The Study On Voiding Dysfunction After Acute Stroke Of Its Electroacupuncture Treating,Urodynamics And Related Facters

Voiding dysfunction after acute stroke has high clinic incidencerate, relevant to incidence and death rate of cerebral hemorrhage andinfarction,is a guide line of severity degree.during acute stroke,there are all kinds of characterized by differet damage part anddegree:because of detrusor areflexia,detension bladder,in some timeurine retention or overflow incontinence;part of them detrusoroveractivity,uninhibited hyperreflexic bladder, urgency incontinence;others detrusor external urethral sphincter dyssynergia,dyuria orstress incontinence ,and so on.Now,during the acute stroke, peopletake important of saving the life and coming back body function,indwelling catheter in a long time to the patients with voidingdysfunction,and waiting to get back nerve function and look up voidingdysfunction.It is not only add to urethral infecton,but also some delayrenew turn to serious vesical-ureter reflux, hydronephrosis , renalfailure and other damnify of upper urethral,atrophy bladder.becauseof voiding dysfunction limited of patient movement seriously,notonly bring them to inferiority,turn down life-qulity,decline ofsociety-ability,but also add up economy burden of society and family.Therefore,we should actively prevent voiding dysfunction after acutestroke,turn down intercurrent ill,accelerate patient self-dependence,building up healing confidence.but up to now, which curing voidingdysfunction after acute stroke, still is a difficult question,in allof the world.There is lot of report about it,Ancient docter adopt piontby "traditional medical threapy -connexting pathway",now we adoptBaliao piont and Huiyang piont by current medicine ,piont dissectionof nerve domination,to determine the optimal methods for treatment ofurinary incontinence and urine retention after stroke,abtain asatisfactional clinic curative effect.By physiology of neuroanatomy,We discuss about mechanism of acupuncture adjust to change the urinestorage and voiding;by urodynamics,we assessed bladder-urethrafunction after electro-acpuncture stimulationand open out practicalmachine of electroacpuncture bidirectional regulation.To investigatethe prevalence of voiding dysfunction after stroke and to analyze itsrelated factor.Take a rusult:1.Clinic study of electroacpuncture therapy urine retention orincontinence after acute strokeTherapy urine retention or incontinence after acute stroke byelectroacpuncture stimulating baliao and huiyang piont,we discoverthat every parameters notablely improved.The effective rate of urineretention acpuncture group was about 73.3%,but comparison group wasabout 26.6%. The voiding frequency effective rate of incontinenceacpuncture group was about 90%, but comparison group was about 26.6%.Incontinence degree effective rate of incontinence acpuncture groupwas about 86.7%,but comparison group was about 13.3%.Bladder maximumcapacity of incontinence acpuncture group was about 251±20ml beforetherapy,and about 324±22ml after therapy,turned to normal range.Result show that electroacpuncture therapy urine retention orincontinence has a good curative effect. This will change the functionsof the lower urinary tract, including the bladder and the urethral,and finally change the urine storage and voiding.Baliao piont and huiyang piont locate in rumpbone-bore stern skinnerve and bupic nerve, have a same or near S2～4, such as the pudendalnerve and the pelvic nerve,we presume that electroacpuncture therapyeffected on voiding reflect nerve centre,hibit or excite coming-outnerve impulsion,and adjust detrusor-urethral sphincter action,good tovoiding reflect.2.Study of electroacpuncture therapy voiding dsyfunction byurodynamicsSearching 63 patient with voiding dsyfunction,divided into 4groups by urodynamics:higher inside pressure incontinence group(8);lower urethral pressure incontinence group(23);detrusor dysfunctionurine retention group(11);higher urethral pressure urine retentiongroup (21).Folowing antitheses-self,compare with results before andafter electroacupuctrue by urodynamic.We discovered that electroa-cupunctrue stimulating can turn to pelvic floor EMG boost up amplitudeorderly,improve PVR,Qmax,Pdet.max,Pure.max,maximum bladder capacityand so on.Hinted that the sitimulation of electroacpunctu re canrestrain or excite S2～4 micturition reflexi nerve centre,so restrainor excite detrusor-urethral sphincter action and adjust to change theurine storage and voiding, and improve bladder-urethra function.frombladder function,open out practical machine of electroacpuncturebidirectional regulation. To therapy higher inside pressureincontinence, lower urethral pressure incontinence ,detrusordysfunction urine retention and higher urethral pressure urineretention.3.Investigate voiding dysfunction after stroke of related factersIn this study, we investigate :there are relations from age,sex,pathological changes kind,position, prostate disease, urogenitalinfect etc ,to voiding dysfunction after stroke,and effect prognosis,result to difficultly deal with and diagnose voiding dysfunction afterstroke. The risk factors of the stroke, such as hypertension,diabetes,heart ill,smoking,drinking,are not relating with voiding dysfunctionafter stroke.We should zealously therapy voiding dysfunction afterstroke,reduce an intercurrent disease, accelerate patients healing.