作者：徐淑娴1 ，刘凡1 ，王芳2 ，陈璐2

单位：

1.210008江苏省南京市，江苏大学鼓楼临床医学院　2.210008江苏省南京市，南京大学医学院附属鼓楼医 院神经外科

Units：

1.Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing 210008, China 2.Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China

关键词：

卒中；单侧空间忽略；上肢康复机器人；Meta分析

Keywords：

Stroke; Unilateral spatial neglect; Upper limb rehabilitation robot; Meta-analysis

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2024.00.075

Funds：

2022年省科技（重点研发计划社会发展）面上项目（BE2022668）

摘要：

　目的　系统评价上肢康复机器人辅助训练对脑卒中后单侧空间忽略（USN）患者的影响。方法　计 算机检索中国生物医学文献数据库、中国知网、维普网、万方数据知识服务平台、中国临床试验注册中心、Web of Science、PubMed、Cochrane Library、Embase、CINAHL、Scopus和Clinical Trials数据库公开发表的关于上肢康复机 器人辅助训练治疗脑卒中后USN患者的随机对照试验（对照组实施常规治疗/综合康复训练/低频重复经颅磁刺激， 试验组实施上肢康复机器人辅助训练或在对照组基础上实施上肢康复机器人辅助训练）。检索时限为建库至2024年 1月。提取纳入文献的资料，使用RevMan 5.4.1软件进行Meta分析。结果　共纳入6篇文献，共188例脑卒中后USN患 者。Meta分析结果显示，干预后试验组凯瑟林-波哥量表（CBS）评分低于对照组〔均数差（MD）=－1.67，95%CI （－3.06～－0.28），P=0.02〕。以干预时间进行亚组分析，结果显示，干预时间＜4周时，干预后两组CBS评分比 较，差异无统计学意义〔MD=－0.55，95%CI（－3.27～2.17），P=0.69〕；干预时间≥4周时，干预后试验组CBS评 分低于对照组〔MD=－2.59，95%CI（－3.20～－1.98），P＜0.000 01〕。干预后两组二等分线段测验（LBT）评分 比较，差异无统计学意义〔标准化均数差（SMD）=－1.22，95%CI（－2.54～0.10），P=0.07〕。干预后试验组肢体 功能评分〔SMD=0.85，95%CI（0.43～1.28），P＜0.000 1〕和改良Barthel指数〔SMD=0.52，95%CI（0.21～0.82）， P=0.000 9〕均高于对照组。结论　现有证据显示，上肢康复机器人辅助训练能够减轻脑卒中后USN患者USN严重程 度，改善肢体功能和提高日常生活活动能力，但对患者视觉忽略效果尚不明确。

Abstract：

　Objective To systematically evaluate the effect of upper limb rehabilitation robot-assisted training on patients with unilateral spatial neglect (USN) after stroke. Methods Databases including the CBM, CNKI, VIP, Wanfang Data, Chinese Clinical Trial Registry, Web of Science, PubMed, Cochrane Library, Embase, CINAHL, Scopus and Clinical Trials were retrieved to search for randomized controlled trials on upper limb rehabilitation robot-assisted training treating patients with USN after stroke. The control group received routine treatment/comprehensive rehabilitation training/repetitive transcranial magnetic stimulation, the experimental group received upper limb rehabilitation robot-assisted training or upper limb rehabilitation robot assisted training on the basis of the control group. The search period was from inception of datebase to January 2024. The data of the included literature were extracted, RevMan 5.4.1 software was used for meta-analysis. Results A total of 6 articles were included, and involving 188 patients with USN after stroke. Meta-analysis results showed that, after intervention, the Catherine Bergego Scale (CBS) score in experimental group was lower than that in control group [mean difference (MD) =－1.67, 95%CI (－3.06-－0.28) , P=0.02] . Subgroup analysis based on intervention duration indicated that when the intervention duration was less than 4 weeks, after intervention, there was no statistically significant difference in CBS score between the two groups [MD= －0.55, 95%CI (－3.27-2.17) , P=0.69] ; when the intervention duration was equal to or exceeded 4 weeks, after intervention, the CBS score in experimental group was lower than that in control group [MD=－2.59, 95%CI (－3.20-－1.98) , P < 0.000 01] . After intervention, there was no statistically significant difference in Line Bisection Test (LBT) score between the two groups [standard mean difference (SMD) =－1.22, 95%CI (－2.54-0.10) , P=0.07] . After intervention, the limb function score [SMD=0.85, 95%CI (0.43-1.28) , P < 0.000 1] and modified Barthel Index [ SMD=0.52, 95%CI (0.21-0.82) , P=0.000 9] in experimental group were higher than those in control group. Conclusion The available evidence shows that upper limb rehabilitation robot-assisted training can reduce the severity of USN and improve limb function and activities of daily living in patients with USN after stroke, but its effect on visual neglect is still unclear.

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