AI数字化时代老年脑卒中“防—治—管—康”一体化策略新进展

doi:10.3969/j.issn.1003-9198.2026.05.016

摘要/Abstract

摘要： 随着全球人口老龄化加剧,老年人脑卒中防控形势严峻。老年患者因衰弱、多病共存及多重用药等特征,使得传统管理模式在风险评估与循证实践间存在显著差距。本文旨在系统综述老年脑卒中管理的最新循证证据,并结合人工智能与数字化技术,提出数据驱动的“防—治—管—康”全程一体化管理新范式。该范式针对老年群体的脆弱性,在“防”的层面强调精准化危险因素控制;在“治”的层面聚焦超高龄患者再灌注治疗及“组织窗”理念;在“管”的层面利用卒中单元与持续质量改进工具优化流程;在“康”的层面探索远程医疗与人工智能在闭环管理中的应用。最后,分析了技术推广中的实施障碍与公平性挑战。应对上述挑战,构建整合临床证据与数字技术的管理体系,是改善老年脑卒中预后的核心路径。

关键词: 老年人, 脑卒中, 人工智能, 全程管理, 一体化

Abstract: The global aging trend poses significant public health challenges, with elderly stroke being particularly severe. The unique characteristics of elderly patients, such as frailty, multimorbidity, and polypharmacy, lead to extreme complexity in risk-benefit assessment and a gap between clinical guidelines and practice. This paper systematically reviews evidence-based management for elderly stroke and proposes a data-driven integrated “prevention, treatment, management, and rehabilitation” paradigm empowered by AI and digital technology. Optimized for elderly vulnerability, the paradigm explores precision risk control in “prevention”, reperfusion therapy and the “tissue window” concept in “treatment”, stroke unit-based continuous quality improvement in “management”, and the transformative role of telemedicine and wearables in “rehabilitation”. Finally, implementation barriers and equity challenges are analyzed. Building an integrated system that combines clinical evidence with cutting-edge digital technology is the core path to improving outcomes for elderly stroke patients.

Key words: aged, stroke, artificial intelligence, continuity of care, integrated strategy

中图分类号:

R 473.74

李剑华, 何施乐, 周珑. AI数字化时代老年脑卒中“防—治—管—康”一体化策略新进展[J]. 实用老年医学, 2026, 40(5): 514-519.

LI Jianhua, HE Shile, ZHOU Long. New progress in the integrated “prevention-treatment-management-rehabilitation” strategy for elderly stroke in the AI digital era[J]. Practical Geriatrics, 2026, 40(5): 514-519.

参考文献

[1] GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820.
[2] 《中国卒中中心报告2022》编写组, 王陇德. 《中国卒中中心报告2022》概要[J]. 中国脑血管病杂志, 2024, 21(8): 565-576.
[3] 张飞, 王子雯, 王津云, 等. 衰弱的多组学研究进展[J]. 实用老年医学, 2025, 39(10): 982-986, 1008.
[4] ELLIOTT A, KADICHEENI M, CHIN K, et al. 1644 frailty and outcomes after stroke: a systematic review and meta-analysis[J]. Age Ageing, 2023, 52(Supplement_2): afad104. 107. DOI: 10. 1093/ageing/afad104. 107.
[5] 丁贤彬, 陈莉玲, 吴荣昆, 等. 国家慢性病综合防控示范区建设对脑卒中发病率的影响: 基于西南自然人群队列研究[J]. 中国慢性病预防与控制, 2025, 33(8): 569-574.
[6] KIM S, LEE H, PARK J, et al. Global and regional prevalence of polypharmacy and related factors, 1997-2022: an umbrella review[J]. Arch Gerontol Geriatr, 2024, 124: 105465.
[7] SAGRIS M, VARDAS E P, THEOFILIS P, et al. Atrial fibrillation: pathogenesis, predisposing factors, and genetics[J]. Int J Mol Sci, 2021, 23(1): 6.
[8] 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 中国心房颤动管理指南(2025)[J]. 中国心脏起搏与心电生理杂志, 2025, 39(4): 273-343.
[9] ZHANG S, WU S, REN J, et al. Strategy of blood pressure intervention in the elderly hypertensive patients (STEP): rational, design, and baseline characteristics for the main trial[J]. Contemp Clin Trials, 2020, 89: 105913.
[10] AMARENCO P, KIM J S, LABREUCHE J, et al. A comparison of two LDL cholesterol targets after ischemic stroke[J]. N Engl J Med, 2020, 382(1): 9.
[11] KHAIRANI C D, BEJJANI A, PIAZZA G, et al. Direct oral anticoagulants vs vitamin K antagonists in patients with antiphospholipid syndromes: meta-analysis of randomized trials[J]. J Am Coll Cardiol, 2023, 81(1): 16-30.
[12] 李寅珍, 张晶文, 郑永强. ≥80岁急性脑梗死病人阿替普酶静脉溶栓疗效及溶栓预后相关因素分析[J]. 实用老年医学, 2021, 35(5): 463-466.
[13] HUANG J, ZHOU Q. Observation on the clinical efficacy of intravenous thrombolysis with alteplase in acute ischemic stroke across different age groups[J]. Health, 2025, 17(10): 1242-1251.
[14] BADHIWALA J H, NASSIRI F, ALHAZZANI W, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis[J]. JAMA, 2015, 314(17): 1832-1843.
[15] NOGUEIRA R G, JADHAV A P, HAUSSEN D C, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct[J]. N Engl J Med, 2018, 378(1): 11-21.
[16] ALBERS G W, MARKS M P, KEMP S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging[J]. N Engl J Med, 2018, 378(8): 708-718.
[17] FORD G A, AHMED N, AZEVEDO E, et al. Intravenous alteplase for stroke in those older than 80 years old[J]. Stroke, 2010, 41(11): 2568-2574.
[18] HO J P, POWERS W J. Contemporary management of acute ischemic stroke[J]. Annu Rev Med, 2025, 76(1): 417-429.
[19] MEDEIROS G C, ROY D, KONTOS N, et al. Post-stroke depression: a 2020 updated review[J]. Gen Hosp Psychiatry, 2020, 66: 70-80.
[20] BANDA K J, CHU H, KANG X L, et al. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis[J]. BMC Geriatr, 2022, 22(1): 420.
[21] SUN W J, SONG Y Y, WANG C, et al. Telerehabilitation for family caregivers of stroke survivors: a systematic review and meta-analysis[J]. J Nurs Manag, 2023, 2023: 3450312.
[22] ZHENG B, LI Y, GU G, et al. Comparing 5G mobile stroke unit and emergency medical service in patients acute ischemic stroke eligible for t-PA treatment: a prospective, single-center clinical trial in Ya’an, China[J]. Brain Behav, 2023, 13(11): e3231.
[23] RONDINA J, NACHEV P. Artificial intelligence and stroke imaging[J]. Curr Opin Neurol, 2025, 38(1): 40-46.
[24] HEO J, YOON J G, PARK H, et al. Machine learning-based model for prediction of outcomes in acute stroke[J]. Stroke, 2019, 50(5): 1263-1265.
[25] KIMMEL B, WALDER A, OVALLE A, et al. Stroke survivors’ telemedicine experiences during the COVID-19 pandemic: a phenomenological investigation[J]. Digit Health, 2024, 10: 20552076241281464