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规避手术室不良事件攻略

2015-05-25 MedSci MedSci原创

手术室不良事件棉球
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手术室是医院实施手术和抢救病人的重要科室，在手术室护理工作中，任何疏忽都可能造成病人的死亡、残疾、组织器官损伤等严重后果。而通常情况下，其中很多问题是可以预防的。案例一：消失的沙带一例术前诊断急性、阑尾穿孔的病人，晚上入手术室行剖腹探查术。因为考虑是阑尾穿孔，所以洗手护士只安排实习同学上台洗手，其间添加纱布5块。术中探查发现为肠病变（克隆病），需行肠切除。于是巡回护士通知副班护士过来加班。副班护士


手
术室是医院实施手术和抢救病人的重要科室，在手术室护理工作中，任何疏忽都可能造成病人的死亡、残疾、组织器官损伤等严重后果。而通常情况下，其中很多问题是可以预防的。

案例一：消失的沙带

一例术前诊断急性、阑尾穿孔的病人，晚上入手术室行剖腹探查术。因为考虑是阑尾穿孔，所以洗手护士只安排实习同学上台洗手，其间添加纱布5块。术中探查发现为肠病变（克隆病），需行肠切除。于是巡回护士通知副班护士过来加班。副班护士上台后又加5块，加上原有的，台上纱布总共为20块。关腹前清点用物时发现一块盐水纱布上的纱带不见了。医生重新进腹腔寻找，找了二次仍无结果，大家共同参与查找仍然未见纱带，最后常规关腹，病人返回病房。
教训
1.实习学生不能单独上台行洗手护士职责，必须有带教老师的指导和监督，这个案例中，无论实习同学有无过错，带教老师都需负一定责任。

2.有些岗位的执业人员工作不负责任。分析那根纱带遗留可能不在病人的腹腔内，因为“医生重新进腹腔寻找，找了二次仍无结果”，这时的医生的“寻找”应该是非常认真的，没找着，说明不在腹腔内。可能是厂家的产品质量有缺陷，纱带开始就不在纱布上。但折叠纱布和打包的人却没有发现，且洗手巡回护士在清点用物时也没发现就使这成了无头案。

3.对这类事件的处理，最好就是预防其发生，清点用物时仔细检查有无纱布带的却无、松动，上台的物品，洗手护士要做到心中有数，取出腹腔时要及时检查，以及时发现问题。

4.本案例中存在术中更换洗手护士的情况，实际工作中这种情况还比较普遍，例如人员的临时调动、术中的换饭等等，就存在了很多安全隐患，例如本案例中纱布交接存在的问题，使用中的纱布、脑棉等物品有时就不能详细交接。所以对较大的手术、用物多且复杂的手术应避免洗手护士术中的更换，对不可避免的更换，必须严格执行术中的交接班制度，加强加班者和接班者的责任心，明确所承担的责任，以避免不良事件的发生。
案例二：遗漏的棉球

一位下肢截肢的病人，医生用线锯截段断胫骨后，骨髓腔出血严重，医生用一个棉球添塞住了骨髓腔，为的是减少手术中出血，然后进行其他的操作，各部位清理完成，冲洗刀口，缝合，可是他们都忘记了那骨髓腔内的棉球，手术顺利完成，可是术后患者一直发烧，刀口愈合不良，找不出来原因，后来病人去了上级医院，重新打开了刀口探察，发现了那个棉球，已经几个月过去了，一场医疗事故纠纷不可避免的发生了。

教训
1.现在胃肠道手术中我们还是使用碘伏棉球消毒胃肠道切口残端，一些耳鼻喉科的手术还使用纱球或棉球止血或擦拭血液。

2.一些医院使用的棉球没有清点数量，只是强调洗手护士要督促医生及时将用了的棉球交还护士，由护士扔进污物盆里。而一些医院要求清点棉球，污染的棉球由巡回护士在台下整理后清点，有效避免了棉球的遗漏。

3.手术室护士在手术中重要的是加强责任心和防范意识，一个办法是，每次提供一个消毒棉球时都用钳子夹好，使用后连同钳子一起归还，尽量避免棉球单独上台，特别是体积比较小的消毒棉球，钳子夹住比较醒目，不易遗忘。同时保证每次只上台一个棉球，使用后跟换。巡回护士也要及时提醒。
案例三：不见的管帽

夜班来了一例剖腹探查病人，术中证实为乙状结肠肿瘤，即行乙状结肠癌根治术并常规放置皮管引流。引流放好后医生要求马上连接引流袋。当时护士正在做关腹前清点工作，于是医生直接从器械台上拿走了引流袋连接引流管。护士在关腹后再次清点时，突然想起引流袋的帽子没有取回，急问医生。医生说没看见（合格的引流袋包装，接头处都有一个相连的盖帽）。手术台上寻找不到，只好重新探查腹腔，结果仍未找到。手术延迟了1个多小时，最后由医生签字关腹。
教训
1.医生直接从器械台上拿用物，护士应提醒他们这样做可能会造成清点时出错，直接让他们拿回来。对于引流袋，都应由洗手护士亲自递给医生，如果当时没空给他们的话，会让他们先用血管钳夹闭，上面的小帽由洗手护士扔进污物盆里或和巡回护士一起清点。如果当时是在清点东西，可以清点完某一样物品后马上提供引流袋，再接着点其他的物品，不至让医生等太久。

2.医生直接拿走手术用物，洗手护士没有来得及查看及清点，双方都有责任，作为手术医生，对于物品清点的重要性应该有很清楚的意识，而洗手护士在手术台上应该尽量避免差错的发生。

3.医疗差错事故处理办法中规定，由于寻找手术物品影响手术进行超过30分钟者应定为差错。如 “物品在体内找到主要责任由医生承担” ，“物品在体外找到主要责任由护士承担”。这明确表明了在手术物品管理中，医生、护士的责任缺一不可，并且护士重点负责手术切口外的物品管理，医生重点负责切口内或体内，确保填塞的手术用物如数取出。但在实际工作中，物品不齐往往认为是护士的责任，清点物品是由巡回护士和洗手护士清点，忽略了手术医生在手术物品管理中的责任。本案例应该算是差错，虽然责任归护士不合理，但出了这种事，护士和医生都应承担责任。
案例四：病理标本混淆

患者刘某今日8:00在联合麻下行全子宫切除术，患者王某于今日8:00在全麻下行胆囊切除术，手术同时结束，切下的病理标本，洗手护士让实习生装袋并固定，由于实习生对病理标本不熟悉，，误将两人的标本装错袋内，送入病理科做出的结果与手术病人切下的标本不符。
原因分析
因手术快到下班时间，只想着手术赶快结束，切下的病理标本没及时装袋，标本袋也没注明床号、姓名、标本名称、住院号，带实习生时没有做到放手不放眼，让实习生单独去操作。

防范措施
1.洗手护士在配合手术过程中，要集中精力，凡在手术患者体内取下的组织，器官与患者疾病有关的物体、异物等均视为手术标本，洗手护士负责术中妥善保管切下的标本，术后与手术医师核对无误后装袋并固定，并检查标本袋姓名、标本名称、住院号是否齐全准确，无误后存放柜内并做好登记，每日下午由洗手护士与病检单和标本袋上标签逐一核对无误后及时送病理科。

2.带教实习生时必须要有责任心，做到放手不放眼，实习生没有单独操作的权力。
案例五：气压止血带使用不当

一例三踝内固定手术，使用气压止血带。术中止血带共使用3次。压力均为80kpa。时间分别为60分钟/60分钟/30分钟。充气间隔时间分别为8分钟、5分钟。由于手术不顺利，耗用时间较长，巡回护士建议止血带间隔15分钟后充气，没有得到医生同意。术后包扎病人时发现大腿受压处有水泡。
讨论
1. 医生明显违反操作规程，护士应该怎么做？

2. 护士应如何和医生在术中及时沟通？沟通无效时护士应该怎么做？

3. 发生这样的差错，护士应该承担责任吗？
教训
1.医生违反操作规程，护士有权利提醒和拒绝，就如病房医生开错医嘱，我们有监督的权利和义务，如果医嘱错误，护士照旧执行，出了问题还是护士的错误，因为我们是最后的执行者。手术室护士有权制止，若是医生强行要操作时应及时通知护士长或更高层的管理人员，更好的保护自己。

2.护士应在术中止血带离放气10分钟前及时与医生沟通，让其有所准备与处理，做好伤口局部加压止血，准备好充足的纱布等物品，放松止血带并等待，并强调自己的理由，举具体实例来提醒他们注意避免发生意外。沟通无效时，护士应该向护士长报告。护士长及时出面协调，再不行，只能逐级上报！病人安全第一。

3.这个事情如果病人追究，若是护士依照医生说的去做而不制止的话，护士应承担一定责任，一是口头医嘱，你没有证据保护自己；二我们自己知道操作原则，明知道违反而不拒绝，我们肯定有责任。若医生不听护士劝告而自行操作，责任不在于护士。

4.检讨当时绑扎止血带时，是否平整，是否有异物附着于皮肤，止血带压力是否过大？

5.工作中也存在这样的情况，巡回护士忘记计时或忘记提醒医生定时放止血带，如果因此发生不良后果，护士也必须承担一定责任，这就必须加强护士的责任心，提高安全意识。

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    2016-01-11 medsic

    嗯，

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=55761, encodeId=cfb955e617c, content=嗯，, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55762, encodeId=4d0655e6226, content=不错，, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55763, encodeId=394555e6352, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55764, encodeId=2bb955e649f, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55765, encodeId=af8e55e65e0, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55766, encodeId=6b1255e66ba, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42864, encodeId=17d742864ea, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42865, encodeId=a2a842865e7, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1647956, encodeId=32cb164e95619, content=<a href='/topic/show?id=53725440e91' target=_blank style='color:#2F92EE;'>#手术室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54407, encryptionId=53725440e91, topicName=手术室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be3923540900, createdName=yankaienglish, createdTime=Mon Nov 16 22:12:00 CST 2015, time=2015-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32129, encodeId=af8e32129cb, content=好好活着才能造福更多病人——, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhRUzmFEmHvdIaOns4DmF3BicVffXjkOjBTiaMUIA4o7feGvE5IJ0SfSco4ib955Rx7bvWlib7j9V15xp/0, createdBy=814d1631326, createdName=cmn, createdTime=Thu Jul 09 20:51:00 CST 2015, time=2015-07-09, status=1, ipAttribution=)]
    2016-01-11 medsic

    不错，

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=55761, encodeId=cfb955e617c, content=嗯，, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55762, encodeId=4d0655e6226, content=不错，, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55763, encodeId=394555e6352, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55764, encodeId=2bb955e649f, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55765, encodeId=af8e55e65e0, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55766, encodeId=6b1255e66ba, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42864, encodeId=17d742864ea, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42865, encodeId=a2a842865e7, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1647956, encodeId=32cb164e95619, content=<a href='/topic/show?id=53725440e91' target=_blank style='color:#2F92EE;'>#手术室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54407, encryptionId=53725440e91, topicName=手术室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be3923540900, createdName=yankaienglish, createdTime=Mon Nov 16 22:12:00 CST 2015, time=2015-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32129, encodeId=af8e32129cb, content=好好活着才能造福更多病人——, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhRUzmFEmHvdIaOns4DmF3BicVffXjkOjBTiaMUIA4o7feGvE5IJ0SfSco4ib955Rx7bvWlib7j9V15xp/0, createdBy=814d1631326, createdName=cmn, createdTime=Thu Jul 09 20:51:00 CST 2015, time=2015-07-09, status=1, ipAttribution=)]
    2016-01-11 medsic

    实用，

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=55761, encodeId=cfb955e617c, content=嗯，, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55762, encodeId=4d0655e6226, content=不错，, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55763, encodeId=394555e6352, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55764, encodeId=2bb955e649f, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55765, encodeId=af8e55e65e0, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55766, encodeId=6b1255e66ba, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42864, encodeId=17d742864ea, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42865, encodeId=a2a842865e7, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1647956, encodeId=32cb164e95619, content=<a href='/topic/show?id=53725440e91' target=_blank style='color:#2F92EE;'>#手术室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54407, encryptionId=53725440e91, topicName=手术室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be3923540900, createdName=yankaienglish, createdTime=Mon Nov 16 22:12:00 CST 2015, time=2015-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32129, encodeId=af8e32129cb, content=好好活着才能造福更多病人——, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhRUzmFEmHvdIaOns4DmF3BicVffXjkOjBTiaMUIA4o7feGvE5IJ0SfSco4ib955Rx7bvWlib7j9V15xp/0, createdBy=814d1631326, createdName=cmn, createdTime=Thu Jul 09 20:51:00 CST 2015, time=2015-07-09, status=1, ipAttribution=)]
    2016-01-11 medsic

    实用，

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=55761, encodeId=cfb955e617c, content=嗯，, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55762, encodeId=4d0655e6226, content=不错，, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55763, encodeId=394555e6352, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55764, encodeId=2bb955e649f, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55765, encodeId=af8e55e65e0, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55766, encodeId=6b1255e66ba, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42864, encodeId=17d742864ea, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42865, encodeId=a2a842865e7, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1647956, encodeId=32cb164e95619, content=<a href='/topic/show?id=53725440e91' target=_blank style='color:#2F92EE;'>#手术室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54407, encryptionId=53725440e91, topicName=手术室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be3923540900, createdName=yankaienglish, createdTime=Mon Nov 16 22:12:00 CST 2015, time=2015-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32129, encodeId=af8e32129cb, content=好好活着才能造福更多病人——, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhRUzmFEmHvdIaOns4DmF3BicVffXjkOjBTiaMUIA4o7feGvE5IJ0SfSco4ib955Rx7bvWlib7j9V15xp/0, createdBy=814d1631326, createdName=cmn, createdTime=Thu Jul 09 20:51:00 CST 2015, time=2015-07-09, status=1, ipAttribution=)]
    2016-01-11 medsic

    感谢分享～

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=55761, encodeId=cfb955e617c, content=嗯，, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55762, encodeId=4d0655e6226, content=不错，, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55763, encodeId=394555e6352, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55764, encodeId=2bb955e649f, content=实用，, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55765, encodeId=af8e55e65e0, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55766, encodeId=6b1255e66ba, content=感谢分享～, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 13:24:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42864, encodeId=17d742864ea, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42865, encodeId=a2a842865e7, content=很受用, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=97111661967, createdName=懒惰小姐, createdTime=Sun Nov 08 21:38:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1647956, encodeId=32cb164e95619, content=<a href='/topic/show?id=53725440e91' target=_blank style='color:#2F92EE;'>#手术室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54407, encryptionId=53725440e91, topicName=手术室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be3923540900, createdName=yankaienglish, createdTime=Mon Nov 16 22:12:00 CST 2015, time=2015-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32129, encodeId=af8e32129cb, content=好好活着才能造福更多病人——, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhRUzmFEmHvdIaOns4DmF3BicVffXjkOjBTiaMUIA4o7feGvE5IJ0SfSco4ib955Rx7bvWlib7j9V15xp/0, createdBy=814d1631326, createdName=cmn, createdTime=Thu Jul 09 20:51:00 CST 2015, time=2015-07-09, status=1, ipAttribution=)]
    2016-01-11 medsic

    感谢分享～

    0

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    2015-11-08 懒惰小姐

    很受用

    0

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    2015-11-08 懒惰小姐

    很受用

    0

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    2015-11-16 yankaienglish

    #手术室#

    0

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    2015-07-09 cmn

    好好活着才能造福更多病人——

    0

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