通窍活血汤在创伤性脑梗死大鼠模型中的探索

进好 车(内蒙古民族大学，中国;)
金锁 包(内蒙古民族大学附属医院，中国;)

摘要

目的为探索中药通窍活血汤在创伤性脑梗死大鼠模型治疗方面的作用，并初步探讨其对大脑神经酰胺分泌的可能关联或影响。数据分析后探讨通窍活血汤对创伤性脑梗死大鼠模型的治疗效果和可能机制。结果：通窍活血汤治疗后，中浓度和高浓度大鼠神经功能损伤情况明显改善，并具有时间依赖性和浓度相关性，外伤性损伤脑组织结构和缺血性海马神经元形态明显改善，水迷宫空间探索定位功能改善，神经酰胺表达明显增高。结论：通窍活血汤可能参与上调神经酰胺的表达，降低创伤性脑梗死大鼠的脑梗死面积并改善神经行为学和学习和空间记忆能力。

关键词

创伤性脑梗死；通窍活血汤；水迷宫；颅脑损伤；神经功能活动；神经酰胺

参考

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齐大河，丁萌萌，王可欣等。中医药干预脑缺血再灌注损伤的信号通路研究进展{J}。中医学报，2023,38（08）：1666-1674Exploration on the Influence of Glycated Hemoglobin on Postoperative Infection after Total Knee Arthroplasty and Establishment of Its Predictive ModelJunyi Chen Bin Xu Linhong CaiDepartment of Orthopedics, Putian First Hospital, Putian, Fujian, 351100, ChinaAbstract [Objective] To investigate the independent influence of preoperative glycated hemoglobin (HbA1c) levels on surgical site infection (SSI) after total knee arthroplasty (TKA) and determine the optimal intervention threshold, providing evidence for clinical perioperative management. [Methods] A retrospective analysis was conducted on the clinical data of 528 patients who underwent initial unilateral total knee arthroplasty (TKA) in our department from January 2020 to June 2023. Patients were divided into three groups based on preoperative HbA1c levels: Group A (HbA1c ≤ 6.5%, n=412), Group B (6.5% ＜HbA1c ≤ 7.5%, n=81), and Group C (HbA1c＞ 7.5%, n=35). The incidence rates of superficial infections, deep infections, and overall surgical site infections (SSI) within 90 days postoperatively were compared among the three groups. Multivariate logistic regression analysis was employed to identify independent risk factors for postoperative TKA infections. [Results] The overall incidence of SSI among the three patient groups was 2.18% (9/412),7.25% (6/81), and 14.29% (5/35), respectively, with statistically significant differences between groups (P ＜0.001). Multivariate logistic regression analysis revealed that after adjusting for factors such as age, BMI, and operative time, preoperative HbA1c＞ 7.5% was an independent risk factor for SSI post-TKA (OR = 4.12,95% CI: 1.85–9.17, P = 0.001), and operative time＞ 120 minutes was also an independent risk factor (OR = 2.45,95% CI: 1.12–5.38, P = 0.025). [Conclusion]Preoperative HbA1c levels were significantly associated with postoperative infection risk following total knee arthroplasty (TKA), with HbA1c＞ 7.5% serving as the critical threshold for significantly increased infection risk. It is recommended to maintain preoperative HbA1c levels below 7.5% and strictly control surgical duration to effectively reduce postoperative infection risk.KeywordsGlycated hemoglobin; Total knee arthroplasty; Surgical site infection; Risk factors; Critical values糖化血红蛋白对 TKA 术后感染的影响及其预测模型建立的探索陈俊毅许斌蔡林鸿莆田市第一医院骨科，中国·福建莆田 351100摘要【目的】探讨术前糖化血红蛋白（HbA1c）水平对全膝关节置换术（TKA）后手术部位感染（SSI）的独立影响及最佳干预临界值，为临床围手术期管理提供依据。【方法】回顾性分析2020年1月至2023年6月于我科行初次单侧TKA的528例患者临床资料。根据术前HbA1c水平分为三组：A组（HbA1c ≤ 6.5%，n=412）、B组（6.5% ＜ HbA1c ≤ 7.5%，n=81）、C组（HbA1c ＞ 7.5%，n=35）。比较三组患者术后90天内浅层感染、深部感染及总体SSI发生率，采用多因素Logistic回归分析TKA术后感染的独立危险因素。【结果】三组患者总体SSI发生率分别为2.18%（9/412）、7.25%（6/81）和14.29%（5/35），组间比较差异有统计学意义（P ＜ 0.001）。多因素Logistic回归分析显示，调整年龄、BMI、手术时间等因素后，术前HbA1c ＞ 7.5%是TKA术后SSI的独立危险因素（OR = 4.12，95% CI：1.85~9.17，P = 0.001），手术时间＞120分钟亦为独立危险因素（OR = 2.45，95% CI: 1.12~5.38, P = 0.025）。【结论】术前HbA1c水平与TKA术后感染风险显著相关，HbA1c ＞ 7.5%是感染风险显著增加的关键临界点。建议将术前HbA1c控制在7.5%以下，同时严控手术时间，以有效降低术后感染风险。关键词糖化血红蛋白；全膝关节置换术；手术部位感染；危险因素；临界值【基金项目】莆田学院2023年校内科研项目立项资助（项目编号：2023078）。【作者简介】陈俊毅（1993—），男，中国福建泉州人，硕士，主治医生，从事四肢创伤与组织工程研究。

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v9i3.37323