目的：探索老年缺血性脑卒中患者溶栓后采用手功能康复机器人干预对上肢功能及握力的影响。 方法：前瞻性分析了 2020 年 8 月—2023 年 8 月在昆山市第一人民医院收治的 86 例溶栓后老年缺血性脑卒中患者临床 资料，采用随机数字表法分为对照组和观察组，对照组患者采用常规康复，观察组患者采用手功能康复机器人干预， 均在治疗 4 周后比较疗效。结果：观察组前臂旋后、前臂旋前、肘屈曲、肩内收、肩外展、腕背伸、肘外翻活动度均 优于对照组，差异具有统计学意义（P<0.05）；T2、T3、T4 时段的改良 Barthel 指数评定量表、上肢运动功能评定量 表评分、功能独立性评定量表评分及患侧上肢握力均高于对照组，差异具有统计学意义（P<0.05）。同时，观察组治 疗后 2 周、4 周的改良的 Ashworth 量表分级改善情况优于对照组，差异具有统计学意义（P<0.05）；观察组总有效率 高于对照组，差异具有统计学意义（P<0.05）。结论：手功能康复机器人干预在溶栓后老年缺血性脑卒中患者中效果 显著，可改善患者上肢功能，恢复手肘活动度，提高握力。

Objective: To explore the effect of hand function rehabilitation robot-assisted training on upper limb function and grip strength in elderly patients with ischemic stroke after thrombolysis. Methods: The clinical data of 86 elderly patients with ischemic stroke treated in the First People’s Hospital of Kunshan from August 2020 to August 2023 were prospectively analyzed, and all patients were divided into the control group and the observation group by random number table method. The control group received routine rehabilitation, while the observation group received hand function rehabilitation robot-assisted training. The therapeutic effect was compared after 4 weeks of treatment. Results: Forearm supination, forearm pronation, elbow flexion, shoulder adduction, shoulder abduction, wrist dorsiflexion, and elbow eversion range of motion in the observation group were all better than those in the control group (P<0.05). The Modified Barthel Index (MBI) score, Fugl Meyer Assessment of Upper Extremity (FMA-UE) score, Functional Independence Measure (FIM) score, and grip strength of affected upper limb in T2, T3 and T4 were higher than those in the control group (P<0.05). Meanwhile, the improvement of modified Ashworth Scale (MAS) grading in the observation group was better than that in the control group at 2 and 4 weeks after treatment (P<0.05), and the total response rate in the observation group was higher than that in the control group (P<0.05). Conclusion: The robot-assisted training of hand function rehabilitation has a significant effect in elderly patients with ischemic stroke after thrombolysis, which could improve upper limb function, restore elbow motion and improve grip strength of patients.

收稿日期：2023-11-13  录用日期：2024-01-19 

Received Date: 2023-11-13  Accepted Date: 2024-01-19 

基金项目：上海市科技计划项目（22DZ2302900） 

Foundation Item: Science and Technology Plan Project of shanghai (22DZ2302900) 

通讯作者：李爱仙，Email：LS346397618@163.com 

Corresponding Author: LI Aixian, Email: LS346397618@163.com 

引用格式：隋意，李爱仙，蔡鹤，等 . 老年缺血性脑卒中患者溶栓后采用手功能康复机器人干预对上肢功能及握力的改善效果 [J]. 机器人外科学杂志（中英文），2024，5（2）：158-165. 

Citation: SUI Y, LI A X, CAI H, et al. Effect of hand function rehabilitation robot on upper limb function and grip strength in elderly patients with ischemic stroke after thrombolysis[J]. Chinese Journal of Robotic Surgery, 2024, 5(2): 158-165.

[1] DiCarlo J A, Gheihman G, Lin D J, et al. Reimagining stroke rehabilitation and recovery across the care continuum: results from a designthinking workshop to identify challenges and propose solutions[J]. Arch Phys Med Rehabil, 2021, 102(8): 1645-1657. 

[2] 单丹丹 , 李思思 , 张艳艳 , 等 . 加速康复理念下认 知行为干预对缺血性脑卒中共病糖尿病失眠患者 睡眠质量及自我感受负担的影响 [J]. 中国实用神经 疾病杂志 , 2023, 26(6): 744-747. 

[3] Conforto A B, Machado A G, Ribeiro N H V, et al. Repetitive peripheral sensory stimulation as an add-on intervention for upper limb rehabilitation in stroke: a randomized trial[J].Neurorehabil Neural Repair, 2021, 35(12): 1059-1064. 

[4] 郭娜 , 张勃 . 康复训练通过 DCC/APPL-1/AKT 通路 对缺血性脑卒中大鼠功能恢复和神经细胞凋亡影 响 [J]. 山东医药 , 2023, 63(4): 42-47. 

[5] 刘莉莉 , 王玲 , 于峰 . 脑电仿生电刺激联合上肢智 能力反馈康复机器人治疗老年急性缺血性脑卒中 的临床研究 [J]. 中西医结合心脑血管病杂志 , 2021, 19(23): 4148-4151. 

[6] 纪亮 , 朱湘君 , 徐景 , 等 . 下肢康复机器人辅助步 态训练对亚急性期缺血性脑卒中偏瘫并卒中后神 经源性膀胱患者的影响研究 [J]. 实用心脑肺血管病 杂志 , 2020, 28(6): 74-79. 

[7] 钟迪 , 张舒婷 , 吴波 . 《中国急性缺血性脑卒中诊 治指南 2018》解读 [J]. 中国现代神经疾病杂志 , 2019, 19(11): 897-901. 

[8] 顾旭东 , 吴华 , 郭帅 , 等 . 骨盆辅助步行康复机器 人对脑卒中偏瘫患者运动功能及日常生活能力的 影响 [J]. 中国康复医学杂志 , 2020, 35(5): 556-559. 

[9] MA L Y , DENG L , YU H . The effects of a comprehensive rehabilitation and intensive education program on anxiety, depression, quality of life, and major adverse cardiac and cerebrovascular events in unprotected left main coronary artery disease patients who underwent coronary artery bypass grafting[J]. Ir J Med Sci, 2020, 189(2): 477-488. 

[10] 卓大宏 .中国康复医学 [M]. 2版 . 北京 : 华夏出版社 , 2003: 235-248. 

[11] LI X, TANG Z M, WU D L, et al. Analysis of the positive effect of robot-assisted virtual reality technology on rehabilitation of motor function and nerve function in cerebral stroke patients[J].J Med Imaging Health Inform, 2021, 11(2): 595-600. 

[12] 中医康复临床实践指南·缺血性脑卒中 ( 脑梗死 ) 制定工作组 , 章薇 , 娄必丹 , 等 . 中医康复临床实践 指南·缺血性脑卒中 ( 脑梗死 )[J]. 康复学报 , 2021, 31(6): 437-447.

[13] 王巍 , 高会文 , 霍琰梅 , 等 . 早期精准化运动康复 对急性缺血性脑卒中偏瘫患者血清细胞因子及步 行能力的影响 [J]. 中国实用神经疾病杂志 , 2023, 26(10): 1275-1280. 

[14] Buckley B J R, Harrison S L, Fazio-Eynullayeva E, et al. Exercise-based cardiac rehabilitation associates with lower major adverse cardiovascular events in people with stroke[J]. Cerebrovasc Dis, 2022, 51(4): 488-492. 

[15] 胡靖然 , 陈小飞 . 虚拟现实技术联合下肢康复机器 人训练对缺血性脑卒中患者下肢功能及平衡能力 影响的研究 [J]. 中国康复 , 2020, 35(12): 633-636. 

[16] 张旭 , 邱模炎 , 权范善 , 等 . 步行机器人训练对慢 性期脑卒中偏瘫患者步行能力的影响 [J]. 中华物理 医学与康复杂志 , 2021, 43(1): 30-33.

[17] 于勰荔 , 黄建亮 , 刘建英 , 等 . 任督通调针刺法联 合康复训练治疗缺血性脑卒中后吞咽障碍疗效观 察 [J]. 新中医 , 2023, 55(1): 164-168. 

[18] Coskunsu D K, Akcay S, Ogul O E, et al. Effects of robotic rehabilitation on recovery of hand functions in acute stroke: a preliminary randomized controlled study[J]. Acta Neurol Scand, 2022, 146(5): 499-511. 

[19] Grimley R S, Rosbergen I C, Gustafsson L, et al. Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study[J]. Clin Rehabil, 2020, 34(6): 812-823. 

[20] 金菲 , 练纯 , 吴春秀 , 等 . 针刺与功能性电刺激及下 肢智能康复训练在缺血性脑卒中偏瘫治疗中的联 合应用效果分析 [J]. 中国中医药科技 , 2022, 29(4): 631-633. 

[21] 包译 , 朵强 , 张源芮 , 等 . 下肢康复机器人对缺血 性脑卒中恢复期患者步行功能的影响 [J]. 中国康复 医学杂志 , 2022, 37(8): 1079-1083. 

[22] Yoshida T, Mizuno K, Miyamoto A, et al. Influence of right versus left unilateral spatial neglect on the functional recovery after rehabilitation in sub-acute stroke patients[J]. Neuropsychol Rehabil, 2022, 32(5): 640-661. 

[23] Oyake K, Otaka Y, Matsuura D, et al. Poststroke fatigue at admission is associated with independence levels of activities of daily living at discharge from subacute rehabilitation wards[J].Arch Phys Med Rehabil, 2021, 102(5): 849-855. 

[24] 李京泽 , 邢靖松 , 吕福现 , 等 . 下肢康复机器人训 练对脑卒中偏瘫患者步行功能的影响 [J]. 机器人外 科学杂志 ( 中英文 ), 2023, 4(6): 512-516