【目的】 观察益智清心方联合温针灸治疗脑梗死后血管性认知障碍（VCI）的临床疗效及对认知功能的影响。【方法】 选取 2020年2月至2023年2月北京博爱医院收治的110例明确诊断为脑梗死后VCI的患者为研究对象。按随机数字表将患者随机 分为对照组和观察组，每组各55例。对照组给予盐酸多奈哌齐治疗，观察组在对照组治疗的基础上，给予益智清心方联合 温针灸治疗，连续治疗4周。治疗1个月后，评价2组临床疗效，观察2组患者治疗前后简易智能精神状态检查量表（MMSE） 评分和蒙特利尔认知评估量表（MoCA）评分的变化情况，以及脑血流灌注参数的情况。比较 2 组患者治疗前后 C 反应蛋 白（CRP）、白细胞介素 6（IL-6）、肿瘤坏死因子 α（TNF-α）的变化情况。并评价 2 组的安全性及不良反应的发生情况。 【结果】（1）观察组总有效率为96.36%（53/55），对照组为74.55%（41/55）。观察组疗效优于对照组，差异有统计学意义（P < 0.05）。 （2）治疗后，2组患者的MMSE评分、MoCA评分均明显改善（P < 0.05），且观察组在改善MMSE评分、MoCA评分方面明显优 于对照组，差异有统计学意义（P < 0.05）。（3）治疗后，2组患者的基底节区CBV、MTT、CBF明显改善（P < 0.05），且观察组 在改善基底节区 CBV、MTT、CBF 方面明显优于对照组，差异有统计学意义（P < 0.05）。（4）治疗后，2 组患者的血清 CRP、 IL-6、TNF-α水平明显改善（P < 0.05），且观察组在改善血清CRP、IL-6、TNF-α水平方面明显优于对照组，差异有统计学 意义（P < 0.05）。（5）观察组不良反应发生率为7.27%（4/55），对照组为5.45%（3/55），两组比较，差异无统计学意义（P > 0.05）。 【结论】 益智清心方联合温针灸治疗脑梗死后血管性认知障碍，可有效减轻脑梗死后VCI患者的认知功能，改善患者的脑血 流灌注，抑制炎症因子的释放，从而提高患者生活质量，疗效显著。

Objective To observe the clinical efficacy Yizhi Qingxin Prescription combined with warming-needle muxibustion in the treatment of vascular cognitive impairment（VCI）after cerebral infarction，and to explore its effect on cognitive function. Methods A total of 110 cases of patients with definitive diagnosis of VCI after cerebral infarction admitted to Beijing Bo􀆳ai Hospital from February 2020 to February 2023 were selected for the study. The patients were randomly divided into a control group and an observation group according to random number table method， with 55 cases in each group. The control group was treated with Donepezil Hydrochloride， and the observation group was treated with Yizhi Qingxin Prescription combined with warming-needle muxibustion on the basis of the treatment of the control group，the course of treatment covered four consecutive weeks. After one month of treatment，the clinical efficacy of the two groups was evaluated，and the changes in the scores of the MiniMental State Examination（MMSE）and Montreal Cognitive Assessment（MoCA），as well as the measurements of cerebral blood perfusion were observed before and after the treatment of the patients in the two groups. The changes of C-reactive protein（CRP）， interleukin 6（IL-6）， and tumor necrosis factor α（TNF - α）before and after treatment were compared between the two groups. The safety and incidence of adverse reactions in the two groups were also evaluated. Results（1）The total effective rate was 96.36%（53/55）in the observation group and 74.55% （41/55）in the control group. The efficacy of the observation group was superior to that of the control group，the difference being statistically significant（P < 0.05）.（2）After treatment，the MMSE scores and MoCA scores of the patients in the two groups were improved significantly（P < 0.05），and the improvement in the observation group was significantly superior to that in the control group，the difference being statistically significant（P < 0.05）.（3）After treatment，the CBV，MTT，and CBF of the basal ganglia region of the two groups were significantly improved （P < 0.05），and the improvement in the observation group was significantly superior to that in the control group， the difference being statistically significant（P < 0.05）.（4）After treatment，the serum CRP，IL-6，and TNF-α levels of patients in the two groups were significantly improved （P < 0.05）， and the improvement in the observation group was significantly superior to that in the control group， the difference being statistically significant（P < 0.05）.（5）The incidence of adverse reactions in the observation group was 7.27%（4/55），and that in the control group was 5.45%（3/55），the comparison between the two groups showed that the difference being not statistically significant（P > 0.05）. Conclusion Yizhi Qingxin Prescription combined with warmingneedle muxibustion in the treatment of VCI after cerebral infarction can effectively alleviate the cognitive function of patients，improve their cerebral blood perfusion，and inhibit the release of inflammatory factors，so as to enhance their quality of life.

R246.9

中国康复研究中心研究者科研资助项目（编号：2023YJZ-06）；中国中医科学院科技创新工程资助项目（编号：CI2021A01409）