神經(jīng)源性膀胱的康復進展南昌大學一附院康復科楊初燕共享pptValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL神經(jīng)源性膀胱的康復進展南昌大1輸尿管髂內(nèi)動脈外動脈臀上動脈胱下動脈臍動脈上臀下動脈閉孔動脈膀胱上動脈陰部內(nèi)動脈直腸下動脈輸精管盆腔的血管Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL輸尿管2傳入神經(jīng)纖維Afferentnervefiber副交感神經(jīng)纖維Parasympatheticnervefiber內(nèi)括約肌陰部神經(jīng)PudendalnerveInternalsphincter外括約肌Externalsphincter圖膀胱的神經(jīng)支配示意圖Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL傳入神經(jīng)纖維31.貯尿反射交感神經(jīng)通路:膀胱充盈期支配下尿路的交感神經(jīng)處于張力性激活狀態(tài),是一種負反饋機制,作用是使膀胱不斷適應其容量的增加。它的高級中樞位于腦橋排尿中樞。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL1.貯尿反射4()支配尿道括約肌的體神經(jīng)傳出纖維:充盈期由于來自膀胱的傳入沖動作用,陰部神經(jīng)運動元被激活,而非排尿期被抑制Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL()支配尿道括約肌的體神經(jīng)傳出纖維:充盈期52排尿反射排尿反射是通過激活分布于膀胱的骶副交感神經(jīng)和抑制分布尿道括約肌的體神經(jīng)介導。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL2排尿反射排尿反射是通過激活分布于膀胱6腦橋排尿中樞:對排尿反射通過起著開關作用可能對膀胱容量和逼尿肌外括約肌的協(xié)調(diào)性有調(diào)節(jié)作用。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL腦橋排尿中樞:對排尿反射通過起著開關作用7概述■因神經(jīng)病變或損害引起的膀胱或/和尿道功能障礙稱為神經(jīng)原性膀胱(下尿路神經(jīng)肌肉失調(diào))。處理不當泌尿系統(tǒng)感、染泌尿系統(tǒng)結石、腎積水、腎功能衰竭。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL概述8病因脊髓損害如脊膜膨出、脊髓損傷、脊髓灰質(zhì)炎腰椎間盤突出等脊髓和腰椎病變。脊髓以上的損害如顱腦損傷、腦血管疾病、帕金森病等。外周神經(jīng)損害如糖尿病、盆腔廣泛手術等。藥物作用對交感、副交感神經(jīng)功能有影響藥物,如普魯本辛、阿托品以及用于降血壓、脫敏、抗組胺等藥物均可影響排尿中樞神經(jīng)。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病因9病史①排尿功能障礙伴排便功能紊亂(如便秘、大便失禁等)者②注意有無外傷、手術、糖尿病、脊髓灰質(zhì)炎、怕金森病等病史或藥物使用史。③注意有無尿意、膀胱膨脹等感覺的減退或喪失,如膀胱的感覺有明顯減退或喪失,應懷疑為神經(jīng)原性膀胱Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病史10神經(jīng)源性膀胱的康復進展課件11神經(jīng)源性膀胱的康復進展課件12神經(jīng)源性膀胱的康復進展課件13神經(jīng)源性膀胱的康復進展課件14神經(jīng)源性膀胱的康復進展課件15神經(jīng)源性膀胱的康復進展課件16神經(jīng)源性膀胱的康復進展課件17神經(jīng)源性膀胱的康復進展課件18神經(jīng)源性膀胱的康復進展課件19神經(jīng)源性膀胱的康復進展課件20神經(jīng)源性膀胱的康復進展課件21神經(jīng)源性膀胱的康復進展課件22神經(jīng)源性膀胱的康復進展課件23神經(jīng)源性膀胱的康復進展課件24神經(jīng)源性膀胱的康復進展課件25神經(jīng)源性膀胱的康復進展課件26神經(jīng)源性膀胱的康復進展課件27神經(jīng)源性膀胱的康復進展課件28神經(jīng)源性膀胱的康復進展課件29神經(jīng)源性膀胱的康復進展課件30神經(jīng)源性膀胱的康復進展課件31神經(jīng)源性膀胱的康復進展課件32神經(jīng)源性膀胱的康復進展課件33神經(jīng)源性膀胱的康復進展課件34神經(jīng)源性膀胱的康復進展課件35神經(jīng)源性膀胱的康復進展課件36神經(jīng)源性膀胱的康復進展課件37神經(jīng)源性膀胱的康復進展課件38神經(jīng)源性膀胱的康復進展課件39神經(jīng)源性膀胱的康復進展課件40神經(jīng)源性膀胱的康復進展課件41神經(jīng)源性膀胱的康復進展課件42神經(jīng)源性膀胱的康復進展課件43神經(jīng)源性膀胱的康復進展課件44神經(jīng)源性膀胱的康復進展課件45神經(jīng)源性膀胱的康復進展課件46神經(jīng)源性膀胱的康復進展課件47神經(jīng)源性膀胱的康復進展課件48神經(jīng)源性膀胱的康復進展課件49神經(jīng)源性膀胱的康復進展課件50神經(jīng)源性膀胱的康復進展南昌大學一附院康復科楊初燕共享pptValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL神經(jīng)源性膀胱的康復進展南昌大51輸尿管髂內(nèi)動脈外動脈臀上動脈胱下動脈臍動脈上臀下動脈閉孔動脈膀胱上動脈陰部內(nèi)動脈直腸下動脈輸精管盆腔的血管Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL輸尿管52傳入神經(jīng)纖維Afferentnervefiber副交感神經(jīng)纖維Parasympatheticnervefiber內(nèi)括約肌陰部神經(jīng)PudendalnerveInternalsphincter外括約肌Externalsphincter圖膀胱的神經(jīng)支配示意圖Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL傳入神經(jīng)纖維531.貯尿反射交感神經(jīng)通路:膀胱充盈期支配下尿路的交感神經(jīng)處于張力性激活狀態(tài),是一種負反饋機制,作用是使膀胱不斷適應其容量的增加。它的高級中樞位于腦橋排尿中樞。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL1.貯尿反射54()支配尿道括約肌的體神經(jīng)傳出纖維:充盈期由于來自膀胱的傳入沖動作用,陰部神經(jīng)運動元被激活,而非排尿期被抑制Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL()支配尿道括約肌的體神經(jīng)傳出纖維:充盈期552排尿反射排尿反射是通過激活分布于膀胱的骶副交感神經(jīng)和抑制分布尿道括約肌的體神經(jīng)介導。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL2排尿反射排尿反射是通過激活分布于膀胱56腦橋排尿中樞:對排尿反射通過起著開關作用可能對膀胱容量和逼尿肌外括約肌的協(xié)調(diào)性有調(diào)節(jié)作用。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL腦橋排尿中樞:對排尿反射通過起著開關作用57概述■因神經(jīng)病變或損害引起的膀胱或/和尿道功能障礙稱為神經(jīng)原性膀胱(下尿路神經(jīng)肌肉失調(diào))。處理不當泌尿系統(tǒng)感、染泌尿系統(tǒng)結石、腎積水、腎功能衰竭。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL概述58病因脊髓損害如脊膜膨出、脊髓損傷、脊髓灰質(zhì)炎腰椎間盤突出等脊髓和腰椎病變。脊髓以上的損害如顱腦損傷、腦血管疾病、帕金森病等。外周神經(jīng)損害如糖尿病、盆腔廣泛手術等。藥物作用對交感、副交感神經(jīng)功能有影響藥物,如普魯本辛、阿托品以及用于降血壓、脫敏、抗組胺等藥物均可影響排尿中樞神經(jīng)。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病因59病史①排尿功能障礙伴排便功能紊亂(如便秘、大便失禁等)者②注意有無外傷、手術、糖尿病、脊髓灰質(zhì)炎、怕金森病等病史或藥物使用史。③注意有無尿意、膀胱膨脹等感覺的減退或喪失,如膀胱的感覺有明顯減退或喪失,應懷疑為神經(jīng)原性膀胱Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病史60神經(jīng)源性膀胱的康復進展課件61神經(jīng)源性膀胱的康復進展課件62神經(jīng)源性膀胱的康復進展