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《急性心衰院前和院内早期管理指南》发布及要点

2015-05-29 大鹏 译 医学论坛网

5月21日,《欧洲心脏杂志》(European Heart Journal)刊发了由欧洲心脏学会(ESC)心力衰竭委员会、欧洲急诊治疗学会和流行病学急诊治疗学会联合制定的《急性心力衰竭院前和院内早期的管理指南》(简短版本). 一、急性心衰早期诊疗指南之病房治疗要点 病房治疗及ICU/CCU治疗要点 1.若患者存在显著呼吸困难或血流动力学不稳定状态,应将患者安置于可立即开展心肺复

5月21日,《欧洲心脏杂志》(European Heart Journal)刊发了由欧洲心脏学会(ESC)心力衰竭委员会、欧洲急诊治疗学会和流行病学急诊治疗学会联合制定的《急性心力衰竭院前和院内早期的管理指南》(简短版本).

一、急性心衰早期诊疗指南之病房治疗要点

病房治疗及ICU/CCU治疗要点

1.若患者存在显著呼吸困难或血流动力学不稳定状态,应将患者安置于可立即开展心肺复苏的场所。

2.急性心衰患者需针对性专科护理及诊疗。

3.推荐高危患者入CCU专科治疗,另外急性心衰伴急性冠脉综合征患者亦需转诊入CCU治疗,具体内容如下:

临床风险评估可辅助确定患者急诊之后是否需最高水平入院诊疗;

急诊特定评估法可进一步确定患者是否需要入ICU/CCU;

入ICU标准包括呼吸频率>25、SaO2<90%、存在辅助肌呼吸现象、收缩压<90mmHg;

需转诊ICU标准包括需气管插管(或已插管)或低灌注征象,后者包括少尿、四肢厥冷、精神状态异常、乳酸>2mmol/L、代谢性酸中毒及SvO2<65%。

4.若患者进入ICU/CCU治疗,其后续治疗(ICU/CCU之外的治疗)尽可能在心内科病房完成。

5.应设置急性心衰患者绿色通道。

院内监测注意事项

1.患者需每天称重,并有准确的体液平衡记录表。

2.给予标准无创监测,指标包括脉搏、呼吸频率和血压。

3.每天检测肾功能及电解质情况;

4.出院前检测钠尿肽有助于制定出院后治疗方案。

出院标准及高危患者随访

1.下列急性心衰患者符合出院标准:

出院前24小时血流动力稳定、容量正常、有循证医学口服治疗且肾功能正常;

已被告知自我护理相关内容。

2.对于出院的急性心衰患者,应做到以下几点:

入组疾病管理系统;

出院一周内主治医生随访;

如有条件,出院两周内心脏病学的团队随访。

3.慢性心衰患者应给与多专科心衰随访。

心源性休克诊疗要点

1.心源性休克定义为尽管积极补液,但仍存在低血压(SBP<90 mmHg)及低灌注的疾病表现。

2.对于疑似心源性休克的患者,应立即进行心电图及心脏超声检查。

3.需动脉导管有创监测。

4.监测心源性休克患者血流动力学状态的最佳方式尚无定论。

5.如果患者无容量负荷,推荐溶液冲击作为一线疗法。

6.可使用多巴酚丁胺增加心输出量,可考虑左西孟坦,尤适用于口服β受体阻滞剂的慢性心衰患者。

7.无特殊情况,可使用血管加压药,去甲肾上腺素优于多巴胺。

8.及时转诊至专科机构。

9.不推荐给予主动脉球囊扩张。

10.难治性心源性休克可考虑短期机械循环治疗,且暂不确定何种机械循环更优。

二、急性心衰院前及院内早期管理指南之药物和机械治疗要点篇

病房治疗及ICU/CCU治疗要点

1.若患者存在显著呼吸困难或血流动力学不稳定状态,应将患者安置于可立即开展心肺复苏的场所。

2.急性心衰患者需针对性专科护理及诊疗。

3.推荐高危患者入CCU专科治疗,另外急性心衰伴急性冠脉综合征患者亦需转诊入CCU治疗,具体内容如下:

临床风险评估可辅助确定患者急诊之后是否需最高水平入院诊疗;

急诊特定评估法可进一步确定患者是否需要入ICU/CCU;

入ICU标准包括呼吸频率>25、SaO2<90%、存在辅助肌呼吸现象、收缩压<90mmHg;

需转诊ICU标准包括需气管插管(或已插管)或低灌注征象,后者包括少尿、四肢厥冷、精神状态异常、乳酸>2mmol/L、代谢性酸中毒及SvO2<65%。

4.若患者进入ICU/CCU治疗,其后续治疗(ICU/CCU之外的治疗)尽可能在心内科病房完成。

5.应设置急性心衰患者绿色通道。

院内监测注意事项

1.患者需每天称重,并有准确的体液平衡记录表。

2.给予标准无创监测,指标包括脉搏、呼吸频率和血压。

3.每天检测肾功能及电解质情况;

4.出院前检测钠尿肽有助于制定出院后治疗方案。

出院标准及高危患者随访

1.下列急性心衰患者符合出院标准:

出院前24小时血流动力稳定、容量正常、有循证医学口服治疗且肾功能正常;

已被告知自我护理相关内容。

2.对于出院的急性心衰患者,应做到以下几点:

入组疾病管理系统;

出院一周内主治医生随访;

如有条件,出院两周内心脏病学的团队随访。

3.慢性心衰患者应给与多专科心衰随访。

心源性休克诊疗要点

1.心源性休克定义为尽管积极补液,但仍存在低血压(SBP<90 mmHg)及低灌注的疾病表现。

2.对于疑似心源性休克的患者,应立即进行心电图及心脏超声检查。

3.需动脉导管有创监测。

4.监测心源性休克患者血流动力学状态的最佳方式尚无定论。

5.如果患者无容量负荷,推荐溶液冲击作为一线疗法。

6.可使用多巴酚丁胺增加心输出量,可考虑左西孟坦,尤适用于口服β受体阻滞剂的慢性心衰患者。

7.无特殊情况,可使用血管加压药,去甲肾上腺素优于多巴胺。

8.及时转诊至专科机构。

9.不推荐给予主动脉球囊扩张。

10.难治性心源性休克可考虑短期机械循环治疗,且暂不确定何种机械循环更优。

三、急性心衰院前及院内早期管理指南之入院诊断篇

急性心衰院前及早期治疗策略

1.若急性心衰患者出现急性冠脉综合征,应秉承“及时治疗”理念治疗。所有急性心衰患者均应尽早接受适宜的治疗

2.对于处于院前阶段的急性心衰患者,下列措施能带来治疗收益:

尽早开展无创监测(如急救车内),包括脉搏血氧饱和度、血压、呼吸频率及连续心电监测等;

若患者氧饱和度<90%,氧疗法应纳入常规治疗,除此之外的情况均需根据临床诊断决定是否氧疗;

给予呼吸窘迫患者无创通气;

根据患者血压情况和/或充血程度决定是否给予药物治疗,一般考虑血管扩张剂、利尿剂;

尽快转诊至附近有完备心内科和/或CCU/ICU的大中型医院。

3.一旦患者进入急诊/CCU/ICU,需立即同时开展体检、调查及治疗工作。

如何完善入院临床评估及临床调查

1.对于疑似急性心衰患者,首先根据患者呼吸困难程度、血流动力学状态及心律判断患者心肺功能不稳定严重度,需记录以下检测结果:

呼吸困难严重度,包括呼吸频率、是否能仰卧、呼吸力度及缺氧程度;

血压(舒张期及收缩期);

心律及心率;

体温情况,是否存在低灌注征象(如四肢阙冷、脉压变窄或精神淡漠)。

2.继续评估患者是否存在充血,包括外周水肿情况、是否有啰音、静脉压是否升高等。

3.可能用到的额外检测:

心电图,虽然急性心衰患者很少有正常表现,但可以鉴别诊断ST段抬高型心电图;

实验室检查(见下);

床旁胸部超声,诊断是否有间质水肿,腹部超声检查下腔静脉直径及水肿情况;

胸片,鉴别诊断。

4.除非患者出现血流动力学不稳定状态,否则多数不需要起始超声心动检查,但需在后续检测中开展。

5.尽量避免导尿术。

急性心衰实验室检查

1.所有患者均需检查血浆钠尿肽水平(BNP、 NT-proBNP或 MR-proANP)以鉴别非心因性呼吸困难。

2.入院患者取血后应立即完成下列检测:肌钙蛋白、BUN(或尿素)、肌酐、电解质、血糖和全血细胞计数。

3.疑似急性肺栓塞需D-二聚体检测;

4.除非有特殊需要,否则不需常规动脉血气检查。

心衰诊治评估流程图



下载原文PDF:

Recommendations on pre-hospital and earlyhospital management of acute heart failure: aconsensus paper from the Heart FailureAssociation of the European Society of Cardiology,the European Society of Emergency Medicine andthe Society of Academic Emerge

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    2016-02-26 1de49f9bm57(暂无匿称)

    原则性的概述,个体化的治疗,纠正病因、去除诱因是关键,急则治其标,缓则治其本。

    0

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  3. [GetPortalCommentsPageByObjectIdResponse(id=65798, encodeId=def165e98ee, content=原则性的概述,个体化的治疗,纠正病因、去除诱因是关键,急则治其标,缓则治其本。, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a18f1686707, createdName=1de49f9bm57(暂无匿称), createdTime=Fri Feb 26 21:29:00 CST 2016, time=2016-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1936285, encodeId=b96c1936285fe, content=<a href='/topic/show?id=daa1e60387b' target=_blank style='color:#2F92EE;'>#管理指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76038, encryptionId=daa1e60387b, topicName=管理指南)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Wed Jun 17 14:46:00 CST 2015, time=2015-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769933, encodeId=a08f1e6993395, content=<a href='/topic/show?id=51469830949' target=_blank style='color:#2F92EE;'>#院前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98309, encryptionId=51469830949, topicName=院前)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5ca38130612, createdName=mhzhuang@stu.e, createdTime=Sun Jan 10 09:46:00 CST 2016, time=2016-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25543, encodeId=4fb92554371, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1359772, encodeId=75b41359e728f, content=<a href='/topic/show?id=5aa95229085' target=_blank style='color:#2F92EE;'>#急性心衰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52290, encryptionId=5aa95229085, topicName=急性心衰)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1378804, encodeId=c59913e880402, content=<a href='/topic/show?id=eae2594251f' target=_blank style='color:#2F92EE;'>#早期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59425, encryptionId=eae2594251f, topicName=早期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25335, encodeId=f92925335ec, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Fri May 29 22:29:00 CST 2015, time=2015-05-29, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=65798, encodeId=def165e98ee, content=原则性的概述,个体化的治疗,纠正病因、去除诱因是关键,急则治其标,缓则治其本。, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a18f1686707, createdName=1de49f9bm57(暂无匿称), createdTime=Fri Feb 26 21:29:00 CST 2016, time=2016-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1936285, encodeId=b96c1936285fe, content=<a href='/topic/show?id=daa1e60387b' target=_blank style='color:#2F92EE;'>#管理指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76038, encryptionId=daa1e60387b, topicName=管理指南)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Wed Jun 17 14:46:00 CST 2015, time=2015-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769933, encodeId=a08f1e6993395, content=<a href='/topic/show?id=51469830949' target=_blank style='color:#2F92EE;'>#院前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98309, encryptionId=51469830949, topicName=院前)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5ca38130612, createdName=mhzhuang@stu.e, createdTime=Sun Jan 10 09:46:00 CST 2016, time=2016-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25543, encodeId=4fb92554371, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1359772, encodeId=75b41359e728f, content=<a href='/topic/show?id=5aa95229085' target=_blank style='color:#2F92EE;'>#急性心衰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52290, encryptionId=5aa95229085, topicName=急性心衰)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1378804, encodeId=c59913e880402, content=<a href='/topic/show?id=eae2594251f' target=_blank style='color:#2F92EE;'>#早期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59425, encryptionId=eae2594251f, topicName=早期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25335, encodeId=f92925335ec, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Fri May 29 22:29:00 CST 2015, time=2015-05-29, status=1, ipAttribution=)]
    2015-05-31 huaxipanxing

    看看

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=65798, encodeId=def165e98ee, content=原则性的概述,个体化的治疗,纠正病因、去除诱因是关键,急则治其标,缓则治其本。, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a18f1686707, createdName=1de49f9bm57(暂无匿称), createdTime=Fri Feb 26 21:29:00 CST 2016, time=2016-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1936285, encodeId=b96c1936285fe, content=<a href='/topic/show?id=daa1e60387b' target=_blank style='color:#2F92EE;'>#管理指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76038, encryptionId=daa1e60387b, topicName=管理指南)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Wed Jun 17 14:46:00 CST 2015, time=2015-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769933, encodeId=a08f1e6993395, content=<a href='/topic/show?id=51469830949' target=_blank style='color:#2F92EE;'>#院前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98309, encryptionId=51469830949, topicName=院前)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5ca38130612, createdName=mhzhuang@stu.e, createdTime=Sun Jan 10 09:46:00 CST 2016, time=2016-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25543, encodeId=4fb92554371, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1359772, encodeId=75b41359e728f, content=<a href='/topic/show?id=5aa95229085' target=_blank style='color:#2F92EE;'>#急性心衰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52290, encryptionId=5aa95229085, topicName=急性心衰)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1378804, encodeId=c59913e880402, content=<a href='/topic/show?id=eae2594251f' target=_blank style='color:#2F92EE;'>#早期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59425, encryptionId=eae2594251f, topicName=早期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25335, encodeId=f92925335ec, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Fri May 29 22:29:00 CST 2015, time=2015-05-29, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=65798, encodeId=def165e98ee, content=原则性的概述,个体化的治疗,纠正病因、去除诱因是关键,急则治其标,缓则治其本。, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a18f1686707, createdName=1de49f9bm57(暂无匿称), createdTime=Fri Feb 26 21:29:00 CST 2016, time=2016-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1936285, encodeId=b96c1936285fe, content=<a href='/topic/show?id=daa1e60387b' target=_blank style='color:#2F92EE;'>#管理指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76038, encryptionId=daa1e60387b, topicName=管理指南)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Wed Jun 17 14:46:00 CST 2015, time=2015-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769933, encodeId=a08f1e6993395, content=<a href='/topic/show?id=51469830949' target=_blank style='color:#2F92EE;'>#院前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98309, encryptionId=51469830949, topicName=院前)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5ca38130612, createdName=mhzhuang@stu.e, createdTime=Sun Jan 10 09:46:00 CST 2016, time=2016-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25543, encodeId=4fb92554371, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1359772, encodeId=75b41359e728f, content=<a href='/topic/show?id=5aa95229085' target=_blank style='color:#2F92EE;'>#急性心衰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52290, encryptionId=5aa95229085, topicName=急性心衰)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1378804, encodeId=c59913e880402, content=<a href='/topic/show?id=eae2594251f' target=_blank style='color:#2F92EE;'>#早期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59425, encryptionId=eae2594251f, topicName=早期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25335, encodeId=f92925335ec, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Fri May 29 22:29:00 CST 2015, time=2015-05-29, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=65798, encodeId=def165e98ee, content=原则性的概述,个体化的治疗,纠正病因、去除诱因是关键,急则治其标,缓则治其本。, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a18f1686707, createdName=1de49f9bm57(暂无匿称), createdTime=Fri Feb 26 21:29:00 CST 2016, time=2016-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1936285, encodeId=b96c1936285fe, content=<a href='/topic/show?id=daa1e60387b' target=_blank style='color:#2F92EE;'>#管理指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76038, encryptionId=daa1e60387b, topicName=管理指南)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Wed Jun 17 14:46:00 CST 2015, time=2015-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769933, encodeId=a08f1e6993395, content=<a href='/topic/show?id=51469830949' target=_blank style='color:#2F92EE;'>#院前#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98309, encryptionId=51469830949, topicName=院前)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5ca38130612, createdName=mhzhuang@stu.e, createdTime=Sun Jan 10 09:46:00 CST 2016, time=2016-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25543, encodeId=4fb92554371, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1359772, encodeId=75b41359e728f, content=<a href='/topic/show?id=5aa95229085' target=_blank style='color:#2F92EE;'>#急性心衰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52290, encryptionId=5aa95229085, topicName=急性心衰)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1378804, encodeId=c59913e880402, content=<a href='/topic/show?id=eae2594251f' target=_blank style='color:#2F92EE;'>#早期管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59425, encryptionId=eae2594251f, topicName=早期管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat May 30 23:46:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25335, encodeId=f92925335ec, content=很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Fri May 29 22:29:00 CST 2015, time=2015-05-29, status=1, ipAttribution=)]
    2015-05-29 Jiangyh0406

    很有用

    0

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