急迫性尿失禁.ppt

　　Urge Incontinence急迫性尿失禁

　　Urge urinary incontinence (UUI) is defined as involuntary loss of urine associated with a sudden, strong desire to void. It happens in both men and women and more in the latter. 急迫性尿失禁是指伴有强烈尿意的不自主漏尿。男、女均可发病，女性多于男性，

　　Its incidence increases with age. It comes under the category of enuresis in TCM. 发病率随年龄增长而增加。 属中医学遗尿范畴。

　　Overactive bladder & Urge incontinence

　　Etiology and Pathogenesis UUI can be of neurological or non-neurological origin. The former include stroke, Parkinson's disease, Alzheimer's disease, multiple sclerosis, brain injury and spinal injury. 一.?? 病因和发病机理 引起急迫性尿失禁的原因可以是神经原性或非神经原性的。前者多由中风、帕金森氏病、老年痴呆、多发性硬化、脑损伤和脊髓损伤等疾病引起。

　　Etiology and Pathogenesis The latter include urethral obstruction (chronic prostate hyperplasia), vesical inflammation (calculus, tumor) and stress urinary incontinence. UUI can also be of idiopathic origin. All the above causes can produce detrusor overactivity to result in urge urinary incontinence. 后者由尿道梗阻(慢性前列腺增生)、膀胱炎症(结石、肿瘤)、压力性尿失禁等原因所致，另有些原因不明(特发性)。上述原因都可引起逼尿肌功能亢进，导致急迫性尿失禁。

　　Clinical manifestations 1.??Symptom Involuntary loss of urine associated with a sudden, strong desire to void. 二.?? 临床表现 1.??症状 有突然、强烈的尿意时或之后尿液不自主地从尿道口流出。

　　Clinical manifestations 2.??Signs The observation of involuntary urinary loss from the urethra synchronous with an uncontrollable urge to void. Positive pad test. Perineal anesthesia. Abnormal bulbocavernosus reflex. 2.??体征 有不能控制的尿急时观察到尿液不自主地从尿道口流出。护垫试验阳性。会阴区感觉消失、球海绵体肌反射异常。

　　Laboratory examination 1. Urinalysis, vesicourethral X-ray and endoscopy Showing the non- neurological origins: inflammation, calculus, tumor and urethral obstruction. 三.?? 实验室检查 1.???尿液检查、膀胱尿道X线和内窥镜检查 可发现急迫性尿失禁的非神经原性原因，如炎症、结石、肿瘤、尿道梗阻等。

　　Laboratory examination 2. Urodynamic study Involuntary detrusor contraction (detrusor overactivity). A decrease in bladder capacity at the first desire for urination. A decrease in maximum bladder capacity (incontinence with an uncontrollable desire to void). Low bladder compliance. 2. 尿动力检查 可见无抑制性逼尿肌收缩(逼尿肌功能亢进)、初始尿意时膀胱容量减小、最大膀胱容量减少(有不能忍受的强烈尿意时出现尿失禁)、?低顺应性膀胱。

　　Overactive Bladder:Urodynamics

　　Normal Cystometrogram

　　Cystometrogram in patient with detrusor instability: AKA Overactive Bladder

　　Pves (cmH20)

　　Pves (cmH20)

　　Volume (mL)

　　MCC — Maximum Cystometric Capacity Max Pdet — Maximum Detrusor Pressure

　　Volume (mL)

　　Two nonvoid involuntary contractions that resulted in void

　　Involuntary contractions that resulted in void

　　Detrusor Leak Point Pressure

　　Dagnosis Based on The symptom (history) of urge incotinence Positive pad test. The results of imaging urodynamic study. 四.?? 诊断 根据： 1. 急迫性尿失禁症状(病史)。 2. 护垫试验阳性。 3. 尿动力检查结果。

　　Treatment Acupuncture treatment 1. Therapeutic principle According to TCM theory, it is caused by deficiency of kidney qi and failure of the bladder in restraining the urine discharge, 五. 治疗 中医针刺治疗 1. 治疗原则 中医认为，尿失禁是由于肾气不足，膀胱不固引起，

　　Treatment Acupuncture treatment 1. Therapeutic principle so the therapeutic principle is reinforcing kidney qi and improving vesical restraining function. 因此治疗原则是补益肾气，固脬止遗。

　　2. Point selection The Back-Shu and Front-Mu points of the kidney and bladder are selected as the main acupoints 2. 穴位选择 主穴是肾和膀胱的背俞穴和募穴。

　　2. Point selection The acupoints often selected are Shenshu (B 23), Pangguangshu (B 28), Zhongji (Ren 3), Guanyuan (Ren 4), Mingmen (Du 4), Huiyang (B 35), Sanyinjiao (Sp 6) and Zusanli (S 36). 常用穴位有：肾俞，膀胱俞，中极，关元，命门，会阳，三阴交，足三里。

　　2. Point selection The kidney is exteriorly-interiorly related to the bladder, so the Back-Shu points of the kidney and bladder are applied. Zhongji (Ren 3) is the Front-Mu points of the bladder. The combined use of the above three acupoints contributes to reinforce kidney qi and improve vesical restraining function. 肾和膀胱相表里，故选肾和膀胱的背俞穴。中极是膀胱的募穴。三穴合用有助于补益肾气，固脬止遗。

　　2. Point selection Guanyuan (Ren 4) and Mingmen (Du 4) are the sources of primordial qi and acupuncture of them can tonify primordial yang (kidney-yang). Huiyang (B 35) is the acupoint of the foot-taiyang meridian and acupuincture of it can invigorate the meridional qi of the bladder. 关元、命门是元气之源，针之能补肾益元。会阳是足太阳经穴位，针之能振奋膀胱之经气。

　　2. Point selection Sanyinjiao (Sp 6) is the crossing point of the three foot-yin meridians and acupuncture of it can regulate the qi of the three foot-yin meridians. Zusanli (S 36) belongs to the yangming meridian, which is full of qi and blood, acupuncture of it can tonify qi to stop incontinence. 三阴交是足三阴经交会穴，针之能调节足三阴经气。足三里属阳明经，阳明经多气多血，针之能补气止遗。

　　Electroacupuncture neurostimulation电针神经刺激疗法

　　A combination of acupuncture in traditional Chinese medicine and electrical nerve stimulation in western medicine (including pudendal nerve stimulation, suprapubic transcutaneous electrical nerse stimulation and percutaneous tibial nerve stimulation). 中医针刺疗法和西医神经电刺激疗法(阴部神经刺激，耻骨上经皮神经电刺激和经皮胫神经刺激)的结合。

　　1. Acupoint selection According to TCM theory and modern anatomy in combination with clinical practice, we sift out two groups of acupoints: (1) Four abdominal points (empirical) and (2) Four sacral points (empirical). 1. 穴位选择 根据中医理论和西医解剖学，结合临床实践，筛选出二组穴位：(1)“腹四穴” (经验穴) ;(2) “骶四穴” (经验穴)。

　　Four sacral points骶四穴

　　2 Acupuncture methods 1) Four sacral points (1) The upper two points: located by the two edges of the sacrum on a level with the fourth sacral foramina; 2 针刺方法 1)骶四穴 (1)上两针刺点：骶骨边缘旁，平第4骶后孔水平处(双侧)。

　　Four sacral points骶四穴

　　2 Acupuncture methods 1) Four sacral points (1) The upper two points: use a long needle of 4 cun (100mm); puncture perpendicularly 3~3.5 cun in depth; make the needling sensation reach the urethra or anus. 使用4寸长针直刺，针刺深度为3-3.5寸，使针感达尿道或肛门。

　　Four sacral points骶四穴

　　2 Acupuncture methods 1) Four sacral points (2) The lower two points: 0.5 cun bilateral to the tip of the coccyx; use a long needle of 4 or 5 cun (100 or 125mm); (2)下两针刺点： 尾骨旁开0.5寸(双侧)，使用4寸或5寸长针，

　　Four sacral points骶四穴

　　2 Acupuncture methods 1) Four sacral points (2) The lower two points: puncture obliquely (laterally) towards the ischiorectal fossa, 3~4.5 cun in depth; make the needling sensation reach the urethra. 向外侧(坐骨直肠窝)斜刺，3-4.5寸深，使针感达尿道。

　　Four abdominal points腹四穴

　　2 Acupuncture methods 2) Four abdominal points (1) The two upper points: 2.5 cun bilateral to Guanyuan (Ren 4); 2 针刺方法 2)腹四穴 (1)上两针刺点：关元旁开2.5寸(双侧)。

　　Four abdominal points腹四穴

　　2 Acupuncture methods 2) Four abdominal points (1) The two upper points: use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva. 使用4寸长针，斜刺，1-2寸深，使针感达尿道或外阴部。

　　Four abdominal points腹四穴

　　2 Acupuncture methods 2) Four abdominal points (2) The two lower points: 1.5 cun bilateral to Zhongji (Ren 3); (2)下两针刺点：中极旁开1.5寸(双侧)。

　　Four abdominal points腹四穴

　　2 Acupuncture methods 2) Four abdominal points (2) The two lower points: use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva. 使用4寸长针，斜刺，1-2寸深，使针感达尿道或外阴部。

　　2 Acupuncture methods After the needling sensation reaches the above positions, an electroacupuncture instrument is connected. Used for electroacupuncture are continuous waves, a frequency of 90~150 times/min and an intensity that the patient is adaptable or feels comfortable. It lasts 60 min. The needling sensation must reach the above positions during electroacupuncture. 针感达上述部位后接电针仪。电针采用连续波，频率90~150次/分，强度以患者能适应或感到舒适为准，每次持续60分钟。电针期间需保持针感达上述部位。

　　2 Acupuncture methods The treatment is given once every other day. The two groups of acupoints are alternated. The course of treatment depends on the patient’s condition. 治疗隔日1次，两组穴位交替使用，治疗次数视病情而定。

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