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心肺复苏术(cardiopulmonary resuscitation, CPR)过程与图示(图)

2015-12-02 网络 MedSci原创

心搏骤停一旦发生,如得不到即刻及时地抢救复苏,4~6min后会造成患者脑和其他人体重要器官组织的不可逆的损害,因此心搏骤停后的心肺复苏(cardiopulmonary resuscitation, CPR)必须在现场立即进行。基础生命支持(basic life support, BLS)又称初步急救或现场急救,目的是在心脏骤停后,立即以徒手方法争分夺秒地进行复苏抢救,以使心搏骤停病人心、脑及全

心搏骤停一旦发生,如得不到即刻及时地抢救复苏,4~6min后会造成患者脑和其他人体重要器官组织的不可逆的损害,因此心搏骤停后的心肺复苏(cardiopulmonary resuscitation, CPR)必须在现场立即进行。

基础生命支持(basic life support, BLS)又称初步急救或现场急救,目的是在心脏骤停后,立即以徒手方法争分夺秒地进行复苏抢救,以使心搏骤停病人心、脑及全身重要器官获得最低限度的紧急供氧(通常按正规训练的手法可提供正常血供的25%—30%)。BLS的基础包括突发心脏骤停(sudden cardiac arrest, SCA)的识别、紧急反应系统的启动、早期心肺复苏(CPR)、迅速使用自动体外除颤仪(automatic external defibrillator, AED)除颤。对于心脏病发作和中风的早起识别和反应也被列为BLS的其中部分。在2010成人BLS指南对于非专业施救者和医务人员都提出了这一要求。BLS步骤由一系列连续评估和动作组成(图3):
图3 成人、儿童和婴儿的关键基础生命支持步骤的总结
基础生命支持步骤基础生命支持步骤
1、评估和现场安全:急救者在确认现场安全的情况下轻拍患者的肩膀,并大声呼喊“你还好吗?”检查患者是否有呼吸。如果没有呼吸或者没有正常呼吸(即只有喘息),立刻启动应急反应系统。BLS程序已被简化,已把“看、听和感觉”从程序中删除,实施这些步骤既不合理又很耗时间,基于这个原因,2010心肺复苏指南强调对无反应且无呼吸或无正常呼吸的成人,立即启动急救反应系统并开始胸外心脏按压。
2、启动紧急医疗服务(emergency medical service, EMS)并获取AED:
(1)如发现患者无反应无呼吸,急救者应启动EMS体系(拨打120),取来AED(如果有条件),对患者实施CPR,如需要时立即进行除颤。
(2)如有多名急救者在现场,其中一名急救者按步骤进行CPR,另一名启动 EMS体系(拨打120),取来AED(如果有条件)。
(3)在救助淹溺或窒息性心脏骤停患者时,急救者应先进行5个周期(2min)的CPR,然后拨打120启动 EMS系统。
3、脉搏检查:对于非专业急救人员,不再强调训练其检查脉搏,只要发现无反应的患者没有自主呼吸就应按心搏骤停处理。对于医务人员,一般以一手食指和中指触摸患者颈动脉以感觉有无搏动(搏动触点在甲状软骨旁胸锁乳突肌沟内)。检查脉搏的时间一般不能超过10秒,如10秒内仍不能确定有无脉搏,应立即实施胸外按压。
4、胸外按压(circulation, C):确保患者仰卧于平地上或用胸外按压板垫于其肩背下,急救者可采用跪式或踏脚凳等不同体位,将一只手的掌根放在患者胸部的中央,胸骨下半部上,将另一只手的掌根置于第一只手上。手指不接触胸壁(图4)。按压时双肘须伸直,垂直向下用力按压,成人按压频率为至少100次/min,下压深度至少为125px,每次按压之后应让胸廓完全回复。按压时间与放松时间各占50%左右,放松时掌根部不能离开胸壁,以免按压点移位。对于儿童患者,用单手或双手于乳头连线水平按压胸骨,对于婴儿,用两手指于紧贴乳头连线下放水平按压胸骨。为了尽量减少因通气而中断胸外按压,对于未建立人工气道的成人,2010年国际心肺复苏指南推荐的按压-通气比率为30:2。对于婴儿和儿童,双人CPR时可采用15:2的比率。如双人或多人施救,应每2分钟或5个周期CPR(每个周期包括30次按压和2次人工呼吸)更换按压者,并在5秒钟内完成转换,因为研究表明,在按压开始1~2分钟后,操作者按压的质量就开始下降(表现为频率和幅度以及胸壁复位情况均不理想)。
胸外按压法于1960年提出后曾一直认为胸部按压使位于胸骨和脊柱之间的心脏受到挤压,引起心室内压力的增加和房室瓣的关闭,从而促使血液流向肺动脉和主动脉,按压放松时,心脏则“舒张”而再度充盈,此即为“心泵机制”。但这一概念在1980年以后受到“胸泵机制”的严重挑战,后者认为按压胸部时胸内压增高并平均地传递至胸腔内所有腔室和大血管,由于动脉不萎陷,血液由胸腔内流向周围,而静脉由于萎陷及单向静脉瓣的阻挡,压力不能传向胸腔外静脉,即静脉内并无血液返流;按压放松时,胸内压减少,当胸内压低于静脉压时,静脉血回流至心脏,使心室充盈,如此反复。不论“心泵机制”或“胸泵机制”,均可建立有效的人工循环。国际心肺复苏指南更强调持续有效胸外按压,快速有力,尽量不间断,因为过多中断按压,会使冠脉和脑血流中断,复苏成功率明显降低。
胸外按压法胸外按压法
5、开放气道(airway, A):在2010年美国心脏协会CPR及ECC指南中有一个重要改变是在通气前就要开始胸外按压。胸外按压能产生血流,在整个复苏过程中,都应该尽量减少延迟和中断胸外按压。而调整头部位置,实现密封以进行口对口呼吸,拿取球囊面罩进行人工呼吸等都要花费时间。采用30:2的按压通气比开始CPR能使首次按压延迟的时间缩短。有两种方法可以开放气道提供人工呼吸:仰头抬颏法(图5)和推举下颌法。后者仅在怀疑头部或颈部损伤时使用,因为此法可以减少颈部和脊椎的移动。遵循以下步骤实施仰头抬颏:将一只手置于患儿的前额,然后用手掌推动,使其头部后仰;将另一只手的手指置于颏骨附近的下颌下方;提起下颌,使颏骨上抬。注意在开放气道同时应该用手指挖出病人口中异物或呕吐物,有假牙者应取出假牙。
仰头举颏法仰头举颏法
6、人工呼吸(breathing, B):给予人工呼吸前,正常吸气即可,无需深吸气;所有人工呼吸(无论是口对口、口对面罩、球囊-面罩或球囊对高级气道)均应该持续吹气1秒以上,保证有足够量的气体进入并使胸廓起伏;如第一次人工呼吸未能使胸廓起伏,可再次用仰头抬颏法开放气道,给予第二次通气;过度通气(多次吹气或吹入气量过大)可能有害,应避免。
实施口对口人工呼吸是借助急救者吹气的力量,使气体被动吹入肺泡,通过肺的间歇性膨胀,以达到维持肺泡通气和氧合作用,从而减轻组织缺氧和二氧化碳潴留。方法为:将受害者仰卧置于稳定的硬板上,托住颈部并使头后仰,用手指清洁其口腔,以解除气道异物,急救者以右手拇指和食指捏紧病人的鼻孔,用自己的双唇把病人的口完全包绕,然后吹气1秒以上,使胸廓扩张;吹气毕,施救者松开捏鼻孔的手,让病人的胸廓及肺依靠其弹性自主回缩呼气,同时均匀吸气,以上步骤再重复一次。对婴儿及年幼儿童复苏,可将婴儿的头部稍后仰,把口唇封住患儿的嘴和鼻子,轻微吹气入患儿肺部。如患者面部受伤则可妨碍进行口对口人工呼吸,可进行口对鼻通气。深呼吸一次并将嘴封住患者的鼻子,抬高患者的下巴并封住口唇,对患者的鼻子深吹一口气,移开救护者的嘴并用手将受伤者的嘴敞开,这样气体可以出来。在建立了高级气道后,每6-8秒进行一次通气,而不必在两次按压间才同步进行(即呼吸频率8-10次/min)。在通气时不需要停止胸外按压。
7、AED除颤:室颤是成人心脏骤停的最初发生的较为常见而且是较容易治疗的心律。对于VF患者,如果能在意识丧失的3-5min内立即实施CPR及除颤,存活率是最高的。对于院外心脏骤停患者或在监护心律的住院患者,迅速除颤是治疗短时间VF的好方法。除颤会在下文作进一步阐述。

心肺复苏术

心肺复苏术

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createdBy=bf8a28807345, createdName=12498cbcm09(暂无昵称), createdTime=Wed Jun 01 18:15:00 CST 2016, time=2016-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792911, encodeId=b1611e929116a, content=<a href='/topic/show?id=bc5e1488893' target=_blank style='color:#2F92EE;'>#pulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14888, encryptionId=bc5e1488893, topicName=pulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Tue Aug 30 18:15:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305368, encodeId=72f013053685e, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416381, encodeId=1e511416381c9, content=<a href='/topic/show?id=628851e7df' target=_blank style='color:#2F92EE;'>#CPR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5177, encryptionId=628851e7df, topicName=CPR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80513165084, createdName=dangious, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=)]
    2016-06-02 aids222
  3. [GetPortalCommentsPageByObjectIdResponse(id=1707515, encodeId=8dc51e0751515, content=<a href='/topic/show?id=9f7c99e256' target=_blank style='color:#2F92EE;'>#IOP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9972, encryptionId=9f7c99e256, topicName=IOP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb031431834, createdName=124987c6m46暂无昵称, createdTime=Mon Jul 25 13:15:00 CST 2016, time=2016-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684412, encodeId=163c16844126b, content=<a href='/topic/show?id=dfae5133e1d' target=_blank style='color:#2F92EE;'>#心肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51337, encryptionId=dfae5133e1d, topicName=心肺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8e128082444, createdName=aids222, createdTime=Thu Jun 02 22:15:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086585, encodeId=589f20865856a, content=<a href='/topic/show?id=6a3640994f' target=_blank style='color:#2F92EE;'>#Cardiopulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4099, encryptionId=6a3640994f, topicName=Cardiopulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Sat Mar 05 12:15:00 CST 2016, time=2016-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793285, encodeId=bdda1e9328546, content=<a href='/topic/show?id=c0e9153e218' target=_blank style='color:#2F92EE;'>#resuscitation#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, 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createdBy=bf8a28807345, createdName=12498cbcm09(暂无昵称), createdTime=Wed Jun 01 18:15:00 CST 2016, time=2016-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792911, encodeId=b1611e929116a, content=<a href='/topic/show?id=bc5e1488893' target=_blank style='color:#2F92EE;'>#pulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14888, encryptionId=bc5e1488893, topicName=pulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Tue Aug 30 18:15:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305368, encodeId=72f013053685e, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, 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  4. [GetPortalCommentsPageByObjectIdResponse(id=1707515, encodeId=8dc51e0751515, content=<a href='/topic/show?id=9f7c99e256' target=_blank style='color:#2F92EE;'>#IOP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9972, encryptionId=9f7c99e256, topicName=IOP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb031431834, createdName=124987c6m46暂无昵称, createdTime=Mon Jul 25 13:15:00 CST 2016, time=2016-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684412, encodeId=163c16844126b, content=<a href='/topic/show?id=dfae5133e1d' target=_blank style='color:#2F92EE;'>#心肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51337, encryptionId=dfae5133e1d, topicName=心肺)], attachment=null, authenticateStatus=null, createdAvatar=null, 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  5. [GetPortalCommentsPageByObjectIdResponse(id=1707515, encodeId=8dc51e0751515, content=<a href='/topic/show?id=9f7c99e256' target=_blank style='color:#2F92EE;'>#IOP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9972, encryptionId=9f7c99e256, topicName=IOP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb031431834, createdName=124987c6m46暂无昵称, createdTime=Mon Jul 25 13:15:00 CST 2016, time=2016-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684412, encodeId=163c16844126b, content=<a href='/topic/show?id=dfae5133e1d' target=_blank style='color:#2F92EE;'>#心肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51337, encryptionId=dfae5133e1d, topicName=心肺)], attachment=null, authenticateStatus=null, createdAvatar=null, 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GetPortalCommentsPageByObjectIdResponse(id=1706033, encodeId=184d1e0603303, content=<a href='/topic/show?id=2d6f51351f7' target=_blank style='color:#2F92EE;'>#心肺复苏术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51351, encryptionId=2d6f51351f7, topicName=心肺复苏术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b08731134886, createdName=dzx0922899, createdTime=Thu Aug 04 13:15:00 CST 2016, time=2016-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1689403, encodeId=a696168940370, content=<a href='/topic/show?id=c48ae043c3' target=_blank style='color:#2F92EE;'>#ESUS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7043, encryptionId=c48ae043c3, topicName=ESUS)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416381, encodeId=1e511416381c9, content=<a href='/topic/show?id=628851e7df' target=_blank style='color:#2F92EE;'>#CPR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5177, encryptionId=628851e7df, topicName=CPR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80513165084, createdName=dangious, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1707515, encodeId=8dc51e0751515, content=<a href='/topic/show?id=9f7c99e256' target=_blank style='color:#2F92EE;'>#IOP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9972, encryptionId=9f7c99e256, topicName=IOP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb031431834, createdName=124987c6m46暂无昵称, createdTime=Mon Jul 25 13:15:00 CST 2016, time=2016-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684412, encodeId=163c16844126b, content=<a href='/topic/show?id=dfae5133e1d' target=_blank style='color:#2F92EE;'>#心肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51337, encryptionId=dfae5133e1d, topicName=心肺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8e128082444, createdName=aids222, createdTime=Thu Jun 02 22:15:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086585, encodeId=589f20865856a, content=<a href='/topic/show?id=6a3640994f' target=_blank style='color:#2F92EE;'>#Cardiopulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4099, encryptionId=6a3640994f, topicName=Cardiopulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Sat Mar 05 12:15:00 CST 2016, time=2016-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793285, encodeId=bdda1e9328546, content=<a href='/topic/show?id=c0e9153e218' target=_blank style='color:#2F92EE;'>#resuscitation#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, 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GetPortalCommentsPageByObjectIdResponse(id=1706033, encodeId=184d1e0603303, content=<a href='/topic/show?id=2d6f51351f7' target=_blank style='color:#2F92EE;'>#心肺复苏术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51351, encryptionId=2d6f51351f7, topicName=心肺复苏术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b08731134886, createdName=dzx0922899, createdTime=Thu Aug 04 13:15:00 CST 2016, time=2016-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1689403, encodeId=a696168940370, content=<a href='/topic/show?id=c48ae043c3' target=_blank style='color:#2F92EE;'>#ESUS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7043, encryptionId=c48ae043c3, topicName=ESUS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf8a28807345, createdName=12498cbcm09(暂无昵称), createdTime=Wed Jun 01 18:15:00 CST 2016, time=2016-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792911, encodeId=b1611e929116a, content=<a href='/topic/show?id=bc5e1488893' target=_blank style='color:#2F92EE;'>#pulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14888, encryptionId=bc5e1488893, topicName=pulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Tue Aug 30 18:15:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305368, encodeId=72f013053685e, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, 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  7. [GetPortalCommentsPageByObjectIdResponse(id=1707515, encodeId=8dc51e0751515, content=<a href='/topic/show?id=9f7c99e256' target=_blank style='color:#2F92EE;'>#IOP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9972, encryptionId=9f7c99e256, topicName=IOP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb031431834, createdName=124987c6m46暂无昵称, createdTime=Mon Jul 25 13:15:00 CST 2016, time=2016-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684412, encodeId=163c16844126b, content=<a href='/topic/show?id=dfae5133e1d' target=_blank style='color:#2F92EE;'>#心肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51337, encryptionId=dfae5133e1d, topicName=心肺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8e128082444, createdName=aids222, createdTime=Thu Jun 02 22:15:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086585, encodeId=589f20865856a, content=<a href='/topic/show?id=6a3640994f' target=_blank style='color:#2F92EE;'>#Cardiopulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4099, encryptionId=6a3640994f, topicName=Cardiopulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Sat Mar 05 12:15:00 CST 2016, time=2016-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793285, encodeId=bdda1e9328546, content=<a href='/topic/show?id=c0e9153e218' target=_blank style='color:#2F92EE;'>#resuscitation#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, 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GetPortalCommentsPageByObjectIdResponse(id=1706033, encodeId=184d1e0603303, content=<a href='/topic/show?id=2d6f51351f7' target=_blank style='color:#2F92EE;'>#心肺复苏术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51351, encryptionId=2d6f51351f7, topicName=心肺复苏术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b08731134886, createdName=dzx0922899, createdTime=Thu Aug 04 13:15:00 CST 2016, time=2016-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1689403, encodeId=a696168940370, content=<a href='/topic/show?id=c48ae043c3' target=_blank style='color:#2F92EE;'>#ESUS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7043, encryptionId=c48ae043c3, topicName=ESUS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf8a28807345, createdName=12498cbcm09(暂无昵称), createdTime=Wed Jun 01 18:15:00 CST 2016, time=2016-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792911, encodeId=b1611e929116a, content=<a href='/topic/show?id=bc5e1488893' target=_blank style='color:#2F92EE;'>#pulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14888, encryptionId=bc5e1488893, topicName=pulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Tue Aug 30 18:15:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305368, encodeId=72f013053685e, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416381, encodeId=1e511416381c9, content=<a href='/topic/show?id=628851e7df' target=_blank style='color:#2F92EE;'>#CPR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5177, encryptionId=628851e7df, topicName=CPR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80513165084, createdName=dangious, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1707515, encodeId=8dc51e0751515, content=<a href='/topic/show?id=9f7c99e256' target=_blank style='color:#2F92EE;'>#IOP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9972, encryptionId=9f7c99e256, topicName=IOP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb031431834, createdName=124987c6m46暂无昵称, createdTime=Mon Jul 25 13:15:00 CST 2016, time=2016-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684412, encodeId=163c16844126b, content=<a href='/topic/show?id=dfae5133e1d' target=_blank style='color:#2F92EE;'>#心肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51337, encryptionId=dfae5133e1d, topicName=心肺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8e128082444, createdName=aids222, createdTime=Thu Jun 02 22:15:00 CST 2016, time=2016-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086585, encodeId=589f20865856a, content=<a href='/topic/show?id=6a3640994f' target=_blank style='color:#2F92EE;'>#Cardiopulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4099, encryptionId=6a3640994f, topicName=Cardiopulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Sat Mar 05 12:15:00 CST 2016, time=2016-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793285, encodeId=bdda1e9328546, content=<a href='/topic/show?id=c0e9153e218' target=_blank style='color:#2F92EE;'>#resuscitation#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, 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GetPortalCommentsPageByObjectIdResponse(id=1706033, encodeId=184d1e0603303, content=<a href='/topic/show?id=2d6f51351f7' target=_blank style='color:#2F92EE;'>#心肺复苏术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51351, encryptionId=2d6f51351f7, topicName=心肺复苏术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b08731134886, createdName=dzx0922899, createdTime=Thu Aug 04 13:15:00 CST 2016, time=2016-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1689403, encodeId=a696168940370, content=<a href='/topic/show?id=c48ae043c3' target=_blank style='color:#2F92EE;'>#ESUS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7043, encryptionId=c48ae043c3, topicName=ESUS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf8a28807345, createdName=12498cbcm09(暂无昵称), createdTime=Wed Jun 01 18:15:00 CST 2016, time=2016-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792911, encodeId=b1611e929116a, content=<a href='/topic/show?id=bc5e1488893' target=_blank style='color:#2F92EE;'>#pulmonary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14888, encryptionId=bc5e1488893, topicName=pulmonary)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Tue Aug 30 18:15:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305368, encodeId=72f013053685e, content=<a href='/topic/show?id=270342e249d' target=_blank style='color:#2F92EE;'>#复苏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416381, encodeId=1e511416381c9, content=<a href='/topic/show?id=628851e7df' target=_blank style='color:#2F92EE;'>#CPR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5177, encryptionId=628851e7df, topicName=CPR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80513165084, createdName=dangious, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=)]
    2016-08-30 pyaili
  9. 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topicList=[TopicDto(id=42724, encryptionId=270342e249d, topicName=复苏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1d01326, createdName=lizhou0204, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416381, encodeId=1e511416381c9, content=<a href='/topic/show?id=628851e7df' target=_blank style='color:#2F92EE;'>#CPR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5177, encryptionId=628851e7df, topicName=CPR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80513165084, createdName=dangious, createdTime=Fri Dec 04 00:15:00 CST 2015, time=2015-12-04, status=1, ipAttribution=)]
    2015-12-04 lizhou0204
  10. 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    2015-12-04 dangious

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