心理行为疗法与兴趣激励在儿童弱视治疗中的作用

Effects of psychological behavior therapy and interests actuating in the treatment of amblyopia in children

目的:采用心理行为疗法中正强化疗法与兴趣激励结合治疗儿童弱视,并观察其效果。方法:①选择2000-01/2003-06在开封市儿童医院眼科门诊就诊的弱视患儿172例(287眼)。患者及家长知情同意。随机分为2组:对照组87例(141眼);心理干预组85例(146眼)。②对照组采用眼科常用的综合疗法(戴镜+遮盖+红光闪烁及精细作业训练,1次/d,15min/次);心理干预组在常用综合治疗基础上增加心理行为治疗中的正强化疗法及兴趣激励,及时奖赏孩子不同分级的奖品或出游活动,激发弱视儿童的内在合作动机以提高其顺应性。③观察两组患儿视力变化,每3个月复查、验光1次,进行疗效比较。无效为视力退步、不变或提高0.1;有效为视力增长0.2或0.2以上;显著有效为视力提高达≥0.9。有效率=显著有效+有效例数/该组总例数。④计数资料差异性测定采用χ2检验。结果:弱视患儿172例(287眼)均进入结果分析。干预有效率:两组随干预时间延长而增高。干预3个月时,对照组与心理干预组相近(46.1%,49.3%,P>0.05);但干预6和9及12个月时心理干预组明显高于对照组(71.3%,78.8%,83.5%;55.3%,59.6%,64.5%,χ2=7.83,12.43,13.56,P<0.01)。结论:将适合儿童心理特点的心理行为治疗法中的正强化方法与儿童兴趣激励结合起来,可更有效提高对弱视患儿视力水平的治疗效果。

AIM： The reinforcement method of psychological behavior therapy combined with the interests actuating in the treatment of amblyopia of children, and to observe its effects. METHODS： ① 172 amblyopie children （287 eyes） who were diagnosed in Outpatient Ophthalmology Clinic of Kaifeng Children＇s Hospital between January 2000 and June 2003 were selected, based on the awareness of patients and parents. They were randomly divided into two groups： Control group with 87 cases （141 eyes） and psychotherapy group with 85 cases （146 eyes）. ② The commonly used complex treatment （wearing glasses ＋ covering ＋ red light scintillation and meticulous exercises training, once for 15 minutes in each day） were applied in control group; The reinforcement therapy of psychotherapy and interest actuating were add to psychotherapy group on the base of the commonly used complex treatment. The different grade prizes or outside activities were awarded to children in time to irritate children＇s synergie motivation and enhance their acclimatization. ③ The sight changes of the children in the two groups were observed, and review and eyesight examination were conducted once every 4 months respectively and the effects were compared. Inefficiency was retrogress, immovability or increase of 0.1 of sight; Utility was increase of 0.2 or over 0.2 of sight; Significant utility was that the sight increased to t≥ 0.9 （The effective rate=significant utility ＋ eases of utility/the total cases of the group）. ④ The difference of enumeration data was detected by χ^2 check. RESULTS： 172 children patients （287 eyes） with amblyopia were all involved in the result analysis. The effective rate of intervention： It baeame higher as the prolongation of intervention time in the two groups. At the intervention for 3 months, it was similar in control group and psychotherapy group （46.1%, 49.3%, P 〉 0.05）; But at the intervention for 6, 9 and 12 months, it was significantly higher in psychotherapy group than that in control group （71.3%, 78.8%, 83.5%; 55.3%, 59.6%, 64.5%, χ^2=7.83, 12.43, 13.56, P 〈 0.01 ）. CONCLUSION： The reinforcement method of psychological behavior therapy which is suitable for the psychological character of children combined with the interests actuating can effectively enhance more effectively the therapeutic efficacy of the sight level of amblyopia children patients.