二种暗示方式治疗癔症性视力下降的疗效比较

目的：比较戴平光眼镜加语言暗示和颞侧皮肤刺激加语言暗示治疗癔症性视力下降的疗效。方法：前瞻性研究。选择2012 年2 月至2016 年10 月在本院诊断为癔症性视力下降的患者32 例，根据采用的治疗方法将患者分为戴镜组（20 例）和器械组（12 例）。戴镜组采用配戴平光眼镜加语言暗示治疗，器械组采用泪道扩张器刺激颞侧皮肤加语言暗示治疗。采用t检验比较治疗前后差异及组间视力提高差异，并用χ2 检验比较组间视野好转率及并发症发生率差异。结果：与治疗前相比，器械组视力提高0.78±0.21，治疗前后差异有统计学意义（t=18.32，P＜0.001）；戴镜组视力提高0.82±0.21，治疗前后差异有统计学意义（t=24.84，P＜0.001）。组间视力提高量比较差异无统计学意义（t=0.75，P=0.45）。器械组视野好转率为83%，戴镜组为89%，组间差异无统计学意义（χ2=1.50，P=0.30）。器械组2 例（2/12）发生并发症，其中1 例破皮，1 例皮下淤血，戴镜组无一例发生并发症，组间差异有统计学意义（χ2=11.89，P=0.002）。结论：戴平光眼镜加语言暗示治疗和泪道扩张器刺激颞侧皮肤加语言暗示治疗均能有效提高癔症性视力下降患者视力，但后者可能出现皮下淤血或破皮等不良反应，前者无并发症，安全性更高。

Comparison of Two Methods for the Treatment of Hysterical Visual Impairment

Objective:To compare the efficacy of two methods of psychological treatment of hysterical visual impairment.Methods:Patients with hysterical visual impairment were prospective divided into an observation group (20 cases) and a control group (12 cases).The observation group was treated by wearing ofplano glasses,and the control group was treated by stimulation of the temporal skin with lacrimal dilator.The curative effects and complications of the two groups were compared by using t test and chi-square test.Results:The visual acuity of the control group increased 0.78±0.21 (t=18.32,P＜0.001 compared to the pretreatment value).The visual acuity of the observation group increased by 0.82±0.21 (t=24.84,P＜0.001 compared to the pretreatment value).The difference of increasement in visudal actity between the two groups was not statistically significant (t=0.75,P=0.45).The improvement rate of visual field was 83％ in the control group and 89％ in the observation group,there was no significant difference between the two groups (22=1.50,P=0.30).Two cases in the control group with complications (skin trauma),and none occurred in the observation group (x2=11.89,P=0.002).Conclusions:Treatment of hysterical vision by spectacle wearing and by skin stimulation similarly improved visual acuity.While skin stimulation caused some complications,there were no adverse reactions to wearing glasses.