心搏骤停后综合征患者应用心肺复苏后GCS评分与APACHE Ⅱ评分评估神经功能预后的临床价值比较

目的:比较心肺复苏后格拉斯哥昏迷量表(GCS)评分与急性生理与慢性健康评价Ⅱ(APACHEⅡ)评分在评价心搏骤停后综合征患者神经功能预后中的应用价值差异。方法:选取2014-01—2017-01期间我院重症医学科收治的心搏骤停后综合征患者128例,根据心肺复苏后90d格拉斯哥-匹兹堡脑功能表现分类(CPC)评分将患者分为神经功能预后良好组(n=50)与神经功能预后不良组(n=78)。比较两组机械通气时间、心肺复苏时间、GCS评分与APACHEⅡ评分等临床指标的差异,并采用受试者工作特征曲线(ROC)分析GCS评分与APACHEⅡ评分对神经功能预后的预测价值差异。结果:神经功能预后良好组机械通气时间与心肺复苏时间明显短于神经功能预后不良组,GCS评分明显高于神经功能预后不良组,APACHEⅡ评分明显低于神经功能预后不良组(均P<0.05)。心肺复苏后,经Pearson相关性分析显示,GCS评分与APACHEⅡ评分之间存在直线负相关(r=-0.521,P<0.05);GCS评分对心搏骤停后综合征患者神经功能预后的预测价值(0.905)明显高于A PACHEⅡ评分(0.751),差异有统计学意义(P<0.05)。结论:心肺复苏后GCS评分在评价心搏骤停后综合征患者神经功能预后的应用价值明显优于APACHEⅡ评分,可作为理想的评价指标。     

脑电双频指数在评估心肺复苏术后患者脑功能及预后中的价值

目的 探讨心肺复苏成功患者的脑电双频指数(bispectral index,BIS)与格拉斯哥(glasgow coma scale,GCS)评分、血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)的相关性及其在评估神经功能预后方面的价值.方法 选取心脏骤停后心肺复苏成功的昏迷患者,复苏后24 h内行BIS监测,同时进行GCS评分及血清NSE水平检测,观察6个月预后.分析三者之间的相关性,比较不同BIS值之间GCS评分和血NSE的差异.分析对比预后良好与不良组之间三者的统计学差异.绘制三种评估方法的受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积以分析三者对预后的预测价值.应用SPSS 16.0统计软件分析,统计方法包括相关分析、t检验或t'检验、x2检验或Fisher确切概率法、单因素方差分析.结果 BIS值与GCS评分呈正相关(r =0.684),二者与NSE呈负相关(r分别为-0.675和-0.663).不同的BIS值之间,GCS评分和血清NSE浓度差异具有统计学意义.神经功能预后良好与不良组之间GCS评分(P=0.018)、BIS值(P=0.01)、NSE质量浓度(P=0.01)差异有统计学意义.BIS与NSE对预后的评估价值相当,GCS对预后的评估价值相对较低.结论 BIS监测与GCS评分、血清NSE密切相关,是评价患者心肺复苏后昏迷程度及判定神经功能预后的有效指标;在判定预后方面,客观指标BIS与血NSE优于主观指标GCS评分.     

脑电双频指数在评估心肺复苏成功患者的昏迷程度和判定预后中的价值

目的 探讨脑电双频指数(bispectral index,BIS)监测在评估心脏骤停后心肺复苏成功患者昏迷程度和判定预后中的价值.方法 选取ICU病房心脏骤停后心肺复苏成功的昏迷患者,复苏后24 h内行BIS监测,同时进行格拉斯哥昏迷评分(GCS),观察6个月预后.分析GCS评分与BIS的相关性及不同的GCS评分所对应的BIS值,比较不同GCS评分组间的BIS值和死亡率.分析BIS值与预后的关系,计算BIS值判定心肺复苏成功的昏迷患者6个月预后的敏感度、特异度、阳性预测值、阴性预测值、准确度.结果 BIS值与GCS评分呈正相关(r=0.808,P＜0.01),随着GCS评分的升高,BIS值逐渐升高(P＜0.01),死亡率逐渐下降.死亡及植物状态率和意识恢复率与BIS值均具有相关性(χ2=22.42,P=0.000),预后越差,BIS值越低(P＜0.05).BIS值≤40提示预后不良,敏感度100.00%,特异度65.00%;BIS值＞60提示预后良好,敏感度和特异度分别为83.33%和88.89%.BIS值为0的患者神经系统查体均符合脑死亡的诊断标准.结论 BIS监测是评估心肺复苏成功患者昏迷程度和判定预后的有效指标,BIS值为0可成为诊断脑死亡的条件之一.     

脑电双频指数对心肺复苏术后患者预后的评估

目的 讨脑电双频指数(BIS)对心肺复苏术后患者预后的评估价值.方法 收集33例心肺复苏术后患者,根据其复苏结果(7d生存率)分为存活组和死亡组.入ICU行BIS持续监测,同时记录格拉斯哥昏迷评分(GCS)及急性生理健康与慢性疾病评分(APACHE-Ⅱ),监测所有患者动脉氧饱和度( SaO2),对其中23例进行颅底静脉氧饱和度(SjO2)监测,取两者差值(SaO2-SjO2)来反映脑氧代谢状况.比较两组BIS值、SjO2值、SaO2 -SjO2差值,BIS与GCS评分、APACHE-Ⅱ评分的相关性.结果 存活组和死亡组BIS值比较,差异具有统计学意义(P＜0.01);两组SaO2-SjO2差值比较,差异具有统计学意义(P＜0.01); BIS与GCS评分具有良好的相关性(r =0.821,P＜0.01);BIS与APACHE-Ⅱ评分亦具有相关性(r=0.434,P＜0.05).结论 BIS值持续监测在一定程度上反映患者的预后,与SaO2 - SjO2差值相结合对心肺复苏术后患者预后的评估更有价值.     

脑电双频指数与心肺复苏质量指数评估心肺复苏患者预后的临床价值

目的 探讨脑电双频指数（BIS）与心肺复苏质量指数（CQI）评估心肺复苏患者预后的临床价值,为临床提供参考。方法 选取2020年1月至2022年1月无锡市惠山区第三人民医院接受心肺复苏治疗的66例心搏骤停患者作为研究对象进行回顾性分析,根据预后的不同将患者分为预后不良组（28例）和预后良好组（38例）,比较两组患者BIS和CQI水平,分析BIS、CQI与患者预后的关系。结果 预后不良组患者BIS和CQI显著低于预后良好组（P<0.05）。两组患者恢复自主循环（ROSC）时间比较,差异无统计学意义（P>0.05）;预后不良组患者心肺复苏持续时间显著长于预后良好组,入院急性心理与慢性健康评分系统（APACHEⅡ）评分、心肌肌钙蛋白Ⅰ（cTnI）水平显著高于预后良好组,格拉斯哥昏迷量表（GCS）评分显著低于预后良好组（P<0.05）。多因素Logistic分析结果显示,BIS、CQI及GCS评分高是不良预后的保护因素,入院时APACHEⅡ评分高是不良预后的高危因素（P<0.05）。受试者操作特征（ROC）曲线分析结果显示,BIS、CQI、入院时APACHEⅡ和GCS评...     

APACHEⅡ评分对心肺复苏自主循环恢复昏迷患者预后预测的研究

目的 探讨APACHEⅡ评分对心肺复苏自主循环恢复昏迷患者5种不同预后的区别能力.方法 回顾性分析115例心肺复苏自主循环恢复住院患者的资料,比较不同预后患者的APACHEⅡ评分,计算其对两种严重不良(死亡或植物状态)预后与其他类型预后区别能力的ROC曲线下面积.结果 5种不同预后(正常、神经功能轻度障碍、神经功能重度障碍、植物状态和死亡)患者APACHEⅡ评分比较差异有统计学意义(F=57.64, P=0.000).各组之间相互比较,正常组与神经功能轻度障碍组、神经功能轻度障碍组与神经功能重度障碍组比较差异均无统计学意义[(8.89±5.52)分vs (12.50±6.00)分, P=0.109;(12.50±6.00)分vs(13.80±4.98)分, P=0.623];其他各组之间相互比较差异均有统计学意义(正常组vs重度神经功能异常组P=0.019;其他各组之间比较均为P=0.000).13分是区分预后良好的最佳截断点;23分是区分预后严重不良的最佳截断点.APACHEⅡ评分区分严重不良预后与其他类型预后能力的ROC曲线下面积为0.937.结论 APACHEⅡ评分可以作为心肺复苏自主循环恢复昏迷患者不良预后的一个预测、评价工具,若引入其他相关因素,可望进一步提高该类患者不同预后的区别能力.     

两种评分法对心肺复苏自主循环恢复昏迷病人预后预测的比较

目的评价APACHEⅡ评分和CPRROSC预后评分对CPRROSC病人预后的预测价值。方法分别对115例CPRROSC病人进行APACHEⅡ评分和CPRROSC预后评分,比较不同预后病人各分数之间的差异;计算并比较两种评分法对病人严重预后不良和其他预后类型区别能力的ROC曲线下面积。结果5种不同预后之间比较,两种评分方法均有显著性差异(APACHEⅡF=57.64,P=0.000;CPRROSC预后评分,F=65.91,P=0.000)。反映评分区分严重不良预后(植物状态或死亡)能力的ROC曲线下面积分别为CPRROSC预后评分0.950,APACHEⅡ评分0.937,2者差异无统计学意义(P>0.05)。结论APACHE II评分和CPRROSC预后评分总体上均能区分严重不良预后与其他预后类型,可作为心肺复苏自主循环恢复昏迷病人不良预后的预测、评价工具。     

脑电双频指数对心肺复苏术后患者接受不同亚低温治疗策略的疗效评估

目的:评估脑电双频指数(BIS)对心肺复苏术后患者接受不同亚低温治疗策略的疗效。方法:选择2014-04—2016-12期间ICU心肺复苏术后患者80例,分为常温组,短时程亚低温治疗组和长时程亚低温治疗组。常温组给予常规治疗,亚低温治疗组在此基础上给予患者亚低温治疗。短时程亚低温治疗组给予患者持续亚低温治疗24 h,而长时程亚低温治疗组给予患者持续亚低温治疗7 d。记录各组患者1～10 d的APACHEⅡ评分、GCS评分以及BIS值。比较每组患者第1、3、5、7、10天的APACHEⅡ评分、GCS评分、BIS值以及患者28 d的生存率和6个月的CPC评分。结果:3组患者第1、3天的APACHEⅡ评分、GCS评分以及BIS值评分比较均差异无统计学意义(P0.05),3组患者第5、7、10天APACHEⅡ评分、GCS评分以及BIS值比较均差异有统计学意义(P0.05)。患者28 d生存率和6个月的CPC评分3组之间比较均差异有统计学意义(P0.05)。结论:BIS值可以评估心肺复苏术后患者不同亚低温治疗的疗效,亚低温治疗对心肺复苏术后患者28 d生存率和6个月的神经功能恢复有明显改善作用,且长时程亚低温治疗较短时程亚低温治疗,具有更好的提高患者生存率以及改善患者神经功能预后的作用。     

昏迷患者脑电双频指数变化及临床意义

目的 观察昏迷患者的脑电双频指数(BIS),探讨BIS与昏迷患者预后的关系.方法 将32例昏迷患者于发病后2～4 d 行BIS监测12 h,取其平均值.在治疗前记录患者的Glasgow-Pittsberg昏迷量表评分,计算出急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分.入院后3 d,连续查血清神经元特异性烯醇化酶(NSE)及S100蛋白浓度,取最高值.将BIS与G-P评分、APACHEⅡ评分、血清NSE及S100蛋白水平进行相关性比较.将患者按预后分成死亡组(n=10)与存活组(n=22),比较两组的BIS值、G-P评分、APACHEⅡ评分、血清NSE及S100蛋白水平.结果 ①BIS与G-P评分呈明显正相关(r=0.646),与NSE及S100蛋白呈明显负相关(r= -0.652,r= -0.927),与APACHEⅡ评分之间无相关性.②存活组与死亡组之间APACHEⅡ评分差异无统计学意义;死亡组BIS值(12.29±13.67)与G-P评分(7.44±1.01)分明显低于存活组(分别为58.96±20.30,18.23±5.06);死亡组血清NSE(146.47 ±94.93)ng/mL与S100蛋白(3.19±1.12)μg/L明显高于存活组(分别为30.84±18.8,0.38±0.37).结论 BIS能直观、客观的反应昏迷患者的脑损伤程度,与脑损伤程度具有良好的相关性.     

重症心肺复苏患者早期预后的预测指标

目的 结合临床常用炎症指标与格拉斯哥评分(glasgow coma scale,GCS)和急性生理和慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)建立心肺复苏术后评估指标,对1 17例在ICU治疗的心肺复苏术后患者预后的进行评估并评价各指标对患者早期预后的预测价值.方法 选择2010年1月至2012年12月在南方医科大学珠江医院重症医学科住院的心肺复苏术后患者117例,在入院24 h内测定其炎症指标、血常规、电解质、肝肾功能,记录GCS及APACHEⅡ,分别留取患者入院时、住院12 h及住院24 h的动脉血气分析,分别计算12 h及24h的乳酸清除率.在所有病例治疗7d后,根据他们的转归分为生存组和死亡组进行比较分析.结果 (1) 117例患者中有73例死亡,44例生存.单因素分析表明:年龄、复苏后至入ICU时间、D二聚体、FiO2、动脉血pH值、入ICU时动脉血乳酸值、GCS及APACHEⅡ在两组之间的差异具有统计学意义(P＜0.05或P＜0.01).(2)二分类Logistic回归分析显示:D二聚体、GCS及APACHEⅡ与心肺复苏术后患者死亡与否存在显著性的相关关系,相对危险度(OR值)分别为1.000、2.091、0.531(P＜0.05或P＜0.01). (3)受试者工作特征曲线(receiver operation characteristic curve,ROC)分析表明:GCS和APACHEⅡ的ROC曲线下面积(area under the curve,AUC)分别为0.821和0.869 (P＜0.01),比D二聚体更有预测价值.当GCS等于6.5分时,预测患者生存的正确率最高,为84.6％.当APACHEⅡ等于17.5分时,预测患者死亡的正确率最高,为82.1％.结论 GCS和APACHEⅡ与心肺复苏术后患者预后明显相关,可以分别预测重症心肺复苏术后患者7d内的存活及死亡概率,比起单一的监测指标有更大的优越性.希望此结论在今后的临床工作能对加强病情综合评估有用.     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

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.