血流限制训练对脑卒中下肢运动功能康复效果的Meta分析

doi:10.3969/j.issn.1006-9771.2026.07.007

摘要/Abstract

摘要：

目的系统评价血流限制训练(BFRT)辅助康复干预对脑卒中患者下肢运动功能、平衡能力、步行耐力和日常生活活动能力的康复效果。

方法计算机检索中国知网、万方数据、PubMed、Embase、Cochrane Library和Web of Science数据库，搜集建库至2026年1月31日发表的BFRT联合康复训练干预脑卒中患者的随机对照试验(RCT)。由2名研究人员依据PICO原则独立完成文献筛选、数据提取和偏倚风险评价，采用RevMan 5.4.1及Stata 17.0软件进行Meta分析、亚组分析和敏感性分析。

结果最终纳入15篇文献，共712例脑卒中患者，其中对照组354例，试验组358例。相较于常规康复，联合BFRT干预可显著提升患者Fugl-Meyer评定量表下肢部分评分(MD = 1.77, 95%CI 0.02~3.52, P = 0.047)、Berg平衡量表评分(MD = 5.39, 95%CI 2.20~8.59, P < 0.001)和6分钟步行测试距离(MD = 10.24, 95%CI 7.76~12.72, P < 0.001)；两组间改良Barthel指数和起立-行走计时测试无显著性差异(P > 0.05)。亚组分析提示，干预周期 > 4周、BFRT联合抗阻训练的干预方案效果更优。

结论 BFRT作为辅助康复手段，可显著改善脑卒中患者下肢运动功能、平衡能力和步行耐力，对日常生活活动能力和功能性移动能力的改善效果尚不明确。临床优先推荐> 4周的BFRT联合抗阻训练方案，适用于病情稳定、具备基础行走能力、无认知障碍的慢性期脑卒中患者。

关键词: 脑卒中, 血流限制训练, 下肢运动功能, 平衡, 步行耐力, Meta分析

Abstract:

Objective To systematically evaluate the rehabilitation effect of blood flow restriction training (BFRT) as an adjunctive rehabilitation intervention on lower-limb motor function, balance ability, walking endurance and activities of daily living in stroke patients.

Methods Randomized controlled trials (RCT) on BFRT combined with rehabilitation training for stroke patients published from database inception to January 31, 2026 were retrieved from CNKI, Wanfang data, PubMed, Embase, Cochrane Library and Web of Science. Two researchers independently conducted literature screening, data extraction and bias risk assessment based on the PICO principle. Meta-analysis, subgroup analysis and sensitivity analysis were performed using RevMan 5.4.1 and Stata 17.0.

Results A total of 15 RCT were included, involving 712 stroke patients including 354 in the control group and 358 in the experimental group. Compared with rehabilitation training, combination of BFRT significantly improved Fugl-Meyer Assessment-Lower Extremities scores (MD = 1.77, 95%CI 0.02 to 3.52, P =0.047), Berg Balance Scale scores (MD = 5.39, 95%CI 2.20 to 8.59, P< 0.001) and 6-Minute Walk Test distance (MD = 10.24, 95%CI 7.76 to 12.72, P <0.001). There was no significant difference in modified Barthel Index scores and Timed Up and Go Test results between two groups (P> 0.05). Subgroup analysis indicated that the intervention protocol with a duration of more than four weeks and BFRT combined with resistance training achieved better rehabilitation effect.

Conclusion As an adjunctive rehabilitation method, BFRT can significantly improve lower-limb motor function, balance and walking endurance of stroke patients, while its effect on activities of daily living and functional mobility remains unclear. The protocol of BFRT combined with resistance training for more than four weeks is preferentially recommended, which is more suitable for chronic stroke patients with stable condition, basic walking ability and no cognitive impairment.

Key words: stroke, blood flow restriction training, lower-limb motor function, balance, walking endurance, meta-analysis

中图分类号:

R743.3

敦士博, 李玉周. 血流限制训练对脑卒中下肢运动功能康复效果的Meta分析[J]. 《中国康复理论与实践》, 2026, 32(7): 797-806.

Dun Shibo, Li Yuzhou. Effect of blood flow restriction training on lower-limb motor function after stroke: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(7): 797-806.

图/表 13

表1

图1

图2

图3

表2

表3

纳入文献基本特征"

纳入文献	国家	性别(男/女)/n		年龄/岁		卒中类型	干预措施
纳入文献	国家	C	T	C	T	卒中类型	C	T
杨兵^[7](2021)	中国	14/19	15/18	46.26±5.21	46.21±4.98	出血/梗死	抗阻训练	抗阻训练联合BFRT
徐文静等^[8](2023)	中国	24/5	19/10	59.41±11.85	60.10±11.22	未报告	常规康复训练+踏车抗阻训练	常规康复训练+踏车抗阻训练联合BFRT
唐小蝶等^[9](2025)	中国	14/2	13/3	52±9	52±12	缺血	常规康复训练	常规康复训练联合BFRT
孙良文等^[10](2024)	中国	18/7	15/12	71.32±4.21	70.70 ±4.91	缺血/出血	常规康复训练	常规康复训练+全身振动训练联合BFRT
商健等^[11](2025)	中国	14/6	16/4	54.27±7.18	54.40±6.86	首次单侧卒中	常规康复训练+悬吊训练	常规康复训练+悬吊训练联合BFRT
姬长勐等^[12](2025)	中国	16/7	15/8	62.13±10.44	62.43±12.05	出血/梗死	常规康复训练+功率自行车有氧训练	常规康复训练+功率自行车有氧训练联合BFRT
郭玲等^[13](2025)	中国	14/6	13/7	62.95±7.26	62.15±7.36	出血/梗死	常规康复训练+悬吊训练	常规康复训练+悬吊训练联合BFRT
龚健婷等^[14](2025)	中国	13/13	17/9	61.69±9.10	57.50±12.17	梗死/出血	常规康复训练+头针治疗+常规踏车训练	常规康复训练+头针治疗+常规踏车训练联合BFRT
冯雅丽等^[15](2023)	中国	11/3	10/5	45.29±13.74	54.07±10.44	未报告	常规康复+运动训练	常规康复+运动训练联合BFRT
杜燕等^[16](2022)	中国	17/13	18/12	67.2±10.8	66. 8±11.2	首次单侧卒中	抗阻训练	抗阻训练联合BFRT
杜晋楠等^[17](2022)	中国	18/12	17/13	51.8±4.2	52.1±3.9	脑卒中	常规康复训练+rTMS	常规康复训练+rTMS联合BFRT
陈雪梅等^[18](2023)	中国	21/15	22/13	66.9±11.7	65.8±10.2	单侧新发梗死	低强度抗阻训练	低强度抗阻训练联合BFRT
Feng等^[19](2025)	中国	17	19	44.85±12.99	52.70±11.12	缺血/出血	运动训练	运动训练联合BFRT
Bai等^[20](2025)	中国	11/9	12/8	60.9±10.3	61.7±9.6	缺血	热身+踏车抗阻训练	热身+踏车抗阻训练联合BFRT
Ahmed等^[21](2024)	土耳其	9/6	10/5	54.73±14.08	54.20±13.19	单侧缺血	高强度抗阻训练	有氧训练+低强度抗阻联合BFRT

表3

表4

纳入文献BFRT参数及结局"

纳入文献	干预处方	绑带类型/cm	压力模式/mmHg	施压位置	结局指标
杨兵^[7](2021)	每次30~40 min，每周5次，共6周	充气尼龙加压带(7)	固定绝对压力(160~170)	股骨中段	①
徐文静等^[8](2023)	每次20 min，每周6次，共2周	止血带(-)	固定绝对压力(200)	股骨中段	②
唐小蝶等^[9](2025)	每次15~30 min，每周5次，共2周	专用充气袖带(-)	固定绝对压力(70)	大腿近端	①
孙良文等^[10](2024)	每次9 min，每周5次，共6周	止血袖带(9)	相对压力(140~200)	大腿近端	①③
商健等^[11](2025)	每次30 min，每周5次，共4周	BFR训练带(-)	固定绝对压力(200)	股骨中段	②④
姬长勐等^[12](2025)	每次20 min，每周5次，共8周	Theratools血流限制训练带(10)	固定绝对压力(160)	大腿近端	③
郭玲等^[13](2025)	每次30 min，共4周	加压血流限制训练带(-)	固定绝对压力(200)	股骨中段	①②④
龚健婷等^[14](2025)	每次20 min，每周12次，共4周	Theratools血流限制训练带(-)	固定绝对压力(120)	大腿近端	①
冯雅丽等^[15](2023)	每次20 min，每周7次，共3周	B STRONG加压带(-)	绝对压力区间(160~200)	大腿近端	②⑤④
杜燕等^[16](2022)	每次30 min，每周5次，共8周	止血袖带(7)	相对压力(140~200)	股骨中段	①②④
杜晋楠等^[17](2022)	每次20 min，每周5次，共6周	B STRONG加压带(-)	固定绝对压力(250)	股骨中段	②③④
陈雪梅等^[18](2023)	每次30 min，每周5次，共12周	止血袖带(7)	相对压力(140~200)	股骨中段	④
Feng等^[19](2025)	每次30 min，共4周	B STRONG加压带(-)	绝对压力区间(160~200)	大腿近端	②⑤
Bai等^[20](2025)	每次20 min，每周5次，共4周	B STRONG气动袖带(7)	固定绝对压力(200)	大腿近端	②
Ahmed等^[21](2024)	每次40 min，每周3次，共5周	血压袖带(-)	绝对压力区间(150~160)	下肢近端	③⑤

表4

表5

表6

表7

表8

表9

图4

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纳入文献	明确纳入排除标准	随机分配	分配隐藏	基线相似	结果评估施盲	退出率< 15%	组间统计结果分析	点测量和差异值	总分
杨兵^[7](2021)	√			√		√	√	√	4
徐文静等^[8](2023)	√	√		√		√	√	√	5
唐小蝶等^[9](2025)	√			√		√	√	√	4
孙良文等^[10](2024)	√	√		√		√	√	√	5
商健等^[11](2025)	√	√		√		√	√	√	5
姬长勐等^[12](2025)	√	√		√		√	√	√	5
郭玲等^[13](2025)	√	√		√		√	√	√	5
龚健婷等^[14](2025)	√	√		√		√	√	√	5
冯雅丽等^[15](2023)	√	√	√			√	√	√	5
杜燕等^[16](2022)	√	√		√		√	√	√	5
杜晋楠等^[17](2022)	√	√		√		√	√	√	5
陈雪梅等^[18](2023)	√	√		√		√	√	√	5
Feng等^[19](2025)	√	√	√	√	√	√	√	√	7
Bai等^[20](2025)	√	√		√	√	√	√	√	6
Ahmed等^[21](2024)	√	√	√	√	√	√	√	√	7

结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²	P值	效应模型	MD(95%CI)	P值
FMA-LE	8^{[8,11,13,15-17,19-20]}	76%	< 0.001	随机	1.77(0.02~3.52)	0.047
BBS	6^{[7,9-10,13-14,16]}	91%	< 0.001	随机	5.39(2.20~8.59)	< 0.001
MBI	6^{[11,13,15-18]}	90%	< 0.001	随机	4.77(-1.15~10.70)	0.114
6MWT	4^{[10,12,17,21]}	47%	0.132	固定	10.24(7.76~12.72)	< 0.001
TUGT	3^[15,19,21]	0%	0.445	固定	4.02(-2.08~10.11)	0.197

干预周期	MD(95%CI)	Z值	P值	P_交互值	异质性
干预周期	MD(95%CI)	Z值	P值	P_交互值	I²	P值
≤ 4周^{[8,11,13,15,19-20]}	0.54(-0.61~1.69)	0.92	0.358	0.004	15%	0.318
> 4周^[16-17]	4.38(2.00~6.77)	3.60	< 0.001	0.004	71%	0.065

基础训练	MD(95%CI)	Z值	P值	P_交互值	异质性
基础训练	MD(95%CI)	Z值	P值	P_交互值	I²	P值
抗阻训练^[8,16,20]	2.19(-0.02~4.39)	1.94	0.052	0.41	62%	0.071
悬吊训练^[11,13]	0.47(-0.85~1.80)	0.70	0.484		0%	0.424
综合训练^[15,17,19]	1.64(-3.82~7.10)	0.59	0.555		85%	0.002

基础训练	MD(95%CI)	Z值	P值	P_交互值	异质性
基础训练	MD(95%CI)	Z值	P值	P_交互值	I²	P值
抗阻训练^[7,14,16]	7.60(5.74~9.45)	8.02	< 0.001	0.048	0%	0.660
综合训练^[9-10,13]	3.24(-0.67~7.15)	1.62	0.105	0.048	94%	< 0.001