产超广谱β-内酰胺酶大肠埃希菌中检出aac(6′)-Ⅰb-suzhou型基因

目的了解质粒介导的喹诺酮耐药基因在产超广谱β-内酰胺酶(ELBLs)大肠埃希菌的耐药特点及耐药机制。方法用纸片扩散法检测59株产ESBLs的大肠埃希菌对11种抗生素的敏感性,采用聚合酶链反应(PCR)检测qnrA、qnrB和qnrS、qnrC、aac(6′)-Ⅰb及qepA基因,并对扩增阳性基因qnrB、aac(6′)-Ⅰb测序后进行BLAST比对分析。结果 59株产超广谱β-内酰胺酶的大肠埃希菌共检出qnrB 3株(5.1%)、aac(6′)-Ⅰb 22株(37.3%),qnrB经测序证实为qnrB4,aac(6′)-Ⅰb经测序证实为aac(6′)-Ⅰb-cr型1株(1.7%)和aac(6′)-Ⅰb-suzhou型3株(5.1%)。结论大肠埃希菌多重耐药机制与产超广谱β-内酰胺酶及携带qnrB4、aac(6′)-Ⅰb和aac(6′)-Ⅰb-cr基因有关;本研究是国内首次从大肠埃希菌中检出aac(6′)-Ⅰb-suzhou型基因。     

质粒介导喹诺酮耐药基因qnr在大肠埃希菌中流行现状及耐药特征

目的了解该院分离的大肠埃希菌中质粒介导喹诺酮类耐药基因qnrA,qnrB,qnrS的流行情况及其耐药特征。方法用PCR法对129株大肠埃希菌进行qnrA,qnrB,qnrS基因检测,并用K-B纸片法检测其对15种抗菌药的体外抗菌活性,另外用琼脂平皿二倍稀释法检测阳性菌株对环丙沙星的M IC值。结果129株大肠埃希菌中,5株(3.88%)检出qnrA基因,8株(6.20%)检出qnrB基因,3株(2.33%)检出qnrS基因。阳性菌株均对亚胺培南敏感且对多种抗生素耐药,其中2株qnrA阳性菌株和3株qnrB阳性菌株对环丙沙星敏感。结论湖北地区大肠埃希菌中存在质粒介导喹诺酮类耐药基因qnrA,qnrB,qnrS基因的流行,qnr阳性株呈多重耐药,且敏感株中有该类基因的存在,应加强监测。     

致尿路感染的大肠埃希菌耐喹诺酮类抗菌药的相关耐药基因及耐药机制

目的:调查分析致尿路感染的大肠埃希菌喹诺酮类抗菌药相关耐药基因的流行状况,并探讨其耐药机制.方法:收集丽水市中心医院2008年3月至2010年3月从临床分离的导致尿路感染的大肠埃希菌无重复菌株52株,K-B法检测其耐药性,利用PCR扩增法检测并分析大肠埃希菌质粒介导喹诺酮耐药相关的qnrA、qnrB、qnrC、qnrD、qnrR、qnrS、aac(6’)-Ib基因以及DNA解旋酶GyrA与拓扑异构酶Ⅳ基因的喹诺酮决定区域ParC,扩增产物测序后经GenBank比对确认.结果:未检测到qnrA、qnrB、qnrC、qnrD、qnrR及qnrS基因,aac(6')-Ib检出率为26.9％(14/52),经比对未发现aac(6')-Ib-cr阳性菌株;耐药菌gyrA基因喹诺酮耐药决定区氨基酸序列存在两个位点突变;36株耐药菌拓扑异构酶ⅣParC基因测序与敏感菌相比相似性89％～ 95％.结论:致尿路感染大肠埃希菌中未检测到qnrA、qnrB、qnrC、qnrD、qnrR、qnrS基因及aac(6')-Ib-cr阳性株,DNA解旋酶gyrA和ParC基因变异可能是导致我院尿路感染大肠埃希菌对喹诺酮类抗菌药耐药的主要原因.     

耐喹诺酮类药物铜绿假单胞菌的质粒基因研究

目的研究耐喹诺酮类药物铜绿假单胞菌(PA)的质粒基因,并分析其耐药机制。方法临床分离的耐喹诺酮类药物的PA 100株,采用PCR法检测质粒介导的喹诺酮类耐药基因qnrA、qnrB、qnrC、qnrD、qnrS、qepA、aac(6′)-Ib-cr,并对阳性结果进行测序分析。结果 100株PA中检测出含有qnrA基因的菌株34株(34%);qnrB基因79株(79%);qnrD基因14株(14%);qnrS基因8株(8%);aac(6′)-Ib-cr基因55株(55%);未检测出qnrC和qepA基因的菌株。结论质粒携带的qnrA、qnrB/aac(6′)-Ib-cr耐药基因是PA耐喹诺酮类药物的主要机制。     

从患者胆汁分离的大肠埃希菌中质粒介导的氟喹诺酮类耐药基因的检测

目的 分析浙江省衢州市开化县第二人民医院消化内科胆汁分离的大肠埃希菌的耐药特点并调查质粒介导的喹诺酮类耐药基因的分布情况和流行特点。方法 收集该院消化内科患者2011年1月至2013年6月分离的大肠埃希菌724株,均为非重复性菌株,采用全自动微生物分析仪器VITEK 2 COMPACT进行细菌鉴定及药物敏感性分析,采用聚合酶链反应 (polymerase chain reaction,PCR)分析质粒介导的氟喹诺酮类耐药基因(plasmid-mediated quinolone resistance genes, PMQR) 如qnrA、qnrB、qnrS、aac(6')-Ib-cr和qepA 基因的流行特点。结果 胆源性大肠埃希菌的构成比达18.65%(135/724),其对环丙沙星和左氧氟沙星的耐药率高达61.5%(83/135)和55.6%(75/135),未检出碳青霉烯类抗生素耐药菌株;PCR检测PMQR基因结果显示:135株胆源性大肠埃希菌中,121株 (89.63%) qnrA1 基因阳性,45株(33.33%) qnrB4 基因阳性,32株 (23.70%) qnrB6 基因阳性,43株(31.85%) qnrS1 基因阳性,34株(25.19%) aac(6')-Ib-cr 基因阳性菌株,未检出qepA基因;其中45株(33.33%)同时携带 qnrA1、qnrB4 基因,32株(23.70%)同时携带 qnrA1、qnrB6, 25株(18.52%)同时携带 qnrA1、qnrB4、qnrS1, 21株(15.56%)同时携带 qnrA1、qnrB4、qnrS1、acc(6')-Ib-cr, 12株(100%)同时携带 qnrA1、qnrB6、qnrS1、acc(6')-Ib-cr, 且环丙沙星和左氧氟沙星的耐药率随着PMQR基因组合种类的增多而增多。结论 消化内科胆汁分离的大肠埃希菌氟喹诺酮类抗生素耐药严重,耐药基因主要以 qnrA1为主,qnrB4和qnrB6 次之,且存在多种PMQR基因组合形式,这些潜在播散的氟喹诺酮耐药基因对于临床胆道感染的治疗有很大的挑战。     

非发酵菌和环丙沙星敏感肠杆菌科细菌中质粒介导喹诺酮类耐药基因的检测

目的了解3类质粒介导的喹诺酮类耐药基因在浙江省温州地区分离的非发酵菌和环丙沙星敏感肠杆菌科细菌中的分布情况。方法收集2008年1月至2013年6月温州地区分离的非发酵菌和环丙沙星敏感肠杆菌科细菌,共600株,其中非发酵菌419株,环丙沙星敏感肠杆菌科细菌181株。采用聚合酶链反应(PCR)检测qnrA、qnrB、qnrS、aac(6)-Ib以及qepA基因,并通过DNA测序确定qnr基因型和aac(6')-Ib-cr基因变异体;通过接合转移实验研究细菌质粒介导的耐药性传递情况。结果 419株非发酵菌临床株中未检测到qnrA、qnrB、qnrS、aac(6')-Ib和qepA等耐药基因。181株环丙沙星敏感的肠杆菌科细菌临床株中未检到qepA,检到2株qnrA1阳性株,分别为1株肺炎克雷伯菌和1株大肠埃希菌;2株qnrB4阳性株,均为阴沟肠杆菌复合菌;12株检测到aac(6')-Ib,分别为6株大肠埃希菌、3株阴沟肠杆菌复合菌和3株克雷伯菌属细菌。接合转移试验中,2株qnrA1阳性株和1株qnrB4阳性株接合转移成功,12株携带aac(6')-Ib-cr基因的阳性株中4株接合转移成功。结论温州地区,质粒介导的喹诺酮类耐药基因不仅存在于环丙沙星耐药株中,而且还存在于环丙沙星敏感的肠杆菌科细菌中,可能不存在于非发酵菌中。     

肠杆菌科临床株质粒介导的喹诺酮类耐药机制的研究

目的了解天津地区肠杆菌科临床株中质粒介导的喹诺酮类耐药基因qnrA、aac（6＇）-Ib-cr的分布并研究其耐药机制。方法从天津地区8家三甲医院收集环丙沙星耐药（CPLX，MIC≥4μg／ml）的肠杆菌科菌株共116株，包括77株大肠埃希菌、24株阴沟肠杆菌、15株克雷伯菌属细菌。应用PCR方法筛查所有临床株的qnrA基因，并对大肠埃希菌进行aac（6＇）-Ib的检测；琼脂稀释法测菌株的药敏情况；DNA测序检测aac（6＇）-Ib—cr基因变异体；接合传递试验方法探讨细菌质粒介导的耐药性传递。结果116株喹诺酮类耐药的肠杆菌科临床株中未发现qnrA基因阳性株；77株环丙沙星耐药的大肠埃希菌15株检出aac（6＇）-Ib，其中对卡那霉素耐药10株、中敏4株、敏感1株；选出对卡那霉素耐药表型不同的6株菌的aac（6＇）-Ib扩增产物进行测序，结果表明5株菌在第223位（T→C或T→A）和454位（G→T）发生变异，均携带aac（6＇）-Ib-cr；6株测序菌株中4株接合传递成功，临床株对喹诺酮类和氨基糖甙类的耐药性部分传递给了受体株。结论qnrA基因在天津地区116株肠杆菌科临床株中甚为罕见；首次在天津发现aac（6＇）-Ib—cr介导的喹诺酮类耐药。     

儿科临床分离株中质粒介导喹诺酮类药物耐药基因qnr在产ESBLs或AmpC酶大肠埃希菌和肺炎克雷伯菌中的流行

目的了解质粒介导喹诺酮类药物耐药基因qnr在儿科临床分离产ESBLs或AmpC酶大肠埃希菌和肺炎克雷伯菌中的流行情况与分布特点。方法琼脂稀释法测定抗生素MIC;PCR检测喹诺酮类药物耐药基因qnrA、qnrB和qnrS及相应ESBLs和AmpC酶基因;接合试验检测qnr基因是否可通过质粒转移;肠杆菌基因间重复一致序列-聚合酶链反应（ERIC—PCR）检测qnr阳性菌株的同源性。结果702株儿科临床分离产ESBLs或AmpC酶大肠埃希菌和肺炎克雷伯菌共检出含qnr基因菌株99株（14．1％）,其中qnrA、qnrB和qnrS的检出率分别为1．1％（8株）、4．0％（28株）和9．5％（67株）,其中3株菌同时含有qnrA和qnrB,1株含qnrB和qnrS。在99株qnr阳性菌株中,有88株（88．9％）检测到至少1种bla基因。20株qnr阳性菌株通过接合试验传递成功。相对于受体菌,接合子对环丙沙星的MIC提高了2～125倍。ERIC—PCR显示99株qnr阳性菌株有不同的DNA条带,提示其可能属于不同的克隆株。结论在702株儿科临床分离产ESBLs或AmpC酶大肠埃希菌和肺炎克雷伯菌中,质粒介导喹诺酮类药物耐药基因qnr携带率为（14．1％）,qnrS为最流行的亚型。88．9％的qnr阳性株携带1种或1种以上bla基因。     

革兰阴性杆菌临床分离株质粒介导喹诺酮类耐药研究

目的了解质粒介导耐药机制在革兰阴性杆菌临床株对喹诺酮类抗菌药耐药性形成中的作用。方法以PCR方法筛选541株连续分离的所有环丙沙星耐药或中介革兰阴性杆菌中的耐药基因qnrA;以接合试验了解喹诺酮耐药的可转移性;对qnrA阳性株测定氨基糖苷乙酰化酶aac(6′)-Ib-cr基因,分析了gyrA和parC基因的喹诺酮耐药决定区的变异。结果541株革兰阴性杆菌中,7株肠杆菌科细菌qnrA检测阳性,其中4株为阴沟肠杆菌,在不发酵糖菌中未检出qnrA基因。在7株qnrA阳性菌中,4株喹诺酮耐药性可通过质粒转移,接合子对环丙沙星的MIC较受体菌上升12～125倍。4个接合子中环丙沙星MIC较高的2个结合子携带aac(6′)-Ib-cr,7株qnrA阳性临床分离菌中5株耐药决定区gyrA、parC有变异。结论qnrA在肠杆菌属临床分离株中的检出率较高,aac(6′)-Ib-cr基因及靶位改变与qnrA同时存在可能使细菌对喹诺酮类的耐药性进一步上升。     

肠杆菌科细菌质粒介导喹诺酮耐药基因qnr的研究

目的 调查武汉大学人民医院分离的肠杆菌科细菌中质粒介导喹诺酮类耐药基因qnrA、qnrB、qnrS基因的现状、基因型以及qnr基因阳性菌株所携带的广谱B内酰胺酶基因型.方法 PCR法对179株肠杆菌科细菌(129株大肠埃希菌、37株肺炎克雷伯菌和13株阴沟肠杆菌)进行qnrA、qnrB、qneS基因检测.KB纸片法检测对15种抗菌药的体外抗菌活性.琼脂平皿二倍稀释法检测阳性菌株对环丙沙星的MIC值.质粒接合试验分析qnrA、qnrB、qnrS基因的水平转移能力.对qnr阳性株,检测Ⅰ类整合酶基因及SHV-1、TEM-1、CTX-M、OXA-Ⅰ、OXA-Ⅱ、OXA-Ⅲ、DHA、EBC型β内酰胺酶基因.结果 179株肠杆菌科细菌中,共检测出含qnr基因阳性菌株25株(13.97%),包括6株(3.35%)含有qnrA基因,9株(5.02%)含有qnrB基因,10株(5.59%)含有qnrS基因.阳性株菌均对亚胺培南敏感且对多种抗生素耐药,其中2株qnrA阳性菌株和4株qnrB阳性菌株对喹诺酮类药物敏感.2株qnrA阳性菌株和4株qnrB及qnrS阳性菌株质粒接合成功.23株qnr阳性株Ⅰ类整合酶基因阳性,1株qnrB及qnrS阳性菌株Ⅰ类整合酶基因阴性,14株菌携带TEM-1型广谱β内酰胺酶基因、6株菌携带OXA-Ⅲ型广谱β内酰胺酶基因、7株菌携带EBC型AmpC酶.结论 湖北地区肠杆菌科细菌中存在qnrA、qnrB、qnrS基因的流行,qnr阳性菌株呈多重耐药,且喹诺酮类敏感菌株中有qnr基因的存在.qnr阳性菌株可携带多种广谱p内酰胺酶基因.     

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.