可乐定对CO2气腹下腹腔镜手术患者应激反应的影响

目的:探讨可乐定对CO2气腹引起的应激反应的影响。方法:30例瑞芬太尼异丙酚靶控输注麻醉及CO2气腹下择期腹腔镜手术患者,分为对照组(C组)、可乐定组(K组),每组各15例。两组患者麻醉前30min肌注阿托品0.5mg及苯巴比妥钠0.1g,其中K组在麻醉前60min另口服可乐定5μg/kg。两组采用相同的瑞芬太尼、异丙酚靶控输注麻醉。观察两组CVP、SpO2、PETCO2、SBP、DBP、MAP变化,并计算各时点的HR和收缩压乘积(RPP)。术毕统计瑞芬太尼和异丙酚总用量。结果:两组一般资料比较无明显差异,两组麻醉方法相同;两组患者麻醉前、气腹后1、5、15、30min之CVP、SpO2、PETCO2数值均无明显差异;与麻醉前值比较,两组在气腹后1minHR、RPP变化及C组在气腹后1cm之血压和在气腹后5min之RPP有较明显升高(P<0.05或P<0.01);两组比较,在气腹后1、5min之RPP变化K组明显低于C组(P<0.05);K组的瑞芬太尼用量明显少于C组(P<0.05);术中应用麻黄碱和阿托品例数K组明显多于C组,但术中需要应用乌拉地尔、苏醒期烦躁不安及术后诉伤口疼痛K组明显少于C组。结论:可乐定对CO2气腹引起的应激反应有明显的抑制作用,并能明显减少瑞芬太尼用量,减少不良反应的发生。     

硬膜外麻醉与全身麻醉下妇科腹腔镜手术病人的血液动力学与血糖变化

目的观察比较硬膜外麻醉和全身麻醉用于妇科腹腔镜手术时患者围麻醉期血流动力学及血糖的变化。方法60例妇科腹腔镜手术病人均分为两组:硬膜外麻醉组(EA组)和全身麻醉组(GA组)。分别于麻醉前、腹压达12mmHg后1min和30min、术毕四个时点监测HR、SBP、DBP、SpO2的变化,并于上述时点测血糖(BS)变化。结果两组手术前后HR无明显变化,在气腹1minEA组HR高于GA组(P<0.01);EA组SBP在气腹30min和术毕均低于麻醉前水平(P<0.05);GA组在气腹后DBP和SBP明显高于麻醉前(P<0.01和P<0.05),DBP直到术毕仍高于麻醉前水平(P<0.05);组间血压比较:气腹后和术毕EA组SBP和DBP明显低于GA组(P<0.05或P<0.01),但维持在正常范围;EA组气腹前后BS的变化无统计学意义(P>0.05),而GA组术毕时BS水平明显高于麻醉前(P<0.05)。结论合适阻滞平面的硬膜外麻醉能较好地消除气腹引起的血压升高和应激反应。     

异丙酚复合瑞芬太尼用于无痛人工流产术的临床观察

目的:比较异丙酚复合瑞芬太尼和单独应用异丙酚用于无痛人工流产术的麻醉效果和对麻醉深度、苏醒时间、呼吸及循环的影响。方法:选择40例拟行无痛人工流产术的患者,ASAⅠ～Ⅱ级,年龄20～40岁,体重45～68kg。分为异丙酚复合瑞芬太尼组(PR组)和异丙酚组(P组)两组,每组各20例。PR组静脉给予瑞芬太尼1μg/kg、异丙酚1.5mg/kg。P组静脉给予异丙酚2mg/kg。肢动反应剧烈时间断追加异丙酚0.5mg/kg。监测SBP、DBP、HR、SpO2及脑电双频指数(BIS)值的变化,记录异丙酚的总剂量、苏醒时间、异丙酚追加次数及呼吸抑制和肢动反应的发生情况。结果:两组SBP、DBP、BIS值给药后均有下降,最低值与给药时、呼之睁眼时比较差异有显著性(P<0.05),PR组BIS最低值显著高于P组(P<0.05)。PR组HR显著减慢,P组HR无明显变化。PR组异丙酚总剂量显著低于P组,苏醒时间显著短于P组(P<0.05)。PR组呼吸抑制的发生率明显高于P组,肢动反应的发生率明显低于P组(P<0.05)。PR组麻醉效果显著优于P组(P<0.05)。结论:异丙酚(1.5mg/kg)复合瑞芬太尼(1μg/kg)用于无...     

靶控输注异丙酚复合瑞芬太尼用于重症肌无力患者胸腺切除时瑞芬太尼最佳切皮浓度的选择

目的探讨重症肌无力患者在不使用肌松药的情况下,靶控输注瑞芬太尼复合异丙酚进行胸腺切除手术,切皮时瑞芬太尼的适宜浓度。方法择期拟行胸腺切除术的重症肌无力患者45例,ASAⅠ或Ⅱ级。麻醉诱导:靶控输注异丙酚和瑞芬太尼,在2%利多卡因进行气管内表面麻醉后行气管插管,进行机械通气。切皮时将患者分为三组,每组15例,设定异丙酚血浆靶浓度为3.5μg/ml,瑞芬太尼效应室靶浓度分别为2ng/ml(R2组)、4ng/ml(R4组)、6ng/ml(R6组)。术中调节异丙酚血浆靶浓度,维持BIS40～60;调节瑞芬太尼效应室靶浓度,维持血压波动幅度在基础血压的20%～30%。术毕拔除气管导管或带管回监护病房。记录切皮前异丙酚及瑞芬太尼用药总量、切皮时患者是否有体动,切皮前和切皮后1min、2min、3min的心率(HR)、收缩压(SBP)、舒张压(DBP)、BIS的数值,麻醉诱导期间和切皮时心血管事件的发生情况。结果切皮时R2组有6例患者体动,与其他两组比较有统计学差异(P<0.05)。血流动力学变化,与切皮前比较R2组切皮后1min的SBP、DBP、HR明显高于切皮前的数值(P<0.05),R6组切皮后2min和3min的SBP及HR明显低于切皮前的数值(P<0.05)。切皮时R6组有3例患者发生心动过缓,对症处理后恢复正常。结论重症肌无力患者在不使用肌松药的情况下,在异丙酚血浆靶浓度为3.5μg/ml时,瑞芬太尼切皮的效应室靶浓度应为4ng/ml。     

瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊手术的血流动力学变化

目的:观察瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊切除术中的血流动力学变化。方法:18例择期腹腔镜胆囊切除术患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级I-II级,入室后即行外周动脉心排量监测,以瑞芬太尼-丙泊酚靶控输注复合芬太尼诱导并维持麻醉至手术结束。分别记录手术期间10个时点的心率(HR),平均动脉压(MAP),收缩压(SBP),舒张压(DBP)和外周动脉心功能指数(APCI)。结果:气腹建立后即刻HR增快,DBP升高,APCI明显下降(P<0.05),5min后,DBP进一步升高(P<0.05),SBP、MAP及APCI逐步恢复至气腹前水平且保持相对稳定。气腹解除后即刻HR减慢、DBP降低和APCI升高(P<0.05);5min后MAP、DBP下降(P<0.05),但仍较气腹前高,而HR及APCI恢复气腹前水平。结论:瑞芬太尼-丙泊酚靶控输注全麻下腹腔镜胆囊切除术中,除气腹建立及解除短时间内血流动力学变化较明显外,术中整体血流动力学维持平稳。     

小剂量瑞芬太尼复合异丙酚用于人工流产术

目的:探讨小剂量瑞芬太尼复合异丙酚静脉麻醉用于人工流产术的临床效果和安全性.方法:选择门诊ASAⅠ～Ⅱ早孕需人工流产者150例,随机分成3组,每组50例.R1组,瑞芬太尼0.5μg/kg持续静注60 s,随后静注异丙酚2.0 mg/kg;R2组,瑞芬太尼1.0μg/kg持续静注60 s,随后静注异丙酚2.0 mg/kg;C组,单用异丙酚2.0 mg/kg诱导,术中维持每次追加异丙酚0.5～1.0 mg/kg.观察麻醉前后SBP、DBP、HR、SpO2的变化,呼吸抑制发生情况,注射痛和术后宫缩痛的发生情况,记录异丙酚总用量、手术时间、术毕呼之睁眼时间、离院时间及不良反应.结果:3组患者诱导后SBP、DBP、HR、SpO2均有所下降,R1、C组呼吸抑制发生率明显低于R2组(P＜0.01);R1、R2组心动过缓、低血压发生率明显高于C组(P＜0.05),注射痛和术后宫缩痛的发生率明显低于C组(P＜0.01),术毕呼之睁眼时间明显短于C组(P＜0.01),异丙酚总用量明显少于C组(P＜0.01).结论:小剂量瑞芬太尼复合异丙酚静脉麻醉用于人工流产术具有麻醉效果好,镇痛作用强,呼吸抑制发生率低,能显著减少异丙酚用量等优点.     

瑞芬太尼持续微泵输注复合小剂量异丙酚用于无痛肠镜的临床观察

目的观察瑞芬太尼持续微泵输注复合小剂量异丙酚用于无痛肠镜检查的麻醉效果和安全性。方法选取无痛肠镜检查患者150例,随机分为3组:瑞芬太尼组(R组)、瑞芬太尼十异丙酚组(RP组)、异丙酚组(P组),每组50例。R组给予瑞芬太尼1.5μg/kg持续静脉注射60 s,随后以0.1μg/(kg.min)持续微泵输注至退出肠镜时停药;RP组给予瑞芬太尼1.0μg/kg持续静脉注射60 s,随后以0.05μg/(kg.min)持续输注至开始退出肠镜时停药,在瑞芬太尼负荷剂量注完后同时静脉注射异丙酚1.0 mg/kg,术中必要时追加异丙酚0.5 mg/kg;P组单纯静脉注射异丙酚1.5 mg/kg持续60 s,术中必要时追加异丙酚0.5～1.0 mg/kg。结果 3组患者的麻醉效果均满意。RP组所用瑞芬太尼用量较R组明显减少(P<0.05),RP组异丙酚用量较P组明显减少(P<0.01)。术中在供氧状态下3组患者脉搏氧饱和度均≥98%。结论 瑞芬太尼用于无痛肠镜麻醉与异丙酚同样安全有效,复合小剂量异丙酚后不仅可显著提高麻醉效果,且可显著减少各自用量。     

异丙酚-瑞芬太尼对妇科腹腔镜手术患者血压、心率的影响

目的 探讨异丙酚-芬太尼在妇科腹腔镜手术患者中的麻醉效果及对收缩压(SBP)、舒张压(DBP)、心率(HR)的影响。方法 选择2017年7月至2020年5月妇科腹腔镜手术患者132例,随机数字表法分为2组,各66例。对照组采用瑞芬太尼联合七氟醚静吸复合麻醉,观察组采用异丙酚复合瑞芬太尼麻醉,术后3 d对患者麻醉效果进行评估,比较两组SBP、DBP、HR水平、术后恢复时间、认知功能、不良反应。结果 两组在麻醉诱导前(T₀)、插管前(T₁)、插管后即刻(T₂)、术毕时(T₃)、拔管时(T₄)时间点SBP、DBP、HR水平均低于T0时间点(P<0.05);观察组T₁、T₂时间点SBP、DBP、HR水平均高于对照组(P<0.05);观察组拔管、自主呼吸恢复、定向力恢复时间均短于对照组(P<0.05);两组拔管后1 h、3 h MMSE评分低于术前(P<0.05);观察组拔管后1 h、3 h及24 h MMSE评分均高于...     

瑞芬太尼在无痛人工流产术中的应用

目的:探讨瑞芬太尼在无痛人工流产术中应用的有效性和安全性。方法:选取准备行无痛人工流产术患者150例,随机分为盐水对照组(N组,n=30)、芬太尼组(F组,n=30)和瑞芬太尼组(R组,n=30)。N组采用0.9%氯化钠 异丙酚,F组采用芬太尼0.5μg/kg 异丙酚,R组采用瑞芬太尼0.5μg/kg 异丙酚,各组异丙酚剂量均为1.5~2.0 mg/kg;记录患者入室时(T1)、诱导后2 min(T2)、术毕时(T3)的生命体征(SBP、HR、SpO2),异丙酚总用量及苏醒时间,围术期恶心、呕吐发生率,麻醉效果优良率,苏醒后3 min时腹痛VAS评分及苏醒后幻觉发生率。结果:(1)F组、R组患者在T2时SBP降低,与T1时相比差异有显著性(P<0.05);T2时F组HR升高、R组HR降低,与T1时相比差异有显著性(P<0.05),3组患者SpO2组内、组间差异均无显著性(P>0.05)。(2)F组、R组麻醉效果优良率显著优于单独使用异丙酚的N组(P<0.05);(3)F组、R组苏醒时间均较N组延长(P<0.05),其中F组苏醒时间最长,但F组与R组苏醒时间之间比较差异无显著性(P>0.05);(4)F组、R组患者术后中重度腹痛发生率明显少于N组(P<0.05)。结论:瑞芬太尼复合异丙酚用于无痛人工流产术可以获得良好的麻醉效果,但瑞芬太尼组与芬太尼组各指标相比差异均无显著性,因此瑞芬太尼在小剂量时不能很好地体现出其短效、速效等优点。     

靶控输注异丙酚复合舒芬太尼或瑞芬太尼在神经外科手术中的比较

目的：比较靶控输注异丙酚复合舒芬太尼或瑞芬太尼全静脉麻醉在神经外科手术中的麻醉效果以及术后麻醉恢复情况。方法：将46例神经外科择期手术病人分为两组。以血浆药物浓度为靶浓度,靶控输注舒芬太尼（PS组,n=23）0.4～0.8μg/L或瑞芬太尼（PR组,n=23）2～4μg/L后,逐步升高异丙酚靶浓度至3～4mg/L,视术中情况调整舒芬太尼或瑞芬太尼靶浓度维持麻醉平稳,观察收缩压（SBP）、舒张压（DBP）、心率（HR）以及麻醉恢复情况。结果：麻醉诱导后PS组输注异丙酚后SBP、DBP、HR下降（P〈0.05）;PR组病人SBP、DBP均降低（P〈0.05）,HR降低明显（P〈0.01）。气管插管、切皮及术中血流动力学稳定。术后2hPS组病人平稳。PR组躁动发生率为13%。结论：神经外科手术中靶控输注异丙酚复合舒芬太尼或瑞芬太尼全静脉麻醉均能达到满意的麻醉效果,舒芬太尼麻醉血流动力学稳定,恢复平稳。[著者文摘]     

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.