AMPA受体拮抗剂对新生鼠缺氧缺血性脑损伤自由基的影响

目的:探讨α-氨基-3-羟基-5-甲基异恶唑-4-丙酸(alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionicacid,AMPA)受体拮抗剂GYKI-52466对缺氧缺血新生鼠脑组织自由基的影响。方法:选用7日龄Wistar大鼠30只,随机分为3组,假手术组,缺氧缺血组和治疗组。治疗组在缺氧缺血后即刻开始予GYKI-5246610mg/kg腹腔注射,每小时注射1次,共4次。缺氧缺血组予等量生理盐水腹腔注射。于处置后24h检测脑组织中超氧化物歧化酶(superoxidedismutaseSOD)、谷胱甘肽、丙二醛水平。结果:缺氧缺血组脑组织SOD,GSH水平分别为(1.47±0.15)mkat、(75.03±5.22)mg/g,明显低于假手术组(2.51±0.16)mkat、(88.66±4.50)mg/g(t=3.237～15.573,P均<0.001);MDA含量为(8.03±0.64)pmol/g,较假手术组(5.12±0.57)pmol/g显著升高(t=6.253～15.373,P<0.001)。而治疗组脑组织SOD、谷胱甘肽水平分别为(2.73±0.21)mkat、(83.47±6.38)mg/g,明显高于缺氧缺血组(P<0.001;P<0.005);丙二醛含量为(6.07±0.68)pmol/g,较缺氧缺血组显著下降(P<0.001)。结论:AMPA拮抗剂可通过拮抗氧自由基发挥对缺氧缺血性脑损伤时脑的保护作用。     

川芎嗪抗肝缺血-再灌注损伤作用机制的实验研究

目的 :探讨川芎嗪对肝缺血再灌注损伤 (HIRI)保护作用的机制。方法 :实验兔 30只 ,随机分为正常对照组 (A组 )、肝缺血再灌注组 (B组 )和肝缺血再灌注加川芎嗪治疗组 (C组 )。复制 HIRI模型 ,分别观察肝组织内 ATP、ADP、AMP含量 ,总腺苷酸量 (TAN) ,肝脏的细胞能荷 (E)及肝细胞形态学的变化。结果 :C组与B组比较 ,肝组织内 ATP含量及 E均明显增高〔 ATP:C组为 (2 .84± 0 .77) mg/ g,B组为 (0 .98± 0 .2 5 ) m g/ g,P<0 .0 1;E:C组为 0 .6 1± 0 .0 7,B组为 0 .34± 0 .0 5 ,P<0 .0 1)〕;且与仅行游离、不阻断肝血流的 A组比较无明显差异〔 A组 ATP为 (3.34± 0 .2 7) mg/ g,P<0 .0 5 ;A组 E为 0 .6 7± 0 .0 4 ,P>0 .0 5〕;肝细胞形态学异常改变显著减轻。结论 :川芎嗪可通过改善肝细胞的能量代谢而减轻 HIRI     

氨甲喋呤治疗急性胰腺炎的实验研究

目的 :观察氨甲喋呤 (MTX)对急性胰腺炎时炎症性细胞因子和抗炎症细胞因子的调节作用 ,探讨氨甲喋呤治疗急性胰腺炎的作用机制。方法 :实验用雄性 SD大鼠随机分为 3组 :1正常对照组 (6只 ) ;2胰腺炎组 (8只 ) :采用开腹胰管注射质量分数为 5 %的牛磺胆酸钠 (1.0 m l/ kg)制备急性胰腺炎模型 ;3氨甲喋呤组(6只 ) :胰腺炎诱导成功后 0 .5小时静注氨甲喋呤 (1.2 m g/ kg)。制模后 2、6和 2 4小时处死动物 ,分别取血查肿瘤坏死因子α(TNFα)、白介素 1(IL 1)、IL 6、IL 10和转移生长因子β(TGFβ)及胰淀粉酶、胰腺湿重、白细胞计数。结果 :急性胰腺炎时血中炎症细胞因子和抗炎症细胞因子均显著升高 ;使用氨甲喋呤治疗后 ,上述细胞因子均下降 ,其中 TNFα、IL 1和 IL 6在 2、6、2 4小时均明显下降 (P均 <0 .0 5 ) ,IL 10和TGFβ在 2 4小时均下降明显 (P均 <0 .0 5 ) ;制模后 2 4小时大鼠胰腺湿重〔(1.5 3± 0 .13) g〕和血淀粉酶含量〔(1817.2 5± 4 5 9.35 ) U/ L〕均较正常对照组〔(0 .5 3± 0 .0 9) g和 (374 .2 0± 92 .84 ) U/ L〕增高 ;经氨甲喋呤治疗后 2 4小时 ,胰腺湿重和淀粉酶均明显下降〔(0 .88± 0 .13) g和 (76 6 .33± 373.37) U / L ,P均 <0 .0 5〕。结论 :氨甲喋呤可以同时抑制急性胰腺炎时     

黄芪对急性脑损伤后大鼠脑组织一氧化氮合酶活性影响的实验研究

目的 :观察黄芪对脑损伤后脑组织一氧化氮合酶 (NOS)活性的影响 ,探讨黄芪对急性颅脑损伤的治疗作用及机制。方法 :建立大鼠脑外伤模型 ,采用化学定量法对大鼠脑外伤后脑组织中 NOS含量进行检测。结果 :大鼠脑皮质中 NOS活性在伤后 0 .5 h〔(46 .4 4± 13.4 5 ) nmol/ L〕较正常对照组 (40 .4 6± 12 .85 ) nm ol/ L明显升高 (P<0 .0 5 ) ,2 h较对照组升高更显著 (P<0 .0 1) ,6 h开始下降 (P<0 .0 1) ,2 4 h降至基础水平〔4 1.2 3±12 .5 7) nm ol/ L〕。黄芪治疗组伤后 2 h〔(6 4 .2 6± 19.78) nmol/ L〕、6 h〔(5 2 .91± 2 1.36 ) nmol/ L〕NOS活性较损伤组明显降低〔分别为 (6 7.4 9± 2 2 .4 5 ) nmol/ L 和 (6 3.4 6± 2 4 .6 8) nmol/ L,P<0 .0 1和 P<0 .0 5〕。结论 :颅脑损伤后 ,受损脑组织中 NOS活性升高 ;黄芪可通过抑制损伤后 NOS活性 ,起到保护创伤神经元的作用     

醒脑静注射液对实验性脑缺血-再灌注损伤中一氧化氮和内皮素水平的影响

目的 :探讨醒脑静注射液 (XNJI)对脑缺血再灌注损伤 (CIRI)家兔一氧化氮 (NO)和内皮素 (ET)水平的影响。方法 :采用“四动脉闭塞法”制备家兔 CIRI模型 ,随机分为假手术对照组 (A组 )、脑缺血再灌注组(B组 )和脑缺血再灌注加 XNJI治疗组 (C组 )。分别在脑缺血前、缺血 30分钟及再灌注 30、6 0和 12 0分钟不同时间点 ,检测血浆及脑组织 NO浓度和 ET含量。结果 :脑缺血再灌注期间 ,血浆和脑组织 NO水平明显下降 ,血浆为 (43.80± 10 .4 0 )μmol/ L、(43.6 0± 8.96 )μm ol/ L、(37.5 0± 13.6 0 )μmol/ L、(39.80± 8.2 2 )μmol/ L、(40 .70± 7.86 )μmol/ L (P<0 .0 5和 P<0 .0 1) ,脑组织为 (319.0 0± 70 .70 )μmol/ g(P>0 .0 5 ) ;ET水平显著升高 ,血浆为 (73.80± 34.70 ) ng/ L、(81.30± 32 .5 0 ) ng/ L、(78.2 0± 36 .80 ) ng/ L、(10 4 .0 0± 4 2 .0 0 ) ng/ L、(111.0 0± 5 0 .70 ) ng/ L(P<0 .0 5和 P<0 .0 1) ,脑组织为 (93.10± 4 2 .30 ) ng/ g(P<0 .0 5 ) ;使用 XNJI后 ,上述各指标的异常变化明显减轻 ,与对照组相比有显著性差异 (P<0 .0 5和 P<0 .0 1)。结论 :XNJI可提高机体 NO水平、降低 ET水平而抗 CIRI     

窒息复苏新生儿红细胞胞浆钙系统的变化规律及其意义

目的 :探讨窒息复苏新生儿红细胞胞浆钙系统的变化及规律。方法 :使用原子吸收分光光度仪 ,荧光分光光度仪以及钠、钙泵同步测定法检测 2 6例重度窒息缺氧缺血性脑病 (HIE)新生儿及 16例足月正常新生儿红细胞胞浆总钙、游离钙、钙泵、钠泵含量及活性变化。结果 :HIE早期患儿红细胞胞浆总钙〔(3.79± 0 .14)×10 - 3 m mol/ L〕、游离钙含量〔(3.0 4± 0 .5 2 )× 10 - 3 g/ L〕均明显升高 (P<0 .0 5或 P<0 .0 0 1) ;钙泵活性〔(17.6 7± 9.6 9) pmol· g- 1 Hb· h- 1〕、钠泵活性〔(5 .99± 4.31) pmol· g- 1 Hb· h- 1〕均显著降低 (P均 <0 .0 0 1)。结论 :窒息缺氧缺血性脑病过程伴发红细胞内钙系统的稳态失调 ;检测红细胞胞浆钙系统有助于对窒息复苏后缺氧缺血性脑病的早期诊断。     

破瘀通脉散对脑缺血再灌注损伤的影响及机制探讨

目的 :探讨中药破瘀通脉散对脑缺血再灌注损伤的作用及可能机制。方法 :采用线栓法制作大鼠局灶性脑缺血再灌注损伤模型。将 4 5只大鼠随机分为 5组 :假手术组 ( 8只 ) ,模型组 ( 8只 ) ,治疗组中小剂量组( 9只 )、中剂量组 ( 10只 )和大剂量组 ( 10只 )。治疗组分别按体重计算 ,用中药破瘀通脉散灌胃 ,每日 1次 ,连用7日观察结果。结果 :模型组脑组织内皮素 ( ET)含量为 ( 2 1.14 4± 3 .72 6) ng/g,用药后大剂量组显著降低〔( 10 .3 68± 1.5 0 4 ) ng/g,P<0 .0 5〕,而中、小剂量组与模型组差异不显著 ( P均 >0 .0 5 )。模型组脑组织一氧化氮 ( NO)含量为 ( 13 .2 0 4± 2 .978) μmol/g,用药后中、大剂量组均显著降低〔分别为 ( 8.681± 1.85 8) μm ol/g和( 6.2 84± 0 .84 3 ) μmol/g〕,P均 <0 .0 1;与小剂量组无显著性差异 ( P>0 .0 5 )。病变程度以中、大剂量组较模型组改变显著。结论 :破瘀通脉散有抑制 ET生成的作用 ,可降低脑缺血再灌注脑组织的 NO含量 ,因此可减轻脑缺血再灌注损伤 ,其机制可能为通过调节 ET和 NO的合成与释放     

川芎嗪对脑缺血/再灌注后脑组织肿瘤坏死因子-α含量及髓过氧化物酶活性的影响

目的:观察川芎嗪对大鼠脑缺血/再灌注后脑组织肿瘤坏死因子α(TNFα)含量及髓过氧化物酶(M PO)活性的影响,探讨其对脑缺血/再灌注损伤保护作用的机制。方法:36只雄性SD大鼠随机分为假手术组、模型组和川芎嗪组。假手术组插入栓线但不阻塞大脑中动脉。模型组制备脑缺血/再灌注损伤模型。川芎嗪组于制模前30 m in腹腔注射川芎嗪注射液33 m g/kg。分别采用放射免疫分析法及分光光度计法测定各组大鼠脑组织缺血/再灌注6 h时TNFα含量及缺血/再灌注24 h时的M PO活性。结果:脑缺血/再灌注大鼠TNFα含量〔(1.576±0.153)μg/L〕及M PO活性〔(0.409±0.044)U/g〕较假手术组〔(0.601±0.089)μg/L和(0.026±0.008)U/g〕均显著升高(P均<0.01);川芎嗪组TNFα含量〔(1.035±0.092)μg/L〕及M PO活性〔(0.293±0.039)U/g〕较模型组均显著降低(P均<0.01)。结论:川芎嗪可通过降低缺血/再灌注后大脑皮质TNFα含量及M PO活性来减轻炎症反应,发挥其脑保护作用。     

麝香酮对SH-SY5Y神经细胞缺氧/缺糖和再给氧损伤的保护作用

目的:研究麝香酮对神经细胞缺氧/缺糖和再给氧损伤的保护作用。方法:培养SH-SY5Y神经细胞。采用含连二亚硫酸钠的无糖Earle液模拟造成缺氧/缺糖和再给氧损伤;用苔盼蓝染色计数法测定细胞死亡率,用四甲基偶氮唑盐(MTT)比色法测定细胞存活率,用Hoechst 33342和碘化丙啶(PI)原位双染法荧光显微镜检测细胞坏死率和细胞凋亡率,用比色法测定乳酸脱氢酶(LDH)漏出率;并评价药效。结果:与正常对照组比较,缺氧/缺糖和再给氧损伤模型组细胞存活率显著下降〔(100.0±4.4)%比(25.6±3.7)%〕,细胞死亡率〔(5.0±2.2)%比(71.2±9.2)%〕、坏死率〔(2.6±1.2)%比(46.8±10.4)%〕、凋亡率〔(3.1±0.8)%比(16.0±4.9)%〕、LDH漏出率〔(20.1±5.8)%比(66.4±7.6)%〕均显著升高(P均<0.01)。麝香酮各终浓度组的细胞存活率显著提高〔(42.7±1.2)%~(47.8±1.7)%,P均<0.01〕,细胞死亡率〔(22.7±5.2)%~(36.1±5.9)%〕、坏死率〔(24.3±8.3)%~(28.9±8.7)%〕、凋亡率〔(7.8±3.1)%~(10.4±4.9)%〕、LDH漏出率〔(37.6±4.1)%~(40.6±2.4)%〕均显著下降(P<0.05或P<0.01)。结论:麝香酮对SH-SY5Y神经细胞缺氧/缺糖和再给氧损伤具有显著的保护作用,提示麝香酮可能应用于中风病急性期的治疗。     

G-csf诊断肝硬化脾功能亢进合并感染的临床应用

目的　探讨造血因子 G- csf在诊断肝硬化脾功能亢进合并感染的临床应用价值。方法　采用ELISA分析38例肝硬化脾功能亢进患者血清G-csf水平变化。结果　肝硬化脾功能亢进粒细胞减少患者血清G-csf水平〔(289±56 30)pg/ml,n=20〕较健康人〔(106±23 94)pg/ml, n=15〕及粒细胞未明显下降肝硬化患者〔(113±44 85)pg/ml,n=8〕明显升高(P<0 05),合并急性细菌感染肝硬化脾功能亢进患者血清 G-csf更为显著上升,达708±440 28pg/ml,明显高于非感染组(P<0 01),感染控制后血清 G-csf明显下降。结论　肝硬化脾功能亢进患者造血因子G-csf普通升高。G-csf显著上升,对肝硬化脾功能亢进患者合并急性细菌感染的判断有很好的临床应用价值。     

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.