立体定向手术对难治性精神分裂症患者血浆高香草酸含量的影响

目的探讨立体定向术对难治性精神分裂症患者中枢多巴胺代谢产物血浆高香草酸(pHVA)的影响。方法立体定向术治疗难治性精神分裂症患者48例,以阳性和阴性症状量表(PANSS)评定手术疗效。荧光分光光度法测定手术前后患者pHVA。结果难治性精神病患者手术治疗前,其pHVA含量〔(1.39±0.30)μmol/L〕与对照组含量〔(1.28±0.53)μmol/L〕的差异无显著性(P>0.05),而手术治疗后pHVA含量〔(0.61±0.13)μmol/L〕明显低于治疗前(P<0.01)。手术前患者组pHVA含量与PANSS阳性症状评分〔(18.6±4.4)分〕呈正相关(r=0.42,P<0.01)。治疗前后pHVA含量差值〔(0.79±0.33)μmol/L〕与PANSS阳性症状评分减分值〔(10.4±5.5)分〕呈正相关(r=0.69,P<0.01)。结论立体定向手术可显著降低难治性精神分裂症患者pHVA,基础pHVA含量及治疗前后pHVA水平的变化与临床立体定向手术疗效有明显的相关性。     

重症急性胰腺炎肺损伤与肺微循环及炎症介质变化的相关性研究

目的　探讨重症急性胰腺炎 (SAP)时肺损伤与肺微循环、血清白介素 - 1β(IL - 1β)及磷脂酶A2 (PLA2 )变化的关系。方法　SD大鼠 6 4只 ,随机分成对照组与SAP组。 5 %牛磺胆酸钠胰腺被膜下均匀注射制成SAP模型。采用放射性生物微球技术在制模后 2h及 12h分别测定肺血流量 ,同时观察血清IL - 1β水平与PLA2 活性及肺组织学改变。结果　SAP组制模后 2h、12h肺血流量〔(2 75± 0 4 4 )、(2 4 3± 0 4 2 )mL·min-1·g-1〕均较对照组〔(3 5 5± 0 5 1)、(3 5 1± 0 37)mL·min-1·g-1〕明显降低 (P =0 0 0 4、0 0 0 0 ) ;血清IL - 1β〔(0 78± 0 13)、(0 83± 0 2 0 ) μg/L〕、PLA2 〔(94 2 9± 9 96 )、(10 3 71± 14 4 0 )U/L〕均较对照组〔(0 32± 0 0 6 )、(0 33± 0 0 7) μg/L ,(6 5 2 7± 10 5 2 )、6 6 6 3± 9 81)U/L〕明显增高 (P均 =0 0 0 0 ) ;肺组织学损伤在 2h、12h均较对照组明显加重 (P =0 0 0 4、0 0 0 1)。SAP后 2h、12h肺损伤与肺血流量、血清IL - 1β及PLA2 均密切相关 (P =0 0 4 4～ 0 0 0 1)。结论　SAP大鼠肺微循环障碍和IL - 1β、PLA2 的过度激活是造成SAP肺损伤的重要原因。     

多器官功能障碍综合征患者外周血白三烯B4与血小板活化因子乙酰水解酶的变化

目的探讨多器官功能障碍综合征(MODS)患者外周血中白三烯B4(LTB4)与血小板活化因子乙酰水解酶(PAF-AH)活性变化的临床意义。方法对26例MODS患者进行病情评分,并用ELISA法检测血清中LTB4含量与PAF-AH活性,与12例健康体检者对照。同时比较MODS患者MODS的评分与外周血LTB4及PAF-AH的相互关系,以及比较MODS组死亡患者与存活患者的MODS评分、外周血LTB4含量及PAF-AH活性。结果MODS患者血清中LTB4含量(923·96±308·65)ng/L与健康对照组(2453·31±400·93)ng/L比较,差异有显著性(P<0·01);而MODS患者血清PAF-AH活性(7·60±4·41)μmol/(min·L)与健康对照组(7·42±1·23)μmol/(min·L)比较,则差异无显著性(P>0·05)。MODS组中死亡患者血清LTB4含量(444·98±206·30)ng/L与存活患者血清LTB4含量(1334·51±530·35)ng/L比较,差异有显著性(P<0·01);PAF-AH活性(10·04±4·11)μmol/(min·L)与存活患者(5·16±3·32)μmol/(min·L)有显著性差异(P<0·01)。且MODS患者的MODS评分与外周血LTB4含量之间有明显的负相关性(P<0·01)。结论MODS重症患者病情复杂,LTB4与PAF-AH活性变化不一,它们可能共同参与了MODS的病理生理过程,能作为反映MODS患者病情的监测指标之一。     

慢性肾功能不全患者血清超氧化物歧化酶与谷胱甘肽过氧化物酶变化的意义

本文旨在通过直接测定肾功能不全各阶段SOD及GSH-Px的含量来探讨其变化与临床的关系。 1 材料与方法 1.1 临床资料 正常对照组为某单位体检后的健康人员32例,年龄23～65岁;慢性肾功能不全53例,为我院住院患者。根据肾功能不全分类方法,将其分为4组,其中肾贮备能力丧失期组14例〔血清BUN(7.34±3.86)mmol/L,Cr(126.63±31.42)μmol/L〕;氮质血症期组10例〔血清BUN(11.76±4.23)mmol/L,Cr(188.62±36.33)μmol/L〕;肾功能衰竭期组14例〔血清BUN(25.23±10.44)mmol/L,Cr(562.40±220.11)μmol/L〕;尿毒症期组15例〔血清BUN(31.46±10.28)mmol/L,Cr(1022.36±320.43)μmol/L〕。     

血肿消对高血压性脑出血患者的预防性肾保护作用

目的 :研究中西医结合方法对高血压性脑出血的预防性肾保护作用。方法 :采用随机方法 ,将 90例高血压性脑出血患者分为血肿消加多巴胺组、多巴胺组、普通内科组 ,每组 30例。 3组甘露醇用法相同 (2 5 0 m l,6 h 1次 ) ,其他常规治疗相同。前两组分别加用血肿消和多巴胺 ,连用 2 8d。观察 3组患者的临床疗效、脑血肿吸收率、治疗前后的肾功能变化和急性肾损害发生率。结果 :3组间临床疗效、肾功能损害发生率均有明显差异(P均 <0 .0 5 ) ,血肿消加多巴胺组总有效率 96 .6 7% ,治疗后血尿素氮 (5 .72± 0 .5 8) mm ol/ L,血肌酐 (91 .0 0±2 0 .1 1 ) μmol/ L,肾损害发生率 3.33% ,病死率 0 ,优于多巴胺组〔分别为 90 .0 0 %、(6 .90± 5 .35 ) m mol/ L、(98.31± 37.6 6 ) μmol/ L、6 .6 7%和 0〕,多巴胺组优于普通内科组〔分别为 6 3.33%、(7.80± 3.6 7) m mol/ L、(1 4 8.6 2± 4 2 .0 2 ) μmol/ L、2 6 .6 6 %和 6 .6 7%〕。血肿吸收率 3组分别为 (95 .6 0± 1 6 .2 1 ) %、(87.1 0± 1 2 .70 ) %和 (76 .35± 1 4 .36 ) % ,P<0 .0 5。结论 :血肿消能有效预防甘露醇所致的肾损害 ,可促进血肿吸收 ,提高临床治愈率 ,降低病死率 ;合用多巴胺效果更好     

急性呼吸窘迫综合征患者血清和支气管肺泡灌洗液中白介素-1β的变化

目的 :探讨白细胞介素 1β(IL 1β)在急性呼吸窘迫综合征 (ARDS)发病中的作用。方法 :用酶联免疫吸附试验检测了 13例 ARDS患者和 9例健康者支气管肺泡灌洗液 (BAL F)和血清中 IL 1β含量。结果 :ARDS患者 BAL F及血清中 IL 1β含量〔分别为 (14 4 .6 7± 80 .79) ng/ L 和 (4 5 .71± 7.0 9) ng/ L〕明显高于对照组〔分别为 (2 0 .39± 1.87) ng/ L 和 (35 .0 6± 5 .4 6 ) ng/ L,P=0 .0 0 0和 P=0 .0 0 1〕,且 ARDS患者 BAL F中IL 1β含量也明显高于血清 (P=0 .0 0 0 )。结论 :IL 1β参与了 ARDS的发病过程 ,早期测定 ARDS患者肺内细胞因子可能比血液或血浆中更有价值。     

B-型利钠肽在早期心力衰竭患者中的临床意义

目的　探讨心力衰竭 (HF)患者血浆B -型利钠肽 (BNP)的水平变化及在早期HF患者中的临床应用价值。方法　 6 8例HF患者 (NYHAⅠ～Ⅳ )均行超声心动图检查并取肘静脉血 ,用ELISA方法测定血浆BNP水平。结果　HF患者NY HAⅢ～Ⅳ级血浆BNP水平与Ⅰ～Ⅱ级比较有显著性差异〔(0 .5 5± 0 .1 1 )vs (0 .35± 0 .1 3)pg/L〕且Ⅰ～Ⅱ级患者血浆BNP水平明显高于对照组〔(0 .35± 0 .1 3)vs (0 .0 6± 0 .0 2 )pg/L ,P <0 .0 0 1〕。LVEF≤ 4 0 %患者血浆BNP水平明显高于LVEF >4 0 %患者〔(0 .5 3± 0 .1 2 )vs (0 .34± 0 .1 7)pg/L ,P <0 .0 0 1〕。LVEDD≥ 6 0mm患者明显高于LVEDD <6 0mm者〔(0 .5 3± 0 .1 5 )vs (0 .4 7±0 .1 2 )pg/L ,P <0 .0 0 1〕。结论　心衰患者血浆BNP水平是早期心功能受损的敏感指标 ,与心功能指标NYHA、LVEDD、LVEF有明显的相关性 ,其中与NYHA更相关 ,对HF患者的早期诊断具有重要的临床价值     

不同程度慢性肾功能不全患者体内氧化损伤状态的研究

目的 :观察不同程度的慢性肾功能不全 (CRI)患者体内脂质过氧化物和抗氧化酶活性的改变 ,探讨氧化损伤状态和抗氧化系统变化在 CRI发病机制中的作用 ,以及它们与肾功能改变的关系。方法 :采用化学比色法 ,对 36例 CRI患者、12例血液透析患者和 16例正常人的血清丙二醛 (MDA)、谷胱甘肽过氧化物酶(GSH Px)及血清超氧化物歧化酶 (SOD)的含量进行了检测。结果 :36例 CRI患者、12例血液透析患者的血清 MDA水平均明显高于正常对照组〔(4.0 6± 0 .6 7) μmol/ L〕,有显著性差异 (P<0 .0 1) ;GSH Px均明显低于正常对照组〔(12 0 .6 3± 2 7.5 7)× 10 4 U/ L〕,有显著性差异 (P<0 .0 1) ,血清 SOD亦明显高于正常对照组〔(110 .30± 18.6 0 ) k NU / L〕,有显著性差异 (P<0 .0 1)。 36例 CRI患者 SOD、GSH Px和 MDA含量与内生肌酐清除率 (CCr)均呈密切相关 (r G=0 .6 8,P<0 .0 1;r M=0 .5 2 ,P<0 .0 1;r S=0 .4 4 ,P<0 .0 5 )。结论 :自由基、脂质过氧化损伤和抗氧化系统的缺陷在慢性肾功能不全的发病机制中起重要作用 ,并且与肾功能的改变密切相关 ,这些酶活性还可作为临床判断病情严重程度的指标。     

充血性心力衰竭患儿心肌β肾上腺素能受体系统在心室重塑中作用的研究

Objective To study the role of myocardium βadrenoreceptor pathway in ventricu lar remodeling of children with congestive heart failure (CHF).MethodsPlasma concentrations of norepinephrine (NE) and epinephrine (E) were measured b y high performance liquid chromatography electrochemistry detection ( HPLCED) in 18 children with CHF.βadrenergic receptor density (Bmax) of lympho cyte was de termined by³Hdihydroalpneolol (³H-DHA) as ligand, and left ventricle mass index (LVMI) by echocardiogram.ResultsPlasma NE and E levels were significantly increased 〔（520.1±187.3） μg/L and (294.1±178.4）μg/L〕,and the Bmax was decreased 〔（378. 7± 97.2）fmol/10⁶〕 in normal LVMI patients compared with the controls 〔（ 189.3±92.4）μg/L,(94.5±45.1）μg/L,and (568.2±101.8）f mol/10⁶，all P<0.001〕.Also,the Bmax decreased more significantly i n patients with abnormal LVMI than that in normal LVMI patients 〔（268.5± 85.6）fmol/10⁶ vs.(378.7±97.2）fmol/10⁶〕,and that was signific antly negatively correlated with LVMI (r=－0.69，P<0.01).ConclusionsPlasma NE and E levels,as well as Bmax of lymphocytes may be useful parameters t o reflect the severity of heart dysfunction in patients with CHF.The regulation of myocardium βadrenoreceptor pathway is earlier than the patho logic structura l change of left ventricular remodeling.It is sugested that remodeling of LV mig ht be regulated by myocardial βadrenoreceptor pathway.     

急性冠脉综合征患者血清C-反应蛋白浓度的变化及意义

目的　研究急性冠脉综合征 (ACS)患者血清C -反应蛋白 (CRP)浓度水平并与对照组比较 ,探讨CRP是否为ACS的一种危险因子。方法　测定ACS患者和对照组血清CRP浓度 ,同时检测冠心病的常见危险因子并与CRP一起做Logis tic回归分析。结果　①ACS患者血清CRP浓度〔(18.5 0± 2 3.98)mg/L(SE 2 .5 1,n =91)〕显著高于对照组〔(3.89± 7.14 )mg/L(SE 0 .5 1,n =194 )〕 (P <0 .0 1)。②急性心肌梗死 (AMI)急性期患者CRP浓度〔(18.6 5± 2 4 .12 )mg/L〕和不稳定型心绞痛(UAP)CRP浓度〔(17.95± 2 4 .10 )mg/L〕显著高于正常对照组、稳定型心绞痛 (SAP)CRP浓度〔(3.94± 7.5 0 )mg/L〕、AMI患者恢复期〔(5 .93± 13.0 7)mg/L〕和陈旧性心肌梗死 (OMI)患者〔(4 .5 7± 8.2 7)mg/L〕(均P <0 .0 1) ;SAP患者、AMI患者恢复期和OMI患者之间CRP浓度无差别 (P >0 .0 5 ) ,并与正常人群比较无显著性差别 (P >0 .0 5 )。③每增加CRP 5mg/L ,ACS发生危险增加到近 2倍 (用Logistic回归 ,OR =1.6 5 ) ,故CRP是ACS一种潜在决定因子。结论　血清CRP浓度升高与ACS有极大的相关性 ,并提出CRP是ACS的一种新的危险因子。     

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.