BASIC AND CLINICAL RESEACH ON THE CENTRAL NERVOUS CONTROL OF MICTURITION

用去脑犬研究脑干对排尿的控制。在蓝斑α（LCalpha）中的电刺激（ES）（0.2msec，50 Hz，10- 50 μ A）诱发排尿，即膀胱的收缩和内尿道括约肌以及外尿道括约肌的松弛。在排尿过程中，蓝斑下核（LSC）和脑桥口核（PoO）中的ES导致膀胱活动的抑制和尿道外括约肌的兴奋。虽然LCalpha中的ES减少了膀胱容量，但LSC和PoO中的ES增加了膀胱容量。这些结果表明，脑桥排尿中心（PMC）位于LCalpha和脑桥储尿中心（PUSC）位于LSC和PoO的区域。将药物微量注射到LCalpha、LSC和PoO中调节排尿反射。LCalpha中的GABA增加膀胱容量，而LSC和PoO中的GABA降低膀胱容量。恩凯普 ...更多信息 LCalpha和LSC中的盐水抑制排尿，而PoO中的脑啡肽对排尿反射没有影响。应用HRP的神经解剖学研究表明，PMC和PUSC之间有密切的联系。HRP法还显示PUSC与骶髓的中间外侧核、Onuf核及脑内各部位有纤维往来，并对脑血管病患者的膀胱尿道功能与脑内病变部位的关系进行了研究。采用CT和MRI检查脑部病变。同时记录膀胱测压和尿道外括约肌肌电图，评价膀胱尿道功能。结果表明：（1）额叶、壳核和丘脑的损害导致膀胱过度活动（2）55%的额叶病变患者膀胱功能亢进伴尿道功能不全，（3）60%的壳核病变患者尿道功能正常，（4）双侧桥脑背外侧被盖病变3例，其中3例表现为膀胱活动不足，不仅基础研究，而且临床研究均表明桥脑背外侧被盖对排尿反射有重要调节作用。少

Decerebrate dogs were used to investigate the brainstem control of the micturition. Electrical stimulation (ES)(0.2msec, 50Hz, 10-50muA) in the Locus coeruleus alpha (LCalpha) evoked micturition, i.e. contraction of the urinary bladder and relaxation of the internal as well as the external urethral sphincter. ES in the Locus subcoeruleus (LSC) and the Nucleus pontis oralis (PoO) during micturition resulted in an inhibition of the bladder activity and an excitation of the external urethral sphincter. While ES in the LCalpha decreased bladder capacity, ES in the LSC and PoO increased bladder capacity. These results indicates that pontine micturition center (PMC) is located in the LCalpha and the pontine urine storage center (PUSC ) is located in the area of the LSC and the PoO. Microinjection of the drugs into the LCalpha,LSC and PoO modulated the micturition reflex. GABA in the LCalpha increased the bladder capacity while GABA in the LSC and the PoO decreased the bladder capacity. Enkep … More haline in the LCalpha and the LSC inhibited micturition, but Enkephaline in the PoO had no effect on the micturition reflex. Neuroanatomical studies using the HRP demonstrated that intimate connections between the PMC and the PUSC. HRP studies also showed that the PUSC sends and receives the fibers to and from the intermediolateral nucleus and Onuf's nucleus in the sacral spinal cord as well as the various sites of the brain.Correlation between the location of the brain lesions and the vesicourethral function were examined in the patients with cerebrovascular disease. CT and MRI were used to examine the brain lesions. Simultaneous recording of the cystometry and the external urethral sphincter EMG were performed to evaluate the vesicourethral function. Following results were obtained, (1) lesions in the frontal lobe,putamen, and thalamus resulted in a hyperactive bladder (67%,67%,60%,respectively),(2)55% of the patients with lesions in the frontal lobe had a hyperactive bladder with an incompetent urethra, (3) 60% of the patients with putaminal lesion had a normal urethral function,(4) 3 of 3 patients with bilateral lesions in the dorsolateral pontine tegmentum showed an underactive bladder.Not only basic but clinical studies indicate that the dorsolateral pontine tegmentum has an important role to regulate the micturition reflex. Less