作者：朱湘君1，纪亮2，胡丹丹2，徐景2

单位：

1.213000 江苏省常州市爱心护理院　2.213000 江苏省常州市德安医院

Units：

1.Changzhou Caring Nursing Home, Changzhou 213000, China 2.Changzhou Dean Hospital, Changzhou 213000, China

关键词：

卒中；轻度认知障碍；慢性期；上肢智能力反馈训练系统；功能康复

Keywords：

Stroke; Mild cognitive impairment; Chronic phase; Upper limb intelligence feedback training system;Functional rehabilitation

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2021.00.137

Funds：

摘要：

背景　当前我国社区医院、养老机构的康复人力资源较为匮乏，导致慢性期脑卒中患者得不到长期康 复服务，而推动智能化康复仪器设备在基层机构中的应用有利于提高康复效率，促进脑卒中患者高质量的康养融合发 展。目的　探讨上肢智能力反馈训练系统对慢性期脑卒中伴轻度认知障碍患者功能康复的影响。方法　选择2019 年9 月—2020 年8 月在常州市爱心护理院、常州市德安医院综合内科住院的缺血性脑卒中伴轻度认知障碍患者56 例，根 据随机分组软件生成的随机数字分配序列分为观察组与对照组，每组28例。对照组患者给予常规药物治疗与康复训练， 观察组患者在常规药物治疗与康复训练基础上增加上肢智能力反馈训练。比较两组患者训练前及训练8 周Fugl-Meyer 评定量表上肢部分（FMA-UA）评分、改良Barthel 指数（MBI）评分、蒙特利尔认知评估（MoCA）量表各维度评分 及总分、血清同型半胱氨酸（Hcy）和基质金属蛋白酶9（MMP-9）水平。结果　训练8 周观察组患者FMA-UE 评分、 MBI 评分高于对照组（P ＜ 0.05）；两组患者训练8 周FMA-UE 评分、MBI 评分分别高于本组训练前（P ＜ 0.05）。 训练8 周观察组患者执行力、注意力、延迟回忆、定向力、抽象能力评分及MoCA 量表总分高于对照组（P ＜ 0.05）； 观察组患者训练8 周执行力、命名能力、注意力、延迟回忆、定向力、抽象能力评分及MoCA 量表总分高于本组训练 前，对照组患者训练8 周命名能力、延迟回忆、抽象能力评分及MoCA 量表总分高于本组训练前（P ＜ 0.05）。训练 8 周观察组患者血清Hcy、MMP-9 水平低于对照组（P ＜ 0.05）；两组患者训练8 周血清Hcy、MMP-9 水平分别低于 本组训练前（P ＜ 0.05）。结论　上肢智能力反馈训练系统不仅能有效改善慢性期脑卒中伴轻度认知障碍患者上肢运 动功能、日常生活活动能力，还能有效改善患者认知功能，是慢性期脑卒中伴轻度认知障碍患者的有效康复方法。

Abstract：

　Background　At present, there is a lack of rehabilitation human resources in community hospitals and pension institutions in China, which leads to the lack of long-term rehabilitation services for patients with chronic stroke. Promoting the application of intelligent rehabilitation equipment in grass roots institutions is conducive to improve the rehabilitation efficiency and promote the development of high-quality rehabilitation integration for stroke patients. Objective　 To investigate the impact of upper limb intelligence feedback training system on functional rehabilitation of chronic stroke patients with mild cognitive impairment. Methods　A total of 56 chronic stroke patients with mild cognitive impairment hospitalized in the Changzhou Caring Nursing Home and Comprehensive Medicine Department of Changzhou Dean Hospital were selected, and they were divided into observation group and control group according to the random digital distribution sequence generated by the random grouping software, 28 cases in each group. The patients in the control group were given conventional drug treatment and rehabilitation training, while the patients in the observation group were given upper limb intelligence feedback training on the basis of conventional drug treatment and rehabilitation training. The Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE) score, modified Barthel index (MBI) score, each dimension scores and total score of Montreal Cognitive Assessment (MoCA) scale, serum levels of homocysteine (Hcy) and matrix metalloproteinase-9 (MMP-9) were compared between the two groups before training and 8 weeks after training. Results　The FMA-UE score and MBI score of the observation group were higher than those of the control group 8 weeks after training (P < 0.05) ; in the two groups, the FMA-UE score and MBI score 8 weeks after training were higher than those before training, respectively (P < 0.05) . The scores of executive ability, attention, delayed recall, orientation, abstract ability and the total score of MoCA scale of the observation group were higher than those of the control group 8 weeks after training (P < 0.05) ; in the observation group, the scores of executive ability, naming ability, attention, delayed recall, directional ability, abstract ability and the total score of MoCA scale 8 weeks after training were higher than those before training (P < 0.05) ; in the control group, the scores of naming ability, delayed recall, abstract ability and the total score of MoCA scale 8 weeks after training were higher than those before training (P < 0.05) . The serum levels of Hcy and MMP-9 of the observation group were lower than those of the control group 8 weeks after training (P < 0.05) ; in the two groups, the serum levels of Hcy and MMP-9 8 weeks after training were lower than those before training, respectively (P < 0.05) . Conclusion　Upper limb intelligence feedback training system can not only promote the improvement of upper limb motor function and daily living ability of chronic stroke patients with mild cognitive impairment, but also improve the cognitive function of patients. It is an effective rehabilitation method for chronic stroke patients with mild cognitive impairment.

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