放疗常见副作用及处理方法,看这一篇就够了

2022-05-03 网络 网络

一文理清放疗副作用及应对策略!

放疗是放射治疗的简称,是指利用各类放射线(如:放射性同位素产生的α、β、γ射线和x射线等)局部照射使肿瘤细胞死亡的治疗方法。放疗与手术、化疗一起,被认为是三大传统抗肿瘤治疗方式,有重要的意义。
图片
约70%的癌症病人需要接受放疗,临床上适合放疗的肿瘤类型主要有:鼻咽癌、喉癌、舌癌、扁桃体癌、皮肤癌、恶性脑瘤、食管癌、乳腺癌肺癌、直肠癌、恶性骨肿瘤、肝癌、恶性淋巴瘤等。
放射线在杀灭肿瘤细胞的同时,也会对照射范围内的正常组织造成损伤,此时,就会导致放疗副作用的发生。最常见的放疗副作用包括照射野皮肤损伤、恶心呕吐、发热、外周血象下降、乏力等,此外,由于照射部位不同,还可引发口咽干燥疼痛、放射性肺炎、放射性食管炎、脱发等副作用。
 
放疗的副作用因人而异,与治疗时的放射剂量、部位、患者个体健康情况有关。大多数放疗导致的副作用,会随治疗后时间的延长而缓解及消失。当严重的放疗副作用发生时,患者会有明显的痛苦和不适感,合理的辅助缓解治疗是必要的。接下来将逐一详述常见的放疗副作用及对应的处理方式
一、厌食、恶心呕吐
恶心、呕吐也是肿瘤放疗时常见的副作用之一。大多数是因为放疗引起胃肠功能紊乱,导致患者出现厌食、恶心及呕吐等消化道症状
 
图片
应对策略
 
厌食常为放疗中最早出现的症状之一。如因放疗引起的食欲不振,可服用维生素 B6 及助消化药和开胃药,也可选择食用开胃食品山楂等。
  • 高致吐的化疗方案:常推荐在化疗前采用三药联合方案,包括单剂量的 5-HT3 受体拮抗剂、地塞米松和 NK-1 受体拮抗剂;

     

  • 中度致吐化疗方案:推荐第一天采用 5-HT3 受体拮抗剂联合地塞米松,第 2 和第 3 天继续使用地塞米松;

     

  • 低度致吐化疗方案:建议单一止吐药物如地塞米松、5-HT3 受体拮抗剂或多巴胺受体拮抗剂(如甲氧氯普胺)预防呕吐。

     

  • 同时注意适当补液或静脉营养。输液应注意晶体和胶体比例( 3 : 1)以维持正常生理渗透压。补液不宜过多

上述症状较重、处理效果不佳,可考虑输液或停止放疗。
二、发热
放疗时出现的发热原因较多:
 
  • 与放疗造成的组织损伤有关,肿瘤组织的坏死及吸收会引起体温升高;

     

  • 放疗后免疫功能减退易合并病毒或细菌感染而导致发热;

     

  • 若放疗同时联合化疗、免疫增强治疗,也会引起发热。

因此,当放疗后出现发热时,首先应该寻找病因
 
图片
 
应对策略:
  • 非感染因素导致的发热

  • 体温低于38℃,不必使用退热药物,多饮水、休息,物理降温即可;

  • 体温超过38℃,有明显的全身不适感,应使用解热镇痛药物(如:阿司匹林、吲哚美辛等),同时头部冰敷,物理降温。

  • 感染因素导致的发热:依据血常规、血培养等检查结果,选择敏感的抗生素积极抗感染治疗。若体温超过38.5℃,需使用退烧药;严重的感染,要请感染科会诊后确定治疗方案。

三、外周血象下降
 
造血系统对放射线很敏感,原因是放疗时骨髓内各种造血细胞的分裂繁殖受到抑制,向周围血中释放的成熟细胞(包括白细胞、红细胞和血小板)减少,射线对生成这三种细胞的前体细胞的放射敏感程度是一样的,而白细胞和血小板的寿命很短,因此外周血中计数很快下降,而红细胞的生产时间很长,贫血出现较晚。
 
图片
 
应对策略:
  • 当白细胞小于 3×109/L,血小板小于 70×109/L 时应暂停放疗,升血对症治疗,血象恢复后再开始治疗。

  • 如果白细胞在小于 3×109/L,但大于 2×109/L,血小板小于 70×109/L,但大于 50×109/L时,仍可继续放疗,但应严密监测血细胞的变化。

①白细胞降低:易导致机体感染,严重时会引起败血症,所以白细胞降低时要注意预防感染,不去人员密集的地方,外出戴口罩。轻症时口服升白药,也可使用重组人粒细胞集落刺激因子、成分输血等方式使白细胞数尽快回升。
 
②血小板降低易导致机体有出血倾向,严重时会引起内脏、颅内出血而至死亡,当出现血小板低时,应防止损伤,及时纠正。轻症时口服升血小板药物,或者使用注射用重组人白细胞介素11、重组人血小板生成素注射液等快速升血小板。严重时应行成分输血治疗。
 
③红细胞降低口服补充叶酸、维生素C、铁剂等,也可使用重组人粒细胞集落刺激因子和重组人红细胞生成素增加造血,当血红蛋白(Hb)<70g/L时,需要输血治疗。
四、放射治疗区的皮肤损伤
皮肤损伤是放疗后最常发生的局部副作用之一,主要表现为:皮肤瘙痒、红肿、脱皮,糜烂、溃疡等;好发部位为皮肤薄嫩及多皱褶处,如:颈部、腋下、腹股沟等。
 
图片
 
放射性皮损的发生除了与局部皮肤的解剖结构有关外,还与照射总剂量、分割剂量、总疗程时间、射线种类、外界气候条件及患者的自我保护等因素有关。
 
应对策略:
  • 当照射部位皮肤出现灼烧感、瘙痒感时,可用0.2%冰片淀粉或消毒干燥的滑石粉涂抹患处,保持患处皮肤干燥、透气。不能使用凡士林软膏及湿敷,尽量不用肥皂清洗患处皮肤,忌用力搓擦,抓挠。

     

  • 当照射部位皮肤出现红肿或干性脱皮,应停止照射2-3天待局部受损皮肤恢复,避免皮损进一步发展成为湿性脱皮。

     

  • 当照射部位皮肤出现充血、水肿、渗液、糜烂甚至溃疡时,应暂停放疗。可用氯地霜外敷,或硼酸溶液湿敷,以促进皮损愈合。可用庆大霉素等湿敷,以达到消炎抗感染、加速组织修复的目的。禁用酒精擦拭。

     

  • 对于皮肤破溃合并细菌感染者,若破溃较局限,感染较轻,可外用抗炎药膏,如:红霉素软膏、氯霉素软膏;当感染严重时,需加用静脉抗炎药物,如:青霉素、头孢。

五、口咽疼痛、口干
正常人的唾液由腮腺、颌下腺、舌下腺、尤其是腮腺分泌的,以保持口腔湿润,帮助食物的消化,而患头颈部恶性肿瘤的患者在接受放射治疗时,上述腺体大都在放射野内。在接受了高剂量的放疗后,正常腺体的腺细胞不能分泌足够的唾液,唾液变得少而粘稠,故病人会觉得口干。
应对策略:
  • 轻症时,注意多饮水,进食软饭,可采用雾化治疗(每天两次):0.9%氯化钠20ml、庆大霉素8万单位、氨茶碱针0.25g、地塞米松5mg、糜蛋白酶4000单位。

     

  • 疼痛严重,不能进食者,应静脉补充营养成分,保证机体营养供给,同时给予漱口液。

六、脱发
放疗使用的高能射线穿透能力很强,而人的头颅大小有限,所以射线完全可以穿透。只要头颈部照射野内有头发或射线通过的路径上有头发,那么射线对头发毛囊的生长都会有影响,达到一定剂量后就会引起脱发。
应对策略:
放疗引起脱发为可逆性的,脱发一般发生于首剂化疗后 2-3 周,在停止化疗后 6-8 周再逐渐长出,但每个人长出头发的时间不同,在此期间,若介意脱发的患者可佩带假发或帽子。
七、乏力
 
放疗后乏力、疲劳可能会一直存在,其严重程度多取决于放疗的强度、是否联合化疗等。常表现为精神不振、身体虚弱、困倦。
 
应对策略:
 
大多情况下可不做处理,注意休息、补充营养、提高睡眠质量即可。在伴随抑郁、焦虑等问题的情况下,需在心理科医生指导下开展综合治疗。
八、放射性肺炎
放射性肺炎是由于肺癌、乳腺癌、食管癌、恶性淋巴瘤或胸部其他恶性肿瘤经放射治疗后,在放射野内的正常肺组织受到损伤而引起的炎症反应,常出现在放疗后2-3周,轻者无症状或有刺激性干咳,炎症大多可自行消散;重者会出现高热、胸痛、甚至呼吸困难。发现产生放射性肺炎时,应停止放疗。
应对策略:
  • 对于没有症状的轻度放射性肺炎,多饮水,注意休息,可自行好转。

     

  • 伴随咳嗽、咳痰、喘息、发热等症状时,应及时吸氧,使用糖皮质激素,还可以使用乙酰半胱氨酸或氨溴索等祛痰药物、支气管扩张剂等,合并感染时要加用抗生素。

     

  • 对于严重的呼吸困难,应及时气管切开,呼吸机辅助呼吸。

九、放射性食管炎
食管的鳞状上皮对放射性物质比较敏感,因此,在食管癌、肺癌、纵隔肿瘤的放疗过程中,都有可能发生放射性食管损伤,产生放射性食管炎。当放疗与化疗同时进行时,这种食管损伤会更加严重。
 
食管炎典型的症状为咽下疼痛或胸骨后疼痛。常见于放疗后1周或数周内出现,一般症状较轻。严重者可出现胸部剧痛、发热、呛咳、呼吸困难、呕吐、呕血等,应警惕食管穿孔或食管气管瘘的发生。
应对策略:
  • 应多饮水,选择高热量、高蛋白、高维生素和易消化软饭为饮食。

     

  • 常规药物治疗包括解除食管平滑肌痉挛(硝苯地平、硝酸异山梨酯等),保护食管黏膜(硫糖铝等黏膜保护剂),抑制胃酸,防止酸反流入食管(雷尼替丁、奥美拉唑等)。

     

  • 对症治疗止吐、止血、预防感染,疑有穿孔需禁食、输液、抗感染。

 

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    学习了

    0

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    2022-05-11 jing0309

    感谢分享

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1824387, encodeId=4ec3182438ec5, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Aug 04 09:37:09 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228631, encodeId=f975122863109, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220718/40f20a20ac39449bb9b54f0a56b3bd59/badab63a8f8940b1aa22f908b6cb9dc4.jpg, createdBy=5b9f6414712, createdName=ms5000000275821148, createdTime=Sat Jun 25 18:35:39 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218874, encodeId=83de12188e433, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Wed May 11 21:41:51 CST 2022, time=2022-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216690, encodeId=cb671216690ae, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:45:41 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216671, encodeId=22a012166e177, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15585463183, createdName=ms1000000113638233, createdTime=Tue May 03 23:17:34 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216652, encodeId=24f41216652e5, content=学习,受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Tue May 03 21:37:47 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216640, encodeId=432712166408d, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue May 03 21:01:39 CST 2022, time=2022-05-03, status=1, ipAttribution=)]
    2022-05-04 萌宝嘟嘟

    好东西,谢谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1824387, encodeId=4ec3182438ec5, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Aug 04 09:37:09 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228631, encodeId=f975122863109, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220718/40f20a20ac39449bb9b54f0a56b3bd59/badab63a8f8940b1aa22f908b6cb9dc4.jpg, createdBy=5b9f6414712, createdName=ms5000000275821148, createdTime=Sat Jun 25 18:35:39 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218874, encodeId=83de12188e433, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Wed May 11 21:41:51 CST 2022, time=2022-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216690, encodeId=cb671216690ae, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:45:41 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216671, encodeId=22a012166e177, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15585463183, createdName=ms1000000113638233, createdTime=Tue May 03 23:17:34 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216652, encodeId=24f41216652e5, content=学习,受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Tue May 03 21:37:47 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216640, encodeId=432712166408d, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue May 03 21:01:39 CST 2022, time=2022-05-03, status=1, ipAttribution=)]
    2022-05-03 ms1000000113638233

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1824387, encodeId=4ec3182438ec5, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Aug 04 09:37:09 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228631, encodeId=f975122863109, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220718/40f20a20ac39449bb9b54f0a56b3bd59/badab63a8f8940b1aa22f908b6cb9dc4.jpg, createdBy=5b9f6414712, createdName=ms5000000275821148, createdTime=Sat Jun 25 18:35:39 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218874, encodeId=83de12188e433, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Wed May 11 21:41:51 CST 2022, time=2022-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216690, encodeId=cb671216690ae, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:45:41 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216671, encodeId=22a012166e177, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15585463183, createdName=ms1000000113638233, createdTime=Tue May 03 23:17:34 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216652, encodeId=24f41216652e5, content=学习,受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Tue May 03 21:37:47 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216640, encodeId=432712166408d, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue May 03 21:01:39 CST 2022, time=2022-05-03, status=1, ipAttribution=)]
    2022-05-03 97477_6652

    学习,受益匪浅。

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1824387, encodeId=4ec3182438ec5, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Aug 04 09:37:09 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228631, encodeId=f975122863109, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220718/40f20a20ac39449bb9b54f0a56b3bd59/badab63a8f8940b1aa22f908b6cb9dc4.jpg, createdBy=5b9f6414712, createdName=ms5000000275821148, createdTime=Sat Jun 25 18:35:39 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218874, encodeId=83de12188e433, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Wed May 11 21:41:51 CST 2022, time=2022-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216690, encodeId=cb671216690ae, content=好东西,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d0be2111725, createdName=萌宝嘟嘟, createdTime=Wed May 04 06:45:41 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216671, encodeId=22a012166e177, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15585463183, createdName=ms1000000113638233, createdTime=Tue May 03 23:17:34 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216652, encodeId=24f41216652e5, content=学习,受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Tue May 03 21:37:47 CST 2022, time=2022-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216640, encodeId=432712166408d, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue May 03 21:01:39 CST 2022, time=2022-05-03, status=1, ipAttribution=)]
    2022-05-03 医鸣惊人

    认真学习了

    0

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