大鼠动脉硬化闭塞模型两种构建方法的比较

背景：由于动脉硬化闭塞症的发病机制还不明确，所以建立动脉硬化闭塞症的病理动物模型，对于探明动脉硬化闭塞症的病因、病理生理、发病机制及防治药物的研究与开发均具有重要的意义。目的：比较单纯高脂饲料喂养及给予内膜损伤加高脂饲料喂养大鼠动脉硬化闭塞模型复制建立的方法。设计、时间及地点：随机对照动物实验，2007-08／2008-03于中国医科大学实验动物中心完成。材料：清洁级3．0～4．0月龄健康纯种Wistar雄性大白鼠60只，体质量200g。高脂饲料：62．8％基础饲料＋20％猪油＋150g／L胆固醇＋20gm胆酸钠＋2g／L丙基硫氧嘧啶。方法：将60只大鼠随机分成3组，每组20只。普通饲养组给予普通饲料喂养；高脂饲养组给予高脂饲料喂养；高脂饲养加内膜损伤组给予内膜损伤加高脂饲料喂养。后两组同时给予维生素D3，30万u／kg体质量，右后肢肌肉注射，1次，月。主要观察指标：①于内膜损伤后术后30d，各组大鼠取血检测血浆总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇浓度变化。②于内膜损伤后术后7，30，90d时，取大鼠左后肢股一胭动脉，行苏木精一伊红等染色，光镜下观察股一胭动脉的病理变化。结果：高脂饮食组大鼠与正常饮食组大鼠相比，高脂饮食组大鼠血清胆固醇，三酰甘油和低密度脂蛋白胆固醇均明显升高。病理显示：7d高脂饲养组内皮细胞少量脱落，高脂饲养加内膜损伤组内皮细胞完全脱落、弹力板松弛，平滑肌细胞排列紊乱。90d高脂饲养组内皮细胞完全脱落、平滑肌和胶原纤维增多、增厚，为早期硬化改变。高脂饲养加内膜损伤组内膜增厚、大量吞噬脂质、类脂质细胞、管腔闭塞。结论：单纯给予大鼠高脂、高胆固醇饲料喂养不易形成动脉硬化闭塞症病变，大鼠股一胭动脉内注入蒸馏水损伤内皮加高脂饲料喂养可较快形成与人动脉硬化闭塞症相似的、较成熟的大鼠动脉硬化闭塞模型。     

近似人病理生理过程动物脂肪肝模型的综合建立方法

目的建立近似人病理生理过程的动物脂肪肝模型,使之适用于影像学定量诊断或药物疗效的验证研究。方法健康新西兰大白兔45只,随机分为四组：正常对照组10只,普通饲料及水喂养9周;实验1、2、3组,各10只,采用高脂高糖饲料＋酒精饮料分别喂养3周、6周和12周;补充组5只,给予实验组相同的喂养和处理。采用HE染色和苏丹Ⅳ染色对动物肝脏进行组织学检查。结果实验成模率为87％（39／45）,死亡率为13％（6／45）,出现正常肝10只,轻度脂肪肝10只,中度脂肪肝9只,重度脂肪肝10只（HE染色）,与苏丹Ⅳ染色Vv值分级的诊断符合率约为75％。结论综合运用高脂高糖饲料＋酒精饮料可成功建立近似人病理生理过程的动物脂肪肝模型。     

运动对胰岛素抵抗大鼠血清肿瘤坏死因子α水平的影响

目的：观察运动对高脂诱导胰岛素抵抗（IR）大鼠胰岛素敏感性的影响及血清肿瘤坏死因子α（TNF-α）水平的变化。方法：30只雄性大鼠分为对照组8只和高脂组22只，分别给予基础饲料与高脂饲料喂养18周，诱导IR大鼠模型，将IR成功大鼠分为高脂组A10只，高脂组B12只，均继续高脂饮食，高脂组B配合游泳训练6周。结果：高脂组大鼠与对照组比较，胰岛素敏感指数（ISI）显著降低，体重、血脂、血糖及血清TNF-α水平均升高，高脂组A更明显（均P〈0．01）；高脂组B训练后各项指标均与对照组接近。结论：运动可改善IR，其作用可能与降低血清TNF-α水平有关。     

运动对胰岛素抵抗大鼠脂肪组织中糖原合成酶激酶3β表达的影响

目的 探讨运动对高脂饮食诱导的胰岛素抵抗大鼠脂肪组织中糖原合成酶激酶3B（GSK-3β）表达的影响。方法 将30只SPF级雄性Wistar大鼠随机分为2组，其中正常对照组10只，给予常规饲料喂养，模型组20只，给予高脂饲料喂养。模型组大鼠经喂养4周后制成胰岛素抵抗模型，将其随机分为2个亚组（即胰岛素抵抗组和运动干预组），2个亚组继续给予高脂饲料喂养，同时运动干预组大鼠每周进行5d游泳运动，持续6周。采用Western—blot方法检测各组大鼠附睾脂肪组织中GSK-3β的表达；定期检测大鼠体重（BW）、空腹血糖（FPG）、血浆胰岛素（FINS）、血甘油三酯（TG）及胆固醇（TC）水平，并计算胰岛素敏感指数（ISI）。结果 各组大鼠经高脂饲料喂养4周后，与正常对照组比较，模型组大鼠BW、FPG、FINS、TC、TG均显著升高（P〈0．05或0．01），ISI则明显降低（P〈0．01），提示胰岛素抵抗模型诱导成功。经6周运动干预后，与胰岛素抵抗组比较，运动干预组大鼠脂肪组织GSK-3β表达显著下降（P〈0．05），与正常对照组比较，差异无统计学意义（P〉0．05）。结论 运动可下调胰岛素抵抗大鼠脂肪组织GSK-3β的表达，促进葡萄糖的摄取及糖原合成，具有改善胰岛素抵抗功能。     

高脂血症模型大鼠主动脉血管脂联素受体mRNA的表达

目的:观察高脂血症大鼠主动脉脂联素受体(adiponectin receptors1/2,AdipoR1/2)表达的改变,探讨高脂血症诱导形成动脉粥样硬化早期变化的机制。方法:SD大鼠随机分为2组。对照组9只给予基础饲料喂养,高脂组8只给予高脂饲料配方喂养。喂养前后通过酶法检测2组大鼠血脂(甘油三酯、总胆固醇,高密度脂蛋白胆固醇、低密度脂蛋白胆固醇)及ELASA法检测血清脂联素浓度;主动脉病理通过苏木素伊红(HE)染色,荧光定量PCR法检测主动脉脂联素受体AdipoR1和AdipoR2 mRNA的表达。结果:喂养12及16周时,与对照组比较,高脂组血脂明显升高(P0.05,0.01);主动脉血管内皮连续性破坏,内膜及内皮下平滑肌增厚;AdipoR1/2mRNA表达明显下降(P0.05,0.01)。结论:高脂饮食喂养16周大鼠可形成动脉粥样硬化早期内皮损失改变,且这种改变可能与主动脉AdipoR1/2mRNA表达下降有关。     

己酮可可碱对非酒精性脂肪肝大鼠能量储备的影响

目的:探讨己酮可可碱(PTX)对非酒精性脂肪肝(NAFLD)大鼠能量储备的影响.方法:SD大鼠72只,正常喂养1周后,随机分为3组.对照组24只以普通饲料喂养.模型组和干预组各24只,以2%胆固醇+10%猪油+88%普通饲料构成高脂饲料喂养.实验动物自由进食和饮水.干预组高脂饮食4周后,在饮水中加用PTX100 mg/(kg·d),即干预组高脂饮食的同时合并喂养PTX.实验动物于第24周处死,由肝右叶固定部位切取2块肝组织.荧光测定法检测肝脏三磷酸腺苷(ATP)含量.结果:模型组肝脏ATP含量较对照组明显减低,干预组肝脏ATP含量较对照组低,但较模型组明显升高.结论:持续24周高脂饮食可成功复制大鼠NAFLD模型,模型大鼠肝脏ATP含量减少,己酮可可碱可提高NAFLD大鼠肝脏ATP含量.     

非酒精性脂肪肝模型的建立与逆转状况

目的：探讨非酒精性脂肪肝的发病机制、观察脂肪肝的逆转状况，评价脂肪肝转归的影响因素，筛选有效的防治措施。 方法：实验于2004-03／08在福建省厦门市医药研究所药物中心实验室和检验医学实验室共同完成。选择雄性SD大鼠84只，随机分2组，正常对照组24只，饲基础饲料；模型组60只，饲高脂饲料。制备成功的高脂血症性脂肪肝大鼠60只分4组，脂肪肝模型组10只，平脂冲剂抗脂肪肝治疗组18只：改饲基础饲料，同时平脂冲剂18g／kg灌胃，1次／d。东宝肝泰抗脂肪肝治疗组16只：改饲基础饲料，同时东宝肝泰冲剂0．225g／kg灌胃，1次／d。自然恢复组16只：改饲基础饲料，不喂药。第6周末，取血及肝脏组织检测。检验血脂和肝功能；观察肝组织病理变化和肝脏脂肪的多项生化指标。 结果：纳入动物84只，血浆检验79只进入结果分析，肝组织脂质和病理检验69只进入结果分析。因死亡和检验误差部分脱落。与正常对照组比较，7周后模型组的大鼠肝脏细胞发生脂肪变性。①大鼠血脂和肝功能指标：三酰甘油、总胆固醇、高密度脂蛋白胆固醇、丙氨酸氨基转移酶、天门冬酸氨基转移酶、r-谷氨酰转肽酶有不同程度增高（P〈0．01），其中三酰甘油含量明显升高[正常对照组、脂肪肝模型组、抗脂肪肝治疗组、自然恢复组分别为（1．22&;#177;0．89），（2．56&;#177;0．97），（1．39&;#177;0．88）．（1．92&;#177;1．03）mmol／L，P〈0．001]。②大鼠肝脂肪变性与肝脏脂质指标：肝细胞中的胞浆内出现脂滴，肝脂肪变性为＋-＋＋＋。抗脂肪肝治疗和自然恢复后，血脂和肝功能均有不同程度的改善，抗脂肪肝治疗组变化显著（P〈0．001）。肝组织脂质和病理也有不同程度逆转康复。 结论：高脂饮食饲养大鼠可导致肝细胞的脂肪变性，为理想的脂肪肝动物模型，具备人类脂肪肝特征，多数单纯性脂肪肝如能早期诊治，可以阻止脂肪肝的进一步发展并使其逆转。抗脂肪肝治疗好于自然恢复。     

软脉灵对非酒精性脂肪肝大鼠肝组织抗氧化能力的影响

目的观察软脉灵对非酒精性脂肪性肝病大鼠肝组织抗氧化能力的影响。方法采用高脂饲料喂养方式建立SD大鼠模型。模型A组采用高脂饲料喂养，药物A组高脂饲料喂养同时予软脉灵灌胃，两组均于8、16周处死；模型B组高脂饲料喂养16周后改基础饲料喂养，药物B组高脂饲料喂养16周后改基础饲料喂养，并予软脉灵灌胃，两组均于24、32周处死；空白对照组应用基础饲料喂养，于第16、32周处死。观察肝组织抗氧化指标。结果预防实验中，软脉灵能减小肝组织MDA升高的水平及SOD降低的程度（P〈0．05～0.01）；治疗实验中，软脉灵能降低肝组织MDA水平（P〈0．05～0．01），提高SOD活力（P〈0．01）。结论在非酒精性脂肪性肝病大鼠模型中，软脉灵有改善肝脏抗氧化能力的作用。     

白藜芦醇对高脂喂养诱导的脂肪肝大鼠血清TNF-α含量的影响

目的：观察白藜芦醇对非酒精性脂肪肝的治疗效果及其对血清肿瘤坏死因子（TNF-α）含量的影响。方法：30只雄性Wistar大鼠随机分为3组各10只，对照组（NC组）给予基础饲料喂养，模型组（IR组）和干预组（HR组）均给予高脂饲料喂养，其中HR组从第7周开始给予100mg／（kg·d）白藜芦醇灌胃。喂养16周后，以高胰岛素一正糖钳夹技术评价3组大鼠胰岛素敏感性；肝脏石蜡切片HE染色观察病理学改变；酶联免疫吸附试验（ELISA）检测血清TNFha的含量。结果：与NC组比较，IR组大鼠葡萄糖输注率下降，光镜下肝脏出现明显脂肪变性，血清TNF—α含量升高69．3％（P〈0．01）。与IR组比较，HR组葡萄糖输注率明显升高，光镜下肝脏脂肪变性变化不显著；血清TNF-α含量降低31．5％（P％0．01）；与对照组比较，HR组除葡萄糖输注率有所降低（P〈0．01）外，其余检测指标水平均接近。结论：白藜芦醇可能通过降低高脂喂养大鼠的血清TNF-α含量而改善胰岛素抵抗，从而减轻脂肪肝。     

调脂护肝方对高脂饲养所致脂肪肝大鼠生化指标的影响

目的观察调脂护肝方对高脂饲食脂肪肝大鼠的干预效应，探讨其药效学机制。方法将雄性SD大鼠64只正常喂养1周后，随机分为正常组12只饲基础饲料，实验组52只给予高脂饲料饲食（含胆固醇2％，猪油10％，基础饲料88％），13周末随机抽取正常组2只、高脂饲养8只，验证高脂饲养大鼠脂肪肝形成。剩余44只随机分为4组即病理模型组、东宝甘泰组、羊栖菜组、调脂护肝方组，每组11只。在继续饲高脂饲料外，分别给予东宝甘泰，按0．5g／（kg·d）（用蒸馏水配成0．05g/ml的混悬液），羊栖菜煎剂按10ml／（kg·d）（10ml含羊栖菜生药20g），调脂护肝方按10ml／（kg·d）（由羊栖菜、丹参、制大黄、葛根、泽泻、茯苓=3：2：1：1：1：1），共8周。第21周末称重，处死动物，取肝脏，计算肝脂数（肝重／体重×100％），抽血，并检测：血清总胆固醇（TC）、甘油三酯（TG）、高密度脂白蛋白-胆固醇（HLD-C）、血清丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、血清超氧化物歧化酶（SOD）、丙二醛（MDA）。结果与病理模型组、东宝甘泰组比较调脂护肝方组大鼠体重、肝指数血清TC值、TG值均降低，HLD-C值增高，血清ALT、AST、MDA值均较低，SOD值较高（各组比较P〈0．01）。结论调脂护肝方干预非酒精性脂肪肝的药效机制为：降低体重与肝指数，调整脂质代谢，改善肝功能，抗脂质过氧化。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.