糖尿病视网膜病变眼科首诊临床分析

目的 通过分析首诊眼科的糖尿病视网膜病变(diabetic retinopathy,DR)患者临床资料,了解不同阶段DR的临床特征,对DR患者进行全面监测、及时治疗,有效地降低糖尿病致盲性眼病.方法 回顾性分析2008年4月至2009年4月DR住院患者72例144眼的病史资料及眼部特征.结果 1)DR患者眼科初诊时51～70岁占64%,糖尿病病史病程5年以下占40.9%.2)视力:轻、中度非增殖性糖尿病视网膜病变(diabetic retinopathy,NPDR)组(0.49±0.28)、重度NPDR组(0.47±0.31)与增殖性糖尿病视网膜病变(diabetic retinopathy,PDR)组(0.19±0.2)比较差异有统计学意义(均P＝0.00);视野敏感度:轻、中度NPDR组为(28.1±2.0)dB,与重度NPDR组为(24.7±4.4)dB和PDR组为(24.5±4.0)dB比较差异有统计学意义(均P＝0.00);视觉诱发电位(Visual Evoked potential,VEP):44.3%眼VEP正常、55.7%眼VEP异常;光学相干断层扫描(macular imaging of optical coherence tomography,OCT):68.4%眼黄斑结构正常,31.6%眼黄斑结构不同程度水肿;81.9%双眼糖尿病视网膜病变程度对称,31.6%眼底检查联合眼底照相与眼底荧光血管造影(fluorescein angiography,FFA)判断DR分期不符合.结论 DR眼科首诊以51～70岁、DM病程5年以下的轻、中度NPDR为多;重度NPDR期视力无下降但视野敏感度下降,NPDR期双眼病变的不称性、黄斑病变与周围视网膜病变的不平行性、眼底检查与FFA的不符合性应引起重视;眼底检查联合眼底照相能满足基层DR临床诊疗的基本需要.     

中长期随访指导干预对糖尿病视网膜病变患者视力康复的影响

目的：了解随访和中长期干预对糖尿病性视网膜病变视力康复情况的影响，寻求保护糖尿病性视网膜病变患者视力的方法。 方法：随访观察2000-01／2005—06在新乡医学院第三附属医院眼科治疗的糖尿病性视网膜病变患者87例（174眼），男38例，女49例．在糖尿病性视网膜病变患者接受初次治疗后给予干预。糖尿病性视网膜病变的中长期干预方法：通过强烈要求患者定期复诊、电话和信件联络、定期走访部分病例等方法，对患者的饮食控制、药物治疗给予指导，并每一两周对患者血糖水平进行检测，尽力控制空腹血糖〈6．7mmol／L：同时给予长期口服药物治疗糖尿病性视网膜病变，对发现眼底病变有所进展的患者，及时给予眼底补充光凝治疗。使用SPSS10 for Windows软件进行单因素分析和COX比例风险模型多因素分析。 结果：有随访（复诊）记录者87例（174眼），其中非增殖性糖尿病性视网膜病变102眼，增殖性糖尿病性视网膜病变72眼；157眼接受眼底激光光凝治疗；在接受初次诊治后3个月时均保持随访，在接受初次诊治后6，12，24，36，48个月时保持随访观察的病例分别为79，65，48，45,36例。随访时间最长50个月。①患者初次治疗后3个月时视力有提高（χ^21-2=10．79．P〈0．05），并且在初次治疗后的第1～3年延缓了视力的继续损害（χ^22-3=2．99，χ^22-4=0．91，以χ^22-6=5．41，χ^22-6=4．18，P〉0．05）。②初次治疗后48个月时，糖尿病性视网膜病变患者视力还是较初次治疗后3个月时有所下降，但和初次治疗前无明显差异（χ^22-7=9．59，P〈0．05，χ^21-7=8．86，P〉0．05）；对数据的分析还发现，初次治疗后6，12，24，36个月时糖尿病性视网膜病变患者的视力和治疗前并无明显差异，就是说视力无明显提高或降低（χ^21-3=2．98，χ^21-4=8．51，χ^21-5=3．78，χ^21-6=5．67，P〉0．05）。③糖尿病病程、空腹血糖持续高水平、高血压、是否有糖尿病肾病、是否定期看内科医生（内分泌科医生）、是否定期到眼科复诊、是否接受眼底激光光凝治疗等7个因素对糖尿病性视网膜病变患者视力预后有明显影响（P〈0．05）。与糖尿病性视网膜病变患者视力康复有关的重要独立因素为是否定期看内科医生（内分泌科医生）、糖尿病病程、空腹血糖持续高水平、是否定期看眼科医生和持续高血压。 结论：在治疗糖尿病性视网膜病变的同时，眼科医师与内科医师密切协调，对糖尿病性视网膜病变患者进行中长期干预，很大程度上减缓和减轻糖尿病患者的并发症，使糖尿病性视网膜病变患者视力损害的发展得到一定控制，改善糖尿病性视网膜病变患者的生存质量。     

中长期随访指导干预对糖尿病视网膜病变患者视力康复的影响

目的:了解随访和中长期干预对糖尿病性视网膜病变视力康复情况的影响,寻求保护糖尿病性视网膜病变患者视力的方法。方法:随访观察2000-01/2005-06在新乡医学院第三附属医院眼科治疗的糖尿病性视网膜病变患者87例(174眼),男38例,女49例,在糖尿病性视网膜病变患者接受初次治疗后给予干预。糖尿病性视网膜病变的中长期干预方法:通过强烈要求患者定期复诊、电话和信件联络、定期走访部分病例等方法,对患者的饮食控制、药物治疗给予指导,并每一两周对患者血糖水平进行检测,尽力控制空腹血糖<6.7mmol/L;同时给予长期口服药物治疗糖尿病性视网膜病变,对发现眼底病变有所进展的患者,及时给予眼底补充光凝治疗。使用SPSS10forWindows软件进行单因素分析和COX比例风险模型多因素分析。结果:有随访(复诊)记录者87例(174眼),其中非增殖性糖尿病性视网膜病变102眼,增殖性糖尿病性视网膜病变72眼;157眼接受眼底激光光凝治疗;在接受初次诊治后3个月时均保持随访,在接受初次诊治后6,12,24,36,48个月时保持随访观察的病例分别为79,65,48,45,36例。随访时间最长50个月。①患者初次治疗后3个月时视力有提高(χ21-2=10.79,P<0.05),并且在初次治疗后的第1～3年延缓了视力的继续损害(χ22～3=2.99,χ22～4=0.91,χ22～5=5.41,χ22～6=4.18,P>0.05)。②初次治疗后48个月时,糖尿病性视网膜病变患者视力还是较初次治疗后3个月时有所下降,但和初次治疗前无明显差异(χ22～7=9.59,P<0.05,χ21～7=8.86,P>0.05);对数据的分析还发现,初次治疗后6,12,24,36个月时糖尿病性视网膜病变患者的视力和治疗前并无明显差异,就是说视力无明显提高或降低(χ21～3=2.98,χ21～4=8.51,χ21～5=3.78,χ21～6=5.67,P>0.05)。③糖尿病病程、空腹血糖持续高水平、高血压、是否有糖尿病肾病、是否定期看内科医生(内分泌科医生)、是否定期到眼科复诊、是否接受眼底激光光凝治疗等7个因素对糖尿病性视网膜病变患者视力预后有明显影响(P<0.05)。与糖尿病性视网膜病变患者视力康复有关的重要独立因素为是否定期看内科医生(内分泌科医生)、糖尿病病程、空腹血糖持续高水平、是否定期看眼科医生和持续高血压。结论:在治疗糖尿病性视网膜病变的同时,眼科医师与内科医师密切协调,对糖尿病性视网膜病变患者进行中长期干预,很大程度上减缓和减轻糖尿病患者的并发症,使糖尿病性视网膜病变患者视力损害的发展得到一定控制,改善糖尿病性视网膜病变患者的生存质量。     

2型糖尿病患者糖化血红蛋白和空腹血糖水平与视网膜病变相关性分析

目的 探讨2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)和空腹血糖(FPG)水平与视网膜病变(DR)的相关性.方法 对129例T2DM患者进行眼底检查或眼底血管荧光素造影检查,并依据眼底检查结果分组,确定T2DM无视网膜病变(NDR)组患者77例,DR组患者52例,其中非增生性视网膜病变(NPDR)组患者39例,增生性视网膜病变(PDR)组患者13例.所有研究对象HbA1c和FPG水平采用IE-HPLC法及葡萄糖氧化酶法进行定量测定,各组间进行统计学分析.结果 DR组HbA1c水平与NDR组和正常对照组比较差异有统计学显著性意义(P＜0.01),FPG水平也随着DR病情的发展和病变程度显著升高(P＜0.01).各组FPG与HbA1c相关性分析,DR组(NPDR组和PDR组)呈明显正相关(r=0.792);NDR组也呈明显正相关(r=0.684).结论 T2DM患者HbA1c和FPG水平与视网膜病变的发生、发展及病变程度有显著相关性,是糖尿病和并发症监控的重要监测指标.     

上海市北新泾街道糖尿病视网膜病变患者视力功能状况调查

目的：探讨上海市北新泾街道患有糖尿病居民中糖尿病视网膜病变(diabetic retinopathy，DR)患者的视力状况，为提高控制该地区糖尿病患者并发DR可能性提供数据。方法：根据居民健康档案获得糖尿病623例居民资料，采用眼底照相方法确立DR诊断。检查双眼日常生活视力和小孔视力。视力分级采用世界卫生组织标准。结果：实际受检535例，受检率为90．68％。共确诊DR患者146例。糖尿病总体人群中视力&;lt;0．3者占17．57％，DR患眼中视力&;lt;0．3者占25，82％。增殖型DR眼中低视力者12眼，盲者14眼，分别占52．2％和60．9％，视力低于单纯型DR患者。结论：在糖尿病居民中，DR严重危害视力。需密切监测高危DM居民以控制DR患病。     

激光治疗对不同分期糖尿病视网膜病变患者视功能的改善作用

目的:观察不同分期糖尿病视网膜病变(diabeticretinopathy,DR)全视网膜激光治疗分析,探讨激光术后视力的变化。方法:实验于1997-05/2004-02在辽宁省人民医院眼科门诊及病房完成。根据糖尿病性视网膜病变视网膜光凝研究组(diabeticretinopathyphotocoagulationstudygroup,DRPS)治疗技术规定,对152例253只眼的增殖前期糖尿病视网膜病变(preproliferativediabeticretionpathy,PPDR)、增殖期糖尿病视网膜病变(proliferativediabeticretinopathy,PDR)行全视网膜光凝(panretinalphotocoagulation,PRP)治疗,术后3～24个月分别行眼底荧光照影及彩色眼底像,对需要补充光凝的做补充治疗。结果:PPDR视力提高和不变占52只眼(92.9%)早期PDR视力提高和不变占84只眼(82.4%),高危PDR视力提高和不变占73只眼(76.8%)。结论:不同分期的DR行PRP术预后不同,因此选择合适的时期行PRP术治疗DR对患者的预后视力提高有着重要的作用。     

高血压对糖尿病患者视网膜病变的影响

目的探讨高血压对糖尿病视网膜病变的影响作用。方法回顾分析住院的2型糖尿病患者182例，单纯糖尿病不合并高血压者98人为病例1组，合并有高血压者84人为病例2组，对每个患者散瞳后直接检眼镜检查观察糖尿病视网膜病变的严重程度，对比两组间DR的患病率和分期情况。结果病例1组和病例2组糖尿病视网膜病变发生率比较：病例2组DR的的发生率均高于病例1组（χ2=4．12，P〈0．05）。结论高血压可加速糖尿病视网膜病变进展，应加强对糖尿病患者高血压的控制和随访。     

激光治疗不同分期糖尿病视网膜病变的疗效观察

目的观察激光治疗不同分期糖尿病视网膜病变(DR)的临床疗效。方法收集糖尿病性视网膜病变患者300例共408眼,根据眼底荧光素血管造影分为增殖前期(PPDR)246眼和增殖期(PDR)两组162眼。对两组糖尿病视网膜病变患者均行全视网膜光凝术。对比分析两组治疗后的视力及视野、眼底荧光造影(FFA)检查的结果。结果全视网膜光凝术后,PPDR组视力提高81眼(32.9%),PDR组视力提高37眼(22.8%),PPDR组视力提高者比率优于PDR组,差异有统计学意义(P0.05);复查FFA情况,PPDR组有效率90.7%显著高于PDR组的79.6%,差异有统计学意义(P0.05);PPDR和PDR两组的黄斑阈值敏感度变化手术前后比较均无显著性差异,而术后中心30°视野平均阈值敏感度均下降。结论早期进行视网膜光凝术虽对视野有一定损害,但仍可以保持或提高DR患者视功能。     

老年2型糖尿病患者糖化血红蛋白、空腹血糖与视网膜病变的关系

目的　探讨糖化血红蛋白 (HbA1c)、空腹血糖 (FBG)与 2型糖尿病性视网膜病变 (DR)的关系。方法　对我院住院或门诊的 2 38例老年 2型糖尿病 (DM)进行HbA1c、FBG检测并作眼底检查或眼底血管荧光素造影检查。其中不伴DR者 114例 ,伴DR者 12 4例。结果　HbA1c水平有DR组较无DR组为高 (P <0 .0 1) ,HbA1c水平越高 ,DR的发生越高 (P <0 .0 5 ) ,而FBG水平有DR组与无DR组差异无显著性 (P >0 .0 5 )。结论　HbA1c可作为监测老年 2型糖尿病患者发生和发展的指标之一。     

糖尿病性视网膜病变的筛查及护理配合

目的 了解糖尿病患者视网膜病变的发生状况,为指导糖尿病性视网膜病变护理提供科学依据.方法 配合医生对已确诊的380例糖尿病患者进行眼部视力、裂隙灯、眼底检查,对筛查出的患者进行眼底荧光血管造影(FFA)进一步确诊,收集相关实验室检查及个人资料.结果 380例糖尿病患者中有126例患糖尿病性视网膜病变,发生率为33.16%.结论 糖尿病性视网膜病变与糖尿病病程、空腹血糖水平、高血压、高血脂显著相关.应早筛查、早发现、早治疗和护理干预,延缓病情发展,是糖尿病患者防盲的关键.     

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.