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排尿的神经源性调节:豚鼠逼尿肌刺激强度与最大缩短速度之间的关系。

Neurogenic modulation of micturition: the relation between stimulation intensity and the maximum shortening velocity of the guinea pig detrusor muscle.

作者信息

Groen J, Van Mastrigt R, Bosch R

机构信息

Department of Urology, Erasmus University Rotterdam, The Netherlands.

出版信息

J Urol. 1995 Jan;153(1):228-32. doi: 10.1097/00005392-199501000-00082.

Abstract

The course of micturition depends on bladder contractility and urethral resistance. The former is determined by geometrical, muscular and neurogenic factors. The muscular aspects of bladder contractility can be characterized by the parameters Pisv, the isovolumetric detrusor pressure, and vmax, the maximum (unloaded) shortening velocity of the detrusor muscle. The neurogenic control system of the urinary tract modulates bladder contractility, which might effectively change the values of Pisv and vmax. These parameters also depend on the instantaneous bladder volume. In previous work the dependence of Pisv on the intensity of stimulation and bladder volume was measured in guinea pig bladders in vivo and in vitro. In the present work vmax was derived in 5 guinea pig bladder in vitro, using electrical stimulation and the stop-flow technique. This technique implies that pressure values measured at a certain shortening velocity of the bladder circumference and in an isovolumetric contraction at the same volume are used to derive vmax mathematically from the Hill equation. vmax was independent of the bladder volume in the range of 0.6 to 6.1 ml., but it was significantly different for the two intensities of stimulation used. Therefore, it is concluded that the maximum shortening velocity of the guinea pig detrusor muscle depends on the intensity of stimulation. During submaximal stimulation the detrusor not only generates lower pressures, it also contracts more slowly. A possible explanation for this phenomenon is that the bladder is not uniformly stimulated. The isovolumetric pressure measured in the stop-flow test was compared with the isovolumetric pressure measured at the same bladder volume some minutes later. It was observed that shortening had a depressant effect of approximately 33% on the isovolumetric pressure. This implies that the clinically employed stop-flow test might underestimate detrusor contraction strength.

摘要

排尿过程取决于膀胱收缩力和尿道阻力。前者由几何、肌肉和神经因素决定。膀胱收缩力的肌肉方面可以用参数Pisv(等容逼尿肌压力)和vmax(逼尿肌最大(无负荷)缩短速度)来表征。尿路的神经控制系统调节膀胱收缩力,这可能有效地改变Pisv和vmax的值。这些参数也取决于瞬时膀胱容量。在之前的工作中,在体内和体外测量了豚鼠膀胱中Pisv对刺激强度和膀胱容量的依赖性。在本研究中,使用电刺激和停流技术在5个豚鼠膀胱体外测定了vmax。该技术意味着,在膀胱周长以一定缩短速度测量的压力值以及在相同体积的等容收缩中测量的压力值,用于从希尔方程中数学推导vmax。在0.6至6.1毫升的范围内,vmax与膀胱容量无关,但对于所使用的两种刺激强度,vmax有显著差异。因此,得出结论,豚鼠逼尿肌的最大缩短速度取决于刺激强度。在次最大刺激期间,逼尿肌不仅产生较低的压力,而且收缩也更慢。对此现象的一种可能解释是膀胱没有受到均匀刺激。将停流试验中测量的等容压力与几分钟后在相同膀胱容量下测量的等容压力进行比较。观察到缩短对等容压力有大约33%的抑制作用。这意味着临床上使用的停流试验可能低估了逼尿肌收缩强度。

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