摘要
目的 分析儿童癔症性视力障碍患者的临床特征.方法 回顾性病例系列研究.收集分析 2016 年 4 月至 2023 年 4 月在陆军军医大学第一附属医院就诊的儿童癔症性视力障碍 55 例的临床资料,其中男 15 例(27.27%),女 40 例(72.73%);年龄(9.42±2.01)岁.所有患儿采用心理晤谈法分析刺激因素并给予心理暗示疗法干预.根据辅助刺激方式将患者分为眶周按摩刺激组(26例)和戴框架眼镜组(29 例),采用非参数检验比较治疗前后最佳矫正视力(logMAR)及组间视力提高量;观察眼底照相、光学相干断层扫描(OCT)、视野、视觉诱发电位(VEP)、视网膜电图(ERG)等疗效.结果 本研究 55 例中 53 例有明确精神刺激因素,2 例未明确刺激因素.主要刺激因素有学业压力过大(21 例,38.18%)、情感需求未满足(11 例,20.00%)、物质需求未满足(7 例,12.73%)、身体创伤(4 例,7.27%)、受到暗示(3 例,5.45%)等.心理暗示疗法干预前最佳矫正视力 0.50(0.30,0.80),干预后提升到 0(0,0)(Z=-9.08,P<0.001).与干预前相比,眶周按摩刺激组治疗后最佳矫正视力提高量0.50(0.30,0.78),戴框架眼镜组最佳矫正视力提高量0.40(0.30,0.75).两组最佳矫正视力提高量相比差异无统计学意义(Z=-0.52,P=0.604).结论 学业压力过大为儿童癔症性视力障碍最常见刺激因素;明确刺激因素后,接受心理暗示疗法可显著提升视力,不同辅助刺激方式效果一致.
Abstract
Objective To analyze the clinical characteristics of children with hysterical visual impairment.Methods A retrospective case series study was performed.The clinical data of 55 cases of hysterical visual impairment in children treated at the First Affiliated Hospital of Army Military Medical University from Apr.2016 to Apr.2023 were collected analyzed,including 15 male(27.27%)and 40 female(72.73%);aged(9.42±2.01)years old.The stimulation factors were analyzed by psychological interview method.All children received psychological suggestion therapy,and the patients were divided into a periorbital massage stimulation group(26 case)and a glasses wearing group(29 case).Nonparametric test was used to compare the difference in best corrected visual acuity(BCVA,logMAR)before and after intervention and the difference in BCVA improvement between the two groups.Associated efficacies of fundus photography,optical coherence tomography(OCT),visual field,visual evoked potential(VEP),and electroretinography(ERG)were analyzed.Results Among the 55 cases,53 of whom had definite mental trauma and 2 cases had no clear stimulus factors.The main stimulus factors were excessive academic pressure(21 cases,38.18%),unmet emotional needs(11 cases,20.00%),unmet material needs(7 cases,12.73%),physical trauma(4 cases,7.27%),and suggestions(3 cases,5.45%).BCVA was 0.50(0.30,0.80)before intervention and increased to 0(0,0)after intervention,with a statistically significant difference before and after intervention(Z=-9.08,P<0.001).Compared with before intervention,BCVA improvement after treatment was 0.50(0.30,0.78)in the periorbital massage stimulation group and 0.40(0.30,0.75)in the glasses wearing group.There was no statistical difference between the two groups(Z=-0.52,P=0.604).Conclusion Excessive academic pressure is the most common stimulus for hysterical visual impairment in children.After clarifying the stimulation factors,the psychological suggestion therapy can significantly improve the visual acuity,and there is no obvious difference in the effect of different auxiliary stimulation methods.
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