非侵入临时心脏起搏进展

非侵入临时心脏起搏是经体外电极刺激心脏的一种心脏急救起搏方法。本文综述了非侵入心脏起搏技术的进展,介绍了改进的非侵入临时起搏系统的特点、安全性、有效性、血液动力学响应及临床应用,并与侵入式心电膜电极临时起搏作了对比。     

基于有限元法的硬脑膜外视皮层电刺激仿真研究

经硬脑膜对视皮层电刺激是治疗失明的新思路。为从理论上认识其作用机制,首先建立视皮层区域的有限元仿真模型,分析脑组织内电场分布,并用激活函数和组织活化区来表征外加刺激的作用效果;随后逐次改变单相脉冲的幅值、脉宽和频率,通过基波作用下组织活化区的变化来探讨不同刺激参数对结果的影响。仿真结果显示,经硬脑膜可以实现对视皮层的有效刺激,只是所需刺激强度比直接皮层刺激约高30倍;多电极刺激模式下,只要电极间距超过5 mm,电极间的影响可忽略不计;降低幅值、脉宽和频率等参数,可以改善单相方波脉冲的刺激效果,其中幅值的减小对空间分辨率的提高效果最为显著。所得结论对实验具有一定指导意义。     

盆底肌锻炼结合生物反馈刺激改善产后盆底疼痛患者盆底功能及疼痛程度的效果分析

目的:探讨盆底肌锻炼结合生物反馈刺激改善产后盆底疼痛患者盆底功能及疼痛程度的效果.方法:将我科2018年9月至2019年9月期间93例产后盆底疼痛患者按照简单随机化法分为对照组(n=46,给予生物反馈电刺激,频率8～80 Hz;脉宽:20～740μs)和观察组(n=47,在对照组基础上增加盆底肌锻炼),1 m后采用阴道...     

硬膜外脊髓电刺激仪的研制

临床实验证实硬脊膜外脊髓电刺激(ESCS)与减重步态疗法(PWBT)相结合,能明显提高患者脊髓损伤康复后的行走能力,对运动能量代谢产生显著影响,但相应的神经与生理机制目前尚不清楚.本研究开发研制一种小型低功耗的先进ESCS刺激仪,为ESCS机理的实验研究提供所需的刺激模式.基于印刷电路板工艺,采用聚酰亚胺对银电极触点进行绝缘封装,改进电极的设计.进行ESCS刺激仪性能的动物实验验证,改变电压幅值、频率和波宽等刺激参数,观察实验猫肌肉的抽搐情况.实验结果表明:所研制的小型低功耗ESCS刺激器能提供所需的多通道多模式刺激信号,电池供电和低功耗设计可提供使用安全性,ESCS电极满足柔韧性和生物兼容性要求,可为ESCS和PWBT组合疗法的机理研究提供先进实验手段.     

神经电刺激下的人体增强研究进展

近年来,许多研究探索人类记忆、学习、情绪调控等认知功能、感知功能、运动功能的神经电刺激增强。脑机接口可用作更精细化的神经电刺激,它的信息读写性能提升也得到研究。非侵入式刺激以经颅直流电刺激(tDCS)为代表,实施较为便捷,但是在长期有效性和刺激精度方面需要进一步提升。侵入式刺激方式以脑深部电刺激(DBS)、迷走神经刺激(VNS)为代表,已经在临床上取得了广泛的认可和应用,刺激具备高精度特性,但是在增强方面的研究与应用上存在限制。对以上研究进展进行综述,并对人体增强研究的局限和发展趋势进行评论。     

不同刺激参数对SD大鼠肌肉收缩的影响

目的研究不同电刺激参数对SD大鼠肌肉收缩的影响,为临床应用电刺激治疗周围神经损伤提供参考。方法采用低频脉冲发射器对SD大鼠的颈项部肌群进行局部电刺激。刺激时改变频率、脉宽、电压及占空比等参数,观察参数变化对肌肉收缩及动物行为的影响。同时记录受刺激肌肉的肌电图。结果 8只SD大鼠在10~60Hz的频率范围内,随频率增加肌肉收缩率逐步增强。肌电图结果显示在刺激频率不变的前提下,随脉宽的增加（50~200μs）,肌电幅值显著上升,且肌电幅值的变化与大鼠行为改变成正相关。结论不同的刺激参数可影响肌肉的收缩状态与强度,选择合适的参数可使失神经支配肌肉发生有节律地收缩,防止肌萎缩,并有助于建立局部肌痉挛动物模型。     

外部电场作用下的视神经纤维兴奋性的仿真研究

基于刺入式电极的视神经视觉假体,为盲人的视觉修复提供了新的可能性。为了对该视神经假体的电刺激策略和微电极设计提供理论支持,基于真实的电极结构,在COMSOL软件中建立刺入式微电极的外部电场仿真模型,并将其与利用NEURNO软件实现的神经纤维双层电缆模型结合,系统地研究电极与视神经纤维的相对位置、电刺激脉冲宽度以及电极几何结构的改变对视神经纤维兴奋阈值的影响。不同电极位置、刺激脉宽刺激下阈值变化规律的仿真结果,与以往报道的动物实验和仿真实验结果相符,证明了所建模型的有效性。 根据仿真结果,对刺入式视神经假体中刺激脉宽的选择和电极几何结构的设计,建议如下：窄脉宽刺激有利于降低能量消耗;电极锥度的设计要在满足电极力学特性及易于植入视神经的基础上,尽可能地减小,以降低纤维兴奋的阈值;电极的暴露面积越小,纤维兴奋所需的电流阈值越低,但电荷密度阈值越高;较低的电流阈值有利于减少能量消耗,但过高的电荷密度阈值却容易造成组织损伤,因此电极暴露面积的设计需要在耗能与安全性之间进行综合考虑。电极绝缘层厚度的改变对视神经纤维的兴奋阈值没有明显的影响,但从电极插入的难易考虑,应尽可能减小绝缘层厚度。以上结果对人体其他部位神经纤维的电刺激同样具有参考价值     

神经肌肉刺激治疗后妇女会阴部解剖形态变化

目的探讨盆底功能康复训练治疗对女性产后会阴部解剖形态变化的影响,评定盆底康复治疗效果。方法我院2007年6月至2008年12月在产科门诊产后盆底功能康复病例60例,采用法国PHENIX神经肌肉刺激治疗仪进行盆底功能康复训练治疗,治疗前和疗程结束后分别测量病人会阴体长度和阴道口宽度,阴道肌肉收缩力,观察会阴体和阴道的解剖形态及阴道收缩力的变化。结果经一个疗程治疗后,会阴体平均增长2.2 mm,会阴体接近30 mm长度,阴道口宽度平均缩窄6.5 mm;阴道肌力平均增加2.2级。结论盆底功能康复训练治疗后阴道收缩力增强,可使会阴体变长,阴道口变窄,会阴部解剖形态向产前状态恢复,是一种有效的治疗女性盆底功能障碍疾病的好方法。     

体表脉冲电刺激大动物的安全性评估

背景：目前电刺激技术已成为研究热点,但其对机体心电活动的影响尚不明确,且既往此方面研究主要针对小型动物。目的：在不影响心电活动的前提下,寻找刺激猪肝区所能使用最大的脉冲电压及频率。方法：取健康雄性荣昌猪3头,将脉冲电刺激仪输出电极固定于猪肝右叶体表投影前后对应部位,设置固定电刺激参数为波宽10 ms、方波,刺激时间为1 h,分别进行5-100 V的电压耐受实验和1-5 Hz的频率耐受实验,观察猪的动态心电图变化、其不适反应和生活行为的改变。结果与结论：电压耐受实验中脉冲电刺激电压高低与心率增量呈正相关;当电压> 35 V时,可发生窦性心律不齐、室性早搏等轻度心律失常,无恶性心律失常、死亡;当电压> 60 V时,可见电刺激诱发形成的qRs波。频率耐受实验中当频率> 2 Hz时可见心律失常发生,无恶性心律失常,脉冲电刺激可诱发形成qRs波。提示选择参数为电压35 V、频率2 Hz的脉冲电刺激猪肝区是安全的,电压大于35 V或频率大于2 Hz的脉冲电刺激猪肝区均可引发心律失常,多为良性心律失常。中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

生物反馈电刺激个体化治疗方案联合盆底肌训练对女性产后盆底功能障碍效果研究

目的:分析盆底康复治疗对女性产后盆底功能障碍的效果。方法:选取2016年6月-2016年8月我院收治的80例产后尿失禁病患,随机分为两组,每组40例,对照组采取单纯盆底肌训练,观察组进行生物反馈电刺激个体化治疗方案联合盆底肌训练,3个月后按照国际通用会阴肌力测试法(GLAZER)对两组病患的康复训练效果进行分析评价。结果:观察组盆底康复治疗总有效率为95.0%明显高于对照组(77.5%,P0.05)。结论:生物反馈电刺激个体化治疗方案联合盆底肌训练能够明显提高病患的盆底肌力,改善尿失禁症状,提高病患的生活质量。     

聚丙烯补片在改良盆底重建修复盆腔脏器脱垂中的应用

背景：合成补片是重要的盆底组织替代物,能够替代薄弱受损的盆底筋膜组织,己被广泛应用于盆底薄弱组织的修补重建中。 目的：观察补片在改良盆底重建修复盆腔脏器脱垂的疗效及并发症,探讨其安全性及有效性。 方法：纳入45例女性盆腔脏器脱垂患者,根据患者意愿分两组治疗,试验组25例经阴道植入聚丙烯补片进行改良盆底重建修复,对照组20例采用传统经阴道全子宫切除联合阴道壁修补治疗,记录两组围手术期情况,随访评价两组子宫脱垂分期、并发症、盆底功能及盆底不适情况,以及客观治愈率。 结果与结论：与对照组比较,试验组手术时间短、出血量小、感染轻、恢复快(P均 < 0.05)。随访6个月时,试验组子宫脱垂分期评分高于对照组;随访12个月时,试验组并发症发生率、盆底功能影响评分及盆底不适情况评分均低于对照组(P < 0.05),客观治愈率高于对照组(P < 0.05)。表明采用聚丙烯补片进行盆底重建修复盆腔脏器脱垂具有手术时间短、出血量小、恢复快、裸露率低等特点,同时能显著提高盆底功能,改善盆底不适情况,降低术后并发症的发生,提高客观治愈率,短期随访安全有效。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

Y形网片在女性盆底功能疾病中的应用

BACKGROUND: The Y-shaped mesh graft material weaved using lightweight polypropylen has the appropriate porosity, which not only can make the vaginal tissues grow and fuse rapidly on the mesh, but also can maintain good biological strength to ensure the fixed strength for the presacral suspension. OBJECTIVE: To retrospectively analyze the clinical effect of Y-shaped mesh for the biological function reconstruction of the female pelvic floor. METHODS: Ten female cases of pelvic floor dysfunction were enrolled, aged 37-73 years, and all were given the treatment of sacral colposuspension under laparoscopy. Then perioperative complications were recorded; patients were followed up regularly to record the Pelvic Organ Prolapse Quantification (POP-Q) score at different time points; and the subjective satisfaction was investigated using the Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS AND CONCLUSION: After at least 6-month follow-up, no postoperative pelvic infection, nerve damage and complications appeared, the patients healed well, and no mesh erosion, infection and other adverse reactions occurred. The POP-Q and PFIQ-7 scores at 1, 3 and 6 months after repair were significantly improved than those before repair (P < 0.05). These results suggest that the Y-shaped biological mesh repairing female midpelvic floor dysfunction has good biocompatibility, and can restore the anatomy of the pelvic floor.     

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.     

女性盆底功能障碍性疾病治疗的回顾性分析

目的探讨女性盆底功能障碍性疾病的治疗方法及临床疗效。方法回顾我院56例女性盆底功能障碍性疾病的临床资料,对其治疗方法、临床疗效进行分析。结果 56例患者治疗后效果良好,非手术治疗12例,治疗后随访复发3例,经手术治疗44例,复发1例。结论选用合适的治疗方式,联合治疗能有效地治疗女性盆底功能障碍性疾病。     

表面肌电信号评价呼吸电刺激治疗功能性便秘的疗效

目的　利用表面肌电测量腹肌、膈肌和盆底肌肌电改变,评价呼吸电刺激治疗功能性便秘的疗效。 方法　共31例功能性便秘患者纳入研究,按随机数字表法分为对照组和治疗组,对照组采用单纯盆底生物反馈治疗（16例）,治疗组在盆底生物反馈治疗基础上进行呼吸电刺激训练（15例）。分别于治疗前以及治疗后对两组选用便秘评分系统进行评估,采用表面肌电图技术检测膈肌和下腹肌表面肌电均方根,Glazer法评估盆底肌肌电参数。 结果　治疗2周后,两组患者便秘评分系统评估较治疗前下降（P<0.05）,且治疗组评分低于对照组（P<0.05）;两组患者的膈肌和腹直肌均方根值较治疗前改善（P<0.05）,且治疗组膈肌肌电均方根值改善程度与对照组比较有统计学差异（P<0.05）。治疗后,Glazer法评估两组患者前基线、后基线波幅值较治疗前降低（P＜0.05）,且治疗组前基线波幅值较对照组降低,差异有统计学意义（P<0.05）。 结论　呼吸电刺激训练可有效提高膈肌、腹肌收缩力,降低盆底肌的过度活动,增强盆底生物反馈治疗改善功能性便秘的治疗效果。     

Vaginal and Pelvic Floor Responses to Sexual Stimulation

Vaginal vascular responses to vibratory stimulation of the clitoris, recorded as changes in the amplitude of oscillations of light reflectance at the heart-beat frequency, are: a) very repeatable, b) widespread throughout the vagina but of greater amplitude in its lower anterior wall than elsewhere, c) of very short latency (2–3 sec), but cumulative over 30 sec or more. Such responses are not imitated by raising the abdominal pressure, voluntarily contracting the pelvic floor or the flexors or adductors of the hips, or raising the blood pressure by exercise. They are absent in the foot, hand and rectum when present in the vagina. Sexual fantasy provokes vaginal responses very similar to those from vibratory stimulation of the clitoris, though somewhat less repeatable. Mean vaginal light reflectance, averaged over a cardiac cycle, responds to the same stimuli which affect the amplitude of pulsation. It is, however, much more subject to artifact. Changes in thermal conductivity closely parallel those in amplitude of oscillation of reflectance, with a time-lag which is probably mainly instrumental. Vibratory stimulation of the clitoris causes sustained reflex contraction of the pelvic floor. This reflex (never, it seems, previously described) may be regarded as a tonic counterpart of the well-known phasic bulbocavernosus reflex. The vascular events at and after orgasm and their relationship to features of the pelvic floor electromyogram are described and illustrated; the heart rate falls greatly during the 10 sec after orgasm, the amplitude of vaginal vascular pulsation remains above its prestimulation value for as long as 15 min, and pelvic floor electromyographic activity remains enhanced for at least 2 min.     

648例产后女性盆底康复疗效分析

目的:探讨盆底康复治疗对产后女性盆底肌力的改善情况.方法:分别对2015-2017年我院产后门诊就诊的177例剖宫产患者及471例顺产患者进行盆底肌力测试,制定1个疗程连续10次的盆底康复治疗方案,比较盆底康复实施前后盆底肌力评分改变.结果:盆底康复治疗前的剖宫产及顺产患者盆底肌力无明显差异(P>0.05),经过盆底康...     

产后女性进行盆底肌康复治疗对其性功能障碍的改善效果

目的:探究产后女性进行盆底肌康复治疗对其性功能障碍的改善效果。方法:随机选取我院收治的120例产后女性患者,按照数字表法分组,将其分为试验组、对照组两组,对照组采用常规康复治疗,试验组开展盆底肌康复训练治疗,对比分析两组患者预后情况。结果:试验组女性患者治疗后3个月、6个月的性交频率与对照组患者相比明显较高,差异有统计学意义(t=-17.0692,-20.9648;P0.05)。试验组女性患者治疗后3个月、6个月的性功能评分与对照组患者相比明显较高,差异有统计学意义(t=-18.1220,-10.8083;P0.05)。结论:产后女性进行盆底肌康复治疗后,有利于提高性功能,增加性交频率,预后效果显著,临床意义重大。     

Pelvic floor dysfunction—Does menopause duration matter?

Objective

To explore the effect of menopause and hormone replacement therapy on pelvic organ prolapse and pelvic floor muscle function.

Methods

The records of patients who attended a tertiary urogynaecological center were reviewed retrospectively. A standardised interview included menopausal age, i.e. years since last period or onset of menopausal symptoms, current or previous hormone use. The clinical examination included prolapse assessment (POP-Q) and palpation of the levator ani muscle. 4D transperineal ultrasound, supine and after voiding, was performed in all patients. Volume data sets were analysed for pelvic organ descent and measures of contractility and distensibility of the pelvic floor at a later date, blinded to all clinical data.

Results

Of 311 women seen during the inclusion period, 65% were postmenopausal. Current systemic or local hormone use was reported by 7% and 6%, respectively. 163 women (52%) reported prolapse symptoms with a mean bother of 5.7/10. Significant pelvic organ prolapse was found on clinical examination (POP-Q stage ≥ 2) in 77%, and diagnosed on ultrasound in 61%. On multivariate analysis, controlling for calendaric age, parity and levator avulsion, there was no evidence for menopausal age as an independent predictor of any symptom and sign of pelvic organ prolapse and pelvic floor muscle function. Local oestrogen use and past or present hormone replacement therapy had no detectable effect on any pelvic floor parameter.

Conclusions

Hormone deficiency following menopause is unlikely to play a major role in pelvic organ support and levator ani function. Hence, both do not appear to be substantially influenced by local or systemic hormone replacement therapy.     

Vaginal cone use in passive and active phases in patients with stress urinary incontinence

OBJECTIVE:

To evaluate vaginal cone therapy in two phases, passive and active, in women with stress urinary incontinence.

METHODS:

A prospective study was conducted at the Department of Obstetrics and Gynecology, São Paulo University, Brazil. Twenty-four women with a clinical and urodynamic diagnosis of stress urinary incontinence were treated with vaginal cones in a passive phase (without voluntary contractions of the pelvic floor) and an active phase (with voluntary contractions), each of which lasted three months. Clinical complaints, a functional evaluation of the pelvic floor, a pad test, and bladder neck mobility were analyzed before and after each phase.

RESULTS:

Twenty-one patients completed the treatment. The reduction in absolute risk with the pad test was 0.38 (p<0.034) at the end of the passive phase and 0.67 (p<0.0001) at the end of the active phase. The reduction in absolute risk with the pelvic floor evaluation was 0.62 (p<0.0001) at the end of the passive phase and 0.77 (p<0.0001) at the end of the active phase. The reduction in absolute risk of bladder neck mobility was 0.38 (p<0.0089) at the end of the passive phase and 0.52 (p<0.0005) at the end of the active phase. Complete reversal of symptomatology was observed in 12 (57.1%) patients, and satisfaction was expressed by 19 (90.4%).

CONCLUSION:

Using vaginal cones in the passive phase, as other researchers did, was effective. Inclusion of the active phase led to additional improvement in all of the study parameters evaluated in women with stress urinary incontinence. Randomized studies are needed, however, to confirm these results.