【目的】 观察星蒌承气汤联合清心醒神通督针刺治疗脑出血后脑水肿的临床疗效。【方法】 选取2023年10月至2024年 7月承德市中医院脑病科收治的88例明确诊断为脑出血急性期并选择保守治疗的患者为研究对象。按随机数字表将患者随机 分为观察组和对照组，每组各44例。对照组给予常规治疗，观察组在对照组治疗的基础上，给予星蒌承气汤联合清心醒神 通督针刺治疗，2组均治疗4周。治疗1个月后，评价2组临床疗效。观察2组患者治疗前后中医证候积分、美国国立卫生研 究院卒中量表（NIHSS）评分和日常生活活动能力量表（BI）评分的变化情况，以及脑血肿与脑水肿体积的情况。比较2组患者 治疗前后血清水通道蛋白4（AQP4）、中枢神经特异性蛋白（S-100B）、高迁移率族蛋白B1（HMGB-1）、粒细胞-巨噬细胞集落 刺激因子（GM-CSF）水平的变化情况。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93.18%（41/44）， 对照组为 77.27%（34/44）。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 组患者的中医证候积分、 NIHSS 评分、BI评分均明显改善（P＜0.05），且观察组在改善中医证候积分、NIHSS 评分、BI评分方面均明显优于对照组， 差异有统计学意义（P＜0.05）。（3）治疗7 d后、治疗14 d后，2组患者的脑血肿、脑水肿体积明显改善（P＜0.05），且观察组在 改善脑血肿、脑水肿体积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AQP4、S-100B、 HMGB-1、GM-CSF 水平明显改善（P＜0.05），且观察组在改善血清 AQP4、S-100B、HMGB-1、GM-CSF 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6.82%（3/44）；对照组为4.55%（2/44）；观察组与对照组 的不良反应发生率比较，差异无统计学意义（P＞0.05）。【结论】 星蒌承气汤联合清心醒神通督针刺治疗脑出血后脑水肿，能 明显改善血清AQP4、S-100B、HMGB-1、GM-CSF水平，减轻神经损伤及脑血肿、脑水肿体积，提高患者的日常生活能力， 且安全性高，疗效显著。

Objective To observe the clinical efficacy of Xinglou Chengqi Decoction combined with Qingxin Xingshen Tongdu Acupuncture in treating cerebral edema after intracerebral hemorrhage（ICH）. Methods Eighty-eight patients diagnosed with acute ICH who opted for conservative treatment were enrolled from the Department of Encephalopathy at Chengde Hospital of Traditional Chinese Medicine between October 2023 and July 2024. Patients were randomly divided into an observation group and a control group using a random number table，with 44 cases in each group. The control group received conventional treatment，while the observation group received additional treatment with Xinglou Chengqi Decoction combined with Qingxin Xingshen Tongdu Acupuncture，both groups were treated for 4 weeks. After one month，clinical efficacy was evaluated，and the traditional Chinese medicine（TCM） syndrome scores，National Institutes of Health Stroke Scale（NIHSS） scores，Barthel Index（BI）scores，and volumes of cerebral hematoma and edema were compared before and after treatment. Serum levels of aquaporin-4（AQP4），central nervous system-specific protein（S-100B），high-mobility group box 1（HMGB-1）， and granulocyte-macrophage colony-stimulating factor（GM-CSF） were also measured. Safety and adverse events were assessed. Results （1） The total effective rate was 93.18%（41/44） in the observation group versus 77.27% （34/44） in the control group，the clinial efficacy in the observation group was superior to the control group，the difference being statistically significant（P＜0.05）. （2） After treatment， the TCM syndrome scores， NIHSS scores，and BI scores of the two groups of patients significantly improved（P＜0.05），and the observation group was significantly superior to the control group，the difference was statistically significant（P＜0.05）.（3） After 7 days and 14 days of treatment，the cerebral haematoma and cerebral oedema volume of patients in the two groups significantly improved（P＜0.05），and the observation group was significantly superior to the control group，and the difference was statistically significant（P＜0.05）.（4） After treatment，the serum AQP4，S-100B，HMGB-1， and GM-CSF levels of patients in the two groups significantly improved（P＜0.05），and the observation group was significantly superior to the control group， with statistically significant differences（P＜0.05）.（5） The adverse event rates were 6.82%（3/44） in the observation group and 4.55%（2/44） in the control group， the difference between the incidence rate of adverse reactions in the observation group and that in the control group was not statistically significant（P＞0.05）. Conclusion Xinglou Chengqi Decoction combined with Qingxin Xingshen Tongdu Acupuncture significantly improves serum AQP4，S-100B，HMGB-1，and GM-CSF levels，reduces neurological damage，cerebral hematoma and edema volumes，enhances daily living ability，and demonstrates high safety and efficacy in treating cerebral edema after ICH.

R246.9

承德市科技计划资助项目（编号：202303A027）；河北省中医药管理局科研计划资助项目（编号：2022013Y）