The content of the medical examination should include the examination of the feeling center (such as the ability to judge time, place, and characters); examination of cranial nerves, motor nerves, and sensory nerves (including the feeling of the back);Inspection of reflection and anal reflection; examination of gait and cerebellum function.For example, the integrity of the sacral reflection arc (－ 2-4) can be detected through the sponge sponge body muscle reflection, pinching the glans with one hand, and placing the other hand in perineal or anal, you can feel the contraction of the muscle.In clinical examinations, SP70 % of normal men have this physical reflection.The clinical examination of the penis sensation is also useful. For example, acupuncture test and alcohol cotton ball temperature sensor test can confirm whether the sensory component of the penis back nerve is harmed.
The following will be introduced separately:
(1) Bift test reflection
It is a symbolic, superficial body reflection.Using the blunt head of the head to gently draw the inner skin of the thigh, this reflection can be led.The reaction is the increase in the testis of the same side.The reflection is regulated by the iliac groin and reproductive stock neural regulation, and its reflection center is located on the waist of the spinal cord 1, waist 2, and sections.This stimulating test muscle reflection appears slowly, as seen in the process of sexuality.Regardless of any part of the peripheral reflex arc or the damage of the central motor neurons, this reflection will disappear.
(2) Scrotum reflection
It is a shaft and local reflection.When a man naked in a cold house, this phenomenon can often be noticed.This reflection is a slow and peristaltic contraction of the scrotum meat membrane muscles.When a cold object is placed in the scrotum, perineum, or the upper part of the thigh, this reflection can be led.This reflection disappears when patients have muscle or local nerve lesions.
(3), shallow anus reflection
It is a bilateral, body, and superficial reflection. Its reflection center is in the "section 3 and 4. When the skin in the perineal area is drawn, the contraction of the anus sphincter can be seen.
(4) Internal reflection of the anus
It can be used to evaluate the sympathetic ingredients in the abdominal nerve and the anterior nerve bush, and it is speculated that the central hub is located in the 2 sections of the waist baking M waist.When inserting a finger with a sleeve to the anus, this reflection can be led to the contraction of the sphincter in the anus!
(5), sponge body muscle reflection
It is a bilateral, spinal cord, and physical reflection.The introduction of this reflex arc and the rumors of nerve fibers come from the genital nerve, and its reflection center is located in the second and third sections of the ingredients.As early as the beginning of this century, people knew that when the back of the penis and glans was used to apply a little pressure, this reflection could be led.It shows the contraction of the sponge body muscles and anus sphincter, and the naked eye can observe the JU shrinkage of the post -muscle group.This reflection can also be quantitatively measured by more reliable electrical stimulus and muscle diagram records.
(6), the potential measurement measurement
The measurement of the potential potential potential is actually a electrical determination of the above -mentioned electrical biological reflection activity of the sponge sponge body muscle. When conducting this test, you need to place a ring electrode on the penis glans. Through this electrodeThe needle -shaped electrodes on the sponge body muscle and the electrocardiography connected to it to record the reflection of the sponge body muscles. This test measures the time from the stimulation of the penis glans to the sponge body muscleEssenceThe average ball sponge muscle reflection incubation time of a normal -erection ability is 35.0 ± 1.2 milliseconds (28-42 milliseconds). This is the most widely used test indicator in neurophysiology.It is a multi -sudden reflection with a cross -and -right cross, which stimulates one side to cause the incubation reaction of the same and opposite side.The test is used once every second, and each time it continues to bake 氲 氲 氲 氲 氲 龀 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 试 甭龀 甭龀 甭龀 试 试 increases from 30 volts to 60 volt or 6 mAhMost patients can confirm the electrical stimulus or sensory threshold that the first perception; when the pulse strength increases from 45 volts to 60 volts or from 9 mAh to 12 mAh, it can often confirm the initial reaction or reflection of the muscle electrocardiogramThreshold; increase the intensity from 60 to 90 volt or increase from 12 mAh to 15 mAh, will verify the minimum reflection incubation period.It is speculated that the pathway of this body reflection includes fibrous fiber of the penis back nerve and the genital nerve, and the pussy nerve has fiber, and the perineal nerve is deep.The characteristics of this reflection are: ⑴, as the stimulus intensity increases, the minimum reflection incubation time decreases; ⑵, stimulating unilateral nerves can record the muscle image reaction on both sides.Electro -electrocardi reaction can be recorded by the cotton body muscle itself, or it is recorded by the urethral sphincter or anal sphincter.The definition of abnormal sacral reactions is that the period of reflection incubation is greater than the average value (30-40 milliseconds) plus 3 standard deviations, which indicates that there is a high possibility of changes in neuropathological changes.The average incubation time of impotence patients is about 70 milliseconds.
In the investigation of erectile impairment, it is necessary to be very careful when explaining the results of simple physical tests. Although the potential potential can be determined by the body nerve function, rather than evaluate the autonomic nerves such as sponge body nerves, it may be linked to the neuropathy of the autonomic nerve.Especially the lesions of autonomic nerve in the central nervous system.In the middle gray texture, the syndrome neurons are closely adjacent to the body's neurons in anatomy. Therefore, its detection value seems to be confirmed that the existence, position, position, 外, 骶 or above; left; left; left; left; left; left; left; left; left;Side or right) and nature (exercise or sensation), not a conventional screening test for patients with impotence.Classification can be classified according to the test results of the inspection of the sacral stimulation test:
①Surcharology changes: Diabetes or alcoholism, which causes the peripheral sensory changes in the peripheral peripherals, the peripheral conduction time can occur abnormal.Patients with changes in peripheral motor neuropathy may have normal peripheral sensation time, but the cyclone body reflection incubation time measured by the pyramidal section test (exercise and sensation) may be abnormally extended.
②, sacral injury: When having multiple hardening, spinal cord injury or central nervous system tumor caused suspicious sacral damage, it may be proven that the patient's existence of peripheral and total conduction time is prolonged.
③ Damage above the ingredients: When spinal cord injury caused by transverse coordinates, cervical sepasitic disc, head or spinal cord injury, the patient's general conduction time and central conduction time may be extended, and the peripheral conduction time is normalEssence
Institating the potential test through the backing of the back nerve body, it can determine the characteristics of the back nerve impotence or the sensation of the impotence syndrome.The abnormalities of this test indicate that the patient exists. If the animal's back neuronicular injury can be observed, the riding activity can be reduced, ejaculation, and twitching abnormalities can be observed.After the penile back nerve injury, it has adversely affected the patient's erectile ability.To achieve the erectile hardness necessary for the sex exchange, sometimes it takes a few days to repeat the pelvic nerve stimulation.The back nerve will provide sufficient sensing signals to the brain center so that the impulsive reaction signal can reach the pelvic sponge nerve through the brain -骶 conduction pathway.
(7), penile night erection test (NPT)
Some people think that all patients who are suspected of being neurotic impotence should undergo sleep research and examination of NPT, and monitor the activity of sponge sponge muscles and sciatic sponge body muscles during sleep.It can provide more useful information.However, the exact neurological pathway involved in the eye fast movement period (that is, the sleeping period) is not clear. Indirect evidence shows that the erection caused by spontaneous erection and visual pornographic stimulation of the eye fast dynamic period is not controlled by the same neural pathway.However, these channels may be closely related.People do not know which specific areas that interfere with the central nervous system will change the test results of NPT.When determining NPT, monitoring EEG, mandibular muscle electrocomputer, electrochemical and sponge body muscle activity at the same time will help improve the localized neural information provided by the sleep research institute.
(8), penile biochemical sensation threshold measurement
The detection of penile biochemical sensing thresholds will use a moving electromagnetic oscillating device with a fixed oscillation frequency, but the amplitude of the oscillation is variable.The contact head of the device will be placed on the left and right sides of the finger and the left and right side of the penis on both sides of the index finger.When testing, it is advisable to increase the oscillating amplitude slowly. Once the patient feels this vibration, he will tell the doctor immediately; it also requires the patient to tell the doctor to disappear in time when the vibration strength is gradually weakened.The oscillation intensity recorded in these two inspections should be the same.It should be noted that with the age of growing local skin pressure, the sensitivity degradation of small bodies, the collagen infiltration of the skin and the shrinkage of the skin.Under normal circumstances, the vibration sensation threshold of the penis glans is higher, which reflects that the number of small bodies in the middle ring layer of the glans is relatively poor.The detection of penile biochemical sensing threshold seems to be a good screening test with abnormality of the penile back nerve into the pathway.The test confirmed that most patients with abnormal biochemical sensing thresholds have potential diabetes or alcoholic neuropathy. They often have abnormalities of backbone -stimulate the abnormality of the potential test.
(9), detect the nerves and muscle functions of the whole body and local
① Measure the supine position and the blood pressure of the standing position, the changes in heart rate during deep breathing, and the pupil reflection to the light.Standing hypotension and breathing intermittent period of heart rate have decreased or lacks short -term changes in the short -term changes in the short -term change. Pupils are dull or other abnormal manifestations of light reflection, which can help detect dysfunction of systemic plant nerves.
②, Electric activity of penile skin (EDA) during sleep (EDA)
The clinical neurology test also involves the outbreak of skin electrical activities during sleep. This explosion reflects the sympathetic activity in sleep, which decreases in normal eye fast movement.When NPT is abnormal, this kind of electrical activity is disturbed and does not decrease in the eye fast movement period. The reason why an erection cannot be unbalanced between the sense of intercourse and the side intercourse.It is also clinically found that when EDA is abnormal (those with normal NPT will not have this abnormalities), other neurological examinations may be completely normal, so it shows that this test is still unique and may have a certain reference value.
③ Stimulate the pussy nerve with surface stimuli, and use the body of the back nerve of the penis to stimulate the potential to study the integration of leather, spinal cord and peripheral nerves.
Urine dynamic test (bladder muscle electrocomputer and urine flow test), etc., will also have certain reference value for diagnosis.If necessary, perform CT and spinal X -ray to eliminate change.
In short, the value of the above nervous system examination in conventional clinical evaluation of impotence is unclear, but the existence of these reflections will make the doctor convinced that the neurological state of this area is normal.What is more ideal and logical is that the erectile erection itself should be inspired by these reflexes.Through local oscillation stimulus is one of the ways to cause reflex erection.
(Editor in charge: Internship Liu Suling)
