糖皮质激素对大潮气量机械通气大鼠肺组织巨噬细胞炎症蛋白-1 α和核因子-κB表达的影响

目的 观察大潮气量机械通气大鼠血浆和支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)巨噬细胞炎症蛋白-1α(MIP-1α)含量以及肺组织MIP-1α mRNA和NF-κBp65 mRNA表达水平.方法 32只健康雄性Wistar大鼠随机(随机数字法)分为对照组,机械通气致肺损伤(VILI)组、地塞米松干预(DEX)组和布地奈德干预(BUD)组.给与相应处理后分别采用ELISA法检测各组大鼠BALF和血浆MIP-1α含量,采用RT-PCR法检测其肺组织MIP-1αmRNA和NF-κB p65mRNA表达水平,比较4组之间的差异,并将VILI,DEX,BUD组间MIP-1α mRNA与MIP-1α含量,MIP-1α mRNA与NF-κB p65 mRNA表达水平间进行直线相关分析.结果 DEX组和BUD组BALF及血浆中MIP-1α含量及肺组织MIP-1αmRNA和NF-κBp65 mRNA表达水平均明显低于VILI组(P＜0.05),同时肺组织损伤程度明显减轻;BUD组BALF和血浆中MIP-1α含量及肺组织MIP-1α mRNA和NF-κB p65 mRNA表达水平虽高于DEX组,但差异无统计学意义(P＞0.05).相关分析结果表明,肺组织MIP-1α mRNA表达量与BALF中MIP-1α含量呈正相关(r=0.895,P＜0.05);肺组织MIP-1α mRNA表达量与NF-κB p65 mRNA表达量呈正相关(r=0.801,P＜0.05).结论 糖皮质激素可能通过抑制NF-κB的活性而下调肺组织MIP-1α的表达,对VILI有一定防治作用;局部应用糖皮质激素对VILI的保护作用与全身用药的作用相似,且副作用小.     

呼吸机致大鼠急性肺损伤的实验研究

目的探讨不同潮气量机械通气在大鼠急性肺损伤发生中的作用。方法32只Wistar大鼠随机分为对照组、小潮气量组、常规潮气量组和大潮气量组。分别在肉眼、光镜和电镜下观察各组大鼠肺组织病理学改变,测定动脉血气和BALF中性粒细胞计数(PMN)、蛋白含量和髓过氧化物酶(MPO)活性。结果小潮气量组肺组织在肉眼、光镜和电镜下观察与对照组比较差异无显著性;常规潮气量和大潮气量组肺组织在光镜和电镜下可观察到具有不同程度损伤改变,其BALF中PMN、MPO活性和蛋白含量均明显高于对照组和小潮气量组,而动脉血氧分压(PaO_2)明显低于对照组和小潮气量组(P＜0．01,P＜0．05);大潮气量组BALF中MPO活性和蛋白含量与常规潮气量组比较差异也有显著性(P＜0．01);小潮气量组各项指标与对照组比较差异均无统计学意义(P＞0．05)。结论小潮气量通气对正常肺组织无明显影响,但没有任何肺保护措施的常规潮气量通气对正常肺组织具有一定损伤作用,其损伤作用与中性粒细胞在肺内募集和活化有密切关系。     

尘肺合并慢性阻塞性肺疾病患者行大容量肺灌洗手术时低潮气量通气的效果观察

目的:评价尘肺合并慢性阻塞性肺疾病(COPD)患者行大容量肺灌洗手术时低潮气量通气的效果.方法:尘肺合并COPD患者30例,年龄25～60岁,ASAⅡ或Ⅲ级,随机分为TV组(n=15,VT=10 mL/kg)和LV组(n=15,VT=6 mL/kg).监测气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)及动态肺顺应性(Cd).于插管后双肺通气10 min(T1)、单肺通气30 min(T2)、术毕双肺通气10 min(T3)时取动脉血样,血气分析,计算氧合指数(OI)、肺泡-动脉血氧分压差[P(A-a)O2]及呼吸指数(RI);取静脉血样,测定血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)的浓度.结果:与T1时相比,两组T2-3时血清TNF-α及IL-6浓度升高(P＜0.05);与TV组相比LV组T2-3时血清TNF-α及IL-6浓度降低(P＜0.05),T1-3时Ppeak、Pplat、Raw降低,T2、T3时Cd升高(P＜0.05).T1-3时2组OI、P(A-a)O2及RI差异无统计学意义(P＞0.05).结论:低潮气量通气可通过降低炎性反应,减轻尘肺合并COPD患者行大容量肺灌洗手术时机械通气诱发的肺损伤.     

机械通气对急性胰腺炎大鼠肺组织病理及巨噬细胞炎性介质的影响

目的探讨保护性机械通气对急性坏死性胰腺炎(ANP)-肺损伤大鼠肺组织病理和肺泡炎性细胞介质的影响。方法 45只SD大鼠预处理诱导ANP-肺损伤模型,按照ANP和机械通气干预随机分成三组(每组15只):A组,对照组;B组,ANP组;C组,ANP加机械通气;观察时间均2h,连续观察平均动脉压(MAP)、SpO2、体温变化和血气分析,并保持动脉血PaCO2在35～45mmHg。实验开始即刻和实验结束时(除对照组外)抽取动脉血,处死大鼠后取肺叶组织观察肺组织病理和肺湿/干重比值;进行支气管肺泡灌洗液(BALF)提取,分析BALF中细胞变化,检测BALF中巨噬细胞炎性蛋白-2(MIP-2)和TNF-α浓度水平。结果 HE染色切片B、C两组均出现明显病理性改变,B组和C组肺湿/干重比值大于A组(P<0.05);B组和C组比较无明显变化;C组细胞聚集数较A组和B组明显(P<0.05)。各组BALF和血清炎性细胞因子比较,BALF和血清中MIP-2水平C组高于其他两组,C组与B组比较有统计学差异(P<0.05);各组TNF-α水平比较,BALF和血清中B组和C组高于A组,B组与C组BALF中TNF-α水平比较有统计学差异(P...     

大鼠静注鞭毛蛋白后不同时相点肺急性炎症损伤的研究

目的 研究经尾静脉注入鞭毛蛋白后,不同时相点大鼠肺水肿以及肺部炎症的发生情况.方法 210只清洁级雄性Wistar大鼠,分三批,每批随机分为对照组和经尾静脉注入鞭毛蛋白致伤,2、4、6、12、24、48 h 时6个不同时相点检测组,共七组.正常对照组大鼠给予生理盐水,致伤组大鼠给予鞭毛蛋白50 μg/kg,静注后分别于2、4、6、12、24、48 h时,测定动脉血氧分压(PaO2);肺毛细血管通透性(Evans blue含量);肺组织湿干比值(W/D);肺泡灌洗液(BALF)细胞计数以及用ELISA法检测外周血、肺组织与BALF中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和IL-10细胞因子的含量.结果 静注鞭毛蛋白后,随时间的增加,大鼠PaO2下降;毛细血管通透性增加;肺W/D增加;BALF的细胞计数增加;外周血、肺组织及BALF中,TNF-α、IL-1β含量增加,IL-10含量减少.在致伤组与对照组之间,以上各指标差异有统计学意义(P＜0.05).结论 静注鞭毛蛋白后,致大鼠肺急性炎症损伤具有时间差异性.     

机械通气致肺损伤的防护

[目的]通过研究大潮气量机械通气引起的肺损伤(VILI),提出机械通气时通气机所致VELI的护理防护.[方法]将24只健康雄性SD大鼠随机等分为对照组与实验组,对照组小潮气量通气(VT=8mL/kg);实验组为致伤组大潮气量通气(VT=40mL/kg).通气时间均为4 h,每小时行1次动脉血气分析.通气后行支气管肺泡灌洗液(BAIF)中性粒细胞计数,血清和BALF中TNF-α、IL-1β含量测定.[结果]实验组大鼠氧合指数较对照组显著下降,BALF中性粒细胞计数、血清和BALF中TNF-α、IL-1β水平较对照组显著增加.[结论]大潮气量机械通气能引起明显的VILI,临床上对于机械通气的病人,应尽量避免大潮气量通气,加强对通气机所致VILI的护理防护.     

异丙酚后处理对急性肺损伤大鼠肺组织Toll样受体4表达的影响

目的 探讨异丙酚后处理对脂多糖(LPS)诱导急性肺损伤(ALI)大鼠肺组织中Toll样受体4(TLR4)表达的影响.方法 将30只SD大鼠按随机数字表法分为对照组、ALI组及异丙酚后处理组3组,每组10只.经股静脉泵入8 mg/kg LPS 30 min诱导ALI模型,对照组给予等量生理盐水.异丙酚后处理组于制模后股静脉推注20 mg/kg异丙酚,再以40 mg· kg-1·h-1微量泵匀速泵入维持1h.于给药结束后6h处死大鼠,取肺脏测定湿/干重(W/D)比值,计算肺通透性指数(LPI),用酶联免疫吸附试验(ELISA)测定支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)水平,用逆转录-聚合酶链反应(RT-PCR)测定肺组织TLR4 mRNA表达.结果 与对照组比较,ALI组肺W/D比值、LPI、TLR4 mRNA表达及BALF中TNF-α水平(ng/L)均明显升高[肺W/D比值:5.30±0.28比4.21 ±0.14,LPI(×10-3):8.7±2.2比3.3±2.0,TLR4 mRNA:2.451±0.028比0.998±0.021,TNF-α:643.46±62.31比120.43±12.65,均P＜0.05];而异丙酚后处理组肺W/D比值、LPI、TLR4 mRNA表达及BALF中TNF-α水平均较ALI组明显降低[肺W/D比值:4.68±0.19比5.30±0.28,LPI(×10-3):5.8±2.0比8.7±2.2,TLR4 mRNA:1.126±0.025比2.451±0.028,TNF-α:290.53±32.01比643.46±62.31,均P＜ 0.05],但仍显著高于对照组(均P＜0.05).结论 异丙酚后处理能明显改善LPS诱导的ALI,其作用机制可能是通过下调TLR4 mRNA表达,从而抑制“瀑布样”炎症反应.     

肾上腺素α2受体调控MAPK通路对VILI大鼠肺部炎症的影响

目的:研究肾上腺素α₂受体调控的炎症信号传导MAPK通路对呼吸机所致肺损伤大鼠肺部炎症反应的影响。方法:30只SPF级雄性SD大鼠随机均分成5组:常规潮气量通气组（C,8 mL/kg,呼吸频率90次/min）,大潮气量通气组（H,20 mL/kg,呼吸频率50次/min）,大潮气量通气盐酸右旋美托咪啶处理组（D,参数设置同H组）,大潮气量通气育亨宾处理组（Y,参数设置同H组）,大潮气量通气+盐酸右旋美托咪啶+育亨宾处理组（D+Y,参数设置同H组）。观察肺部病理改变,ELISA法检测支气管肺泡灌洗液（BALF）中的肿瘤坏死因子α、IL-1β、IL-6和IL-10,Western Blot方法检测各组肺组织中促分裂原活化蛋白激酶及其和磷酸化水平。结果:和C组相比,H组、D组、Y组和D+Y组大鼠肺组织病理改变,BALF中的TNF-α、IL-1β、IL-6、IL-10和MIP-2,以及肺部磷酸化ERK1/2均有明显增高。H组、Y组和D+Y组相比,D组肺组织和BALF中各项指标均显著降低。结论:α₂受体激动剂能通过调控MAPK通路显著减轻VILI所造成的肺部炎症反应,提示α₂受体在VILI所造成的肺部炎症反应中起到重要作用。     

机械通气对大鼠肺泡巨噬细胞Toll样受体4表达的影响

目的 探讨机械通气对大鼠肺泡巨噬细胞（AM）表面Toll样受体4（TLR4）表达的影响。方法 清洁级成年雄性SD大鼠18只，随机分为自主呼吸组（R组，n=6）、小潮气量（VT）机械通气组（M组，n=6）和大VT机械通气组（N组，n=6）。腹腔注射质量分数为20％的乌拉坦8mg／kg麻醉大鼠，行气管插管。机械通气呼吸机参数设定：M组：VT为6ml／kg，N组VT为40ml／kg，吸：呼为1：1，呼气末正压（PEEP）为0，吸入氧浓度（FiO2）为0．21。调整呼吸频率和潮气末二氧化碳分压（PETCO2）维持在35～45mmHg（1mmHg=0．133kPa）。实验3h结束，放血处死大鼠。监测实验开始及实验1、2和3h时动脉血气分析；并测定大鼠肺组织病理形态学积分、湿／干重（W／D）比值及支气管肺泡灌洗液（BALF）中自细胞计数（WBC）和肺蛋白通透性系数。用逆转录-聚合酶链反应（RT—PCR）测定AM表面的TLR4mRNA表达，用免疫组化法测定AM表面的TLR4蛋白表达。结果 N组实验1h时存在过度通气，pH升高、动脉血二氧化碳分压（PaCO2）降低（P均〈0．05），其他指标都在正常范围内。与R组比较，N组肺组织病理形态学积分、W／D比值，BALF中WBC和肺蛋白透性系数以及TLR4蛋白表达和TLR4mRNA表达均显著升高（P均〈0．01）；M组改变差异均无显著性（P均〉0．05）。结论 大VT机械通气导致大鼠肺损伤，并使AM表面TLR4表达明显上调。小VT机械通气可避免上述改变的发生。     

痰热清注射液对急性肺损伤大鼠肺内炎症因子的影响

目的 研究痰热清注射液对内毒素性急性肺损伤(ALI)大鼠肺内炎症因子的影响。方法 清洁级健康SD雄性大鼠56只,随机（随机数字法）分为空白组、模型组、干预组。模型组、干预组分别给予内毒素(LPS)尾静脉注射,1h后,干预组给予痰热清注射液尾静脉注射。三组分别选取2,4,6h三个观察点,取支气管肺泡灌洗液(BALF)放射免疫法检测TNF-α,IL-1β,IL-8的含量及Wright-Giermsa染色计中性粒细胞的比例(ωPMN),并观察肺组织病理学变化及测湿干质量比值(W/D)。采用SPSS 17.0统计软件,以P＜0.05为差异具有统计学意义。结果2,4,6h三个观察点,模型组BALF中TNF-α,IL-1β,IL-8的含量及ωPMN较空白组明显升高(P＜0.05或P＜0.01),肺组织W/D明显增加(P＜0.01),且病理损伤程度明显重于空白组。干预组BALF中TNF-α,IL-1β,IL-8的含量及ωPMN较模型组明显降低(P＜0.05或P＜0.01),肺组织W/D明显减少(P＜0.01)且病理损伤程度明显轻于模型组。结论 痰热清注射液能抑制内毒素性急性肺损伤肺内炎症因子水平,减轻急性肺损伤程度。     

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.