激或针尖后退离 开原处1∼2厘米时, 盆底肌运动及其运动曲线和锯齿状阴道压变化曲线消失。

结论

电针阴部神经刺激疗法确能兴奋阴部神经, 有效地收缩盆底肌。

Abstract

Purpose

To prove that electroacupuncture pudendal nerve stimulation (EPNS) can exactly excites the pudendal nerve, by simultaneous measurements of pelvic floor muscle (PFM) movements (perineal ultrasound), vaginal pressure and pelvic floor surface myoelectricity.

Methods

Long needles (acupuncture needles) were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. When EPNS was performed, perineal ultrasound B-mode images of PFM movements (contractions), M-mode PFM movement curves; vaginal pressure and pelvic floor surface electromyogram were recorded simultaneously by use of an urodynamic instrument with video suite (Medtronic Duet Encompass). Simultaneous records were also obtained under three conditions in the process of the nerve stimulation: 1) pausing electric stimulation; 2) reducing the intensity of electric stimulation (to about 2/7 of the original); 3) drawing back the two lower needles to make the tips 1–2 cm away from the original position.

Results

Thirty-five female patients with stress incontinence (aged 54.9±9.8) received EPNS and the simultaneous measurements. When EPNS was performed correctly, the patient felt rhythmic and cephalad PFM contractions with the urethra as the center. Simultaneous records showed the following: 1) cranio-caudal PFM movements on the B-mode image; 2) the M-mode curves indicating the PFM contractions (amplitude: about 1 mm, n=31, 14 cases ⩾ 1 mm and 17 cases <1 mm); 3) A sawtooth curve of changes in vaginal pressure [amplitude: 2.61±1.69 (0.7–5.6) cmH2O, n=34]; 4) pelvic floor myoelectric waves [amplitude: 23.9±25.3 (5–96) µV, n=34]. The amplitude of a PFM movement curve conformed basically to that of a vaginal pressure curve. If the electric current was stopped or its intensity was reduced to about 2/7 of the original or during the process of the nerve stimulation the two lower needles were gradually drawn back until the tips were 1–2 cm away from the original positions, then B-mode PFM movements, M-mode curves and sawtooth changes in vaginal pressure disappeared.

Conclusion

Electroacupuncture pudendal nerve stimulation can exactly excites the pudendal nerve and effectively contract the pelvic floor muscles.