【目的】 观察针刺夹脊穴联合益气补血利水汤治疗脑梗死后遗症患者的临床疗效。【方法】 选取 2021年 6月至 2023年 6 月延安市中医医院针灸科收治的129例明确诊断为脑梗死后遗症期的患者为研究对象。按随机数字表将患者随机分为针刺 组，汤药组和联合组共 3组，每组各 43例。针刺组给予针刺夹脊穴治疗，汤药组给予益气补血利水汤治疗，联合组给予针 刺夹脊穴联合益气补血利水汤治疗。治疗 1个月为 1个疗程，3组患者均治疗 3个疗程。治疗 3个月后，评价 3组临床疗效。 观察3组患者治疗前后汉语失语症评定量表（ABC）评分、Fugl-Meyer运动功能评估量表（FMA）评分的变化情况，以及标准吞 咽功能评价量表（SSA）、吞咽障碍功能评分量表（FDS）、进食评估问卷调查工具10（EAT-10）的情况。比较2组患者治疗前 后脑损伤标志物包括胶质纤维酸性蛋白（GFAP）、中枢神经特异蛋白（S100-β）、神经元烯醇化酶（NSE）水平的变化情况，以 及下肢肌群表面肌电图指标的情况。【结果】（1）针刺组总有效率为 72.09%（31/43），汤药组为 74.42%（32/43），联合组为 90.70%（39/43）。联合组疗效优于针刺组和汤药组，差异有统计学意义（P＜0.05）。（2）治疗后，3组患者的ABC量表评分、吞 咽功能评分、FMA评分均明显改善，且联合组ABC各项评分、吞咽功能评分、FMA评分均明显优于针刺组和汤药组，差异 有统计学意义（P＜0.05）。（3）治疗后，3组患者的脑损伤标志物水平均明显改善（P＜0.05），且联合组在改善脑损伤标志物水 平方面明显优于针刺组和汤药组，差异有统计学意义（P＜0.05）。（4）治疗后，3 组患者的表面肌电图指标均明显改善（P＜ 0.05），且联合组在改善表面肌电图指标方面明显优于针刺组和汤药组，差异有统计学意义（P＜0.05）。【结论】 针刺夹脊穴联 合益气补血利水汤治疗脑梗死后遗症，能够明显地改善患者的语言、吞咽和运动功能，抑制脑损伤标志物的表达，改善患 者下肢肌肉神经系统功能，具有良好的康复效果。

Objective To evaluate the clinical efficacy of acupuncture at Jiaji points （EX-B2） combined with Yiqi Buxue Lishui Decoction in patients with sequelae of cerebral infarction. Methods A total of 129 patients diagnosed with sequelae of cerebral infarction and treated in the Acupuncture Department of Yan'an City Hospital of Traditional Chinese Medicine between June 2021 and June 2023 were enrolled. Patients were randomly divided into three groups using a random number table：the acupuncture group （n=43），the herbal medicine group （n=43）， and the combination group （n=43）. The acupuncture group received acupuncture at Jiaji points， the herbal medicine group received Yiqi Buxue Lishui Decoction，and the combination group received both treatments. The treatment course was one month， and all three groups received three courses. After three months of treatment， clinical efficacy was evaluated. Changes in the Aphasia Battery of Chinese （ABC） score，Fugl-Meyer Assessment （FMA） score， Standardized Swallowing Assessment （SSA）， Functional Dysphagia Scale （FDS）， and Eating Assessment Tool-10 （EAT-10） were observed before and after treatment. Levels of brain injury markers， including glial fibrillary acidic protein （GFAP），central nervous system-specific protein （S100-β），and neuronspecific enolase （NSE），as well as surface electromyography （sEMG） indicators of lower limb muscle groups， were compared before and after treatment. Results （1） The total effective rates were 72.09% （31/43） in the acupuncture group， 74.42% （32/43） in the herbal medicine group， and 90.70% （39/43） in the combination group. The combination group showed significantly superior efficacy compared to the acupuncture and herbal medicine groups， with statistically significant difference （P＜0.05）. （2） After treatment， all three groups demonstrated significant improvements in ABC scores， swallowing function scores， and FMA scores. The combination group showed significantly greater improvements in ABC sub-scores， swallowing function scores， and FMA scores compared to the acupuncture and herbal medicine groups，with statistically significant difference （P＜0.05）.（3） After treatment，levels of brain injury markers were significantly improved in all three groups （P＜ 0.05），with the combination group exhibiting significantly greater improvements than the acupuncture and herbal medicine groups，with statistically significant difference （P＜0.05）.（4） After treatment，sEMG indicators were significantly improved in all three groups （P＜0.05）， and the combination group showed significantly greater improvements in sEMG indicators compared to the acupuncture and herbal medicine groups， with statistically significant difference （P＜0.05）. Conclusion Acupuncture at Jiaji points combined with Yiqi Buxue Lishui Decoction significantly improves language，swallowing，and motor functions，suppresses the expression of brain injury markers， and enhances neuromuscular function in the lower limbs of patients with sequelae of cerebral infarction. This combined therapy demonstrates notable clinical and rehabilitative effects.

R246.9

陕西省中医管理局中医药科研资助项目（编号：LCPT128）；延安市科技计划资助项目（编号：2022SLSFGG-032）