BASIC AND CLINICAL RESEACH ON THE CENTRAL NERVOUS CONTROL OF MICTURITION

用去大脑的狗研究排尿的脑干控制。电刺激蓝斑α核(LCalpha)(0.2毫秒、50赫兹、10-50微安)可引起排尿，即膀胱收缩、内外括约肌松弛。排尿时，蓝斑(LSC)和脑桥口核(POO)内的ES对膀胱活动有抑制作用，对外括约肌有兴奋作用。LCalpha中的ES降低膀胱容量，而LSC和POO中的ES增加膀胱容量。这些结果表明，桥脑排尿中心(PMC)位于LCalpha，脑桥尿液储存中心(PUSC)位于LSC和POO区域。在LCalpha、LSC和POO内微量注射药物可调节排尿反射。LCalpha中的GABA增加了膀胱容量，而LSC和POO中的GABA则降低了膀胱容量。Enkep…LCalpha和LSC中较多的卤素抑制排尿，而粪便中的脑啡碱对排尿反射没有影响。用HRP进行的神经解剖学研究表明，PMC和PUSC之间存在密切联系。HRP研究还表明，PUSC在骶髓的中间外侧核和Onuf核以及脑的不同部位之间发送和接收纤维。CT和MRI检查脑部病变。同时记录膀胱测压和外括约肌肌电信号以评价膀胱和输尿管功能。结果：(1)额叶、壳核、丘脑病变导致膀胱过度活跃(分别为67%、67%、60%)；(2)55%额叶病变患者存在膀胱过度活动伴尿路功能不全；(3)60%壳核病变患者尿路功能正常；(4)3例双侧桥脑背外侧被盖病变患者中3例膀胱活动不足。较少

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