手术后病人早期肠内营养并发腹泻怎么办?

2016-08-23 靖江市人民医院普通外科 朱佳莲 南京军区南京总医院普通外科 叶向红 肠外与肠内营养

原题目《手术后病人早期肠内营养并发腹泻的相关因素分析及护理》病人术后机体处于高分解代谢状态,热量消耗增加,体内肌肉和脂肪分解增加,机体处于负氮平衡状态,术后早期肠内营养(EEN)可促进胃肠功能恢复,改善营养代谢,减少并发症的发生。腹泻是EN治疗过程中最常见的胃肠道并发症。EN治疗后72h为病人腹泻的高发时间,少数病人甚至因腹泻而被迫停止治疗,严重者出现脱水、发热、电解质紊乱、肾功能衰竭,甚至死

原题目《手术后病人早期肠内营养并发腹泻的相关因素分析及护理》


病人术后机体处于高分解代谢状态,热量消耗增加,体内肌肉和脂肪分解增加,机体处于负氮平衡状态,术后早期肠内营养(EEN)可促进胃肠功能恢复,改善营养代谢,减少并发症的发生。腹泻是EN治疗过程中最常见的胃肠道并发症。EN治疗后72h为病人腹泻的高发时间,少数病人甚至因腹泻而被迫停止治疗,严重者出现脱水、发热、电解质紊乱、肾功能衰竭,甚至死亡。据报道,在成人病人中,EN 相关腹泻发生率为5%~70%。


肠内营养腹泻的相关因素


1.疾病因素


①低蛋白血症: 血清清蛋白(ALB)是营养状况评价的一个重要指标。胃癌术后病人因低蛋白血症引起血浆渗透浓度降低,导致肠黏膜水肿,影响营养底物通过小肠黏膜上皮细胞。同时,大量液体因渗透浓度差而进入肠腔,引起肠吸收障碍,造成腹泻) 。


②感染:大多数肠道感染均会引发腹泻。当正在接受EN治疗的病人发生腹泻时,应寻找感染源。常见的细菌感染包括难辨梭菌感染和假膜性结肠炎。病毒感染包括巨细胞病毒(CMV)和人类免疫缺陷病毒(HIV)。难辨梭菌是EN最常见的感染因素,也最容易被检测出。此外,营养物输入小肠会增加难辨梭菌感染的危险性,而胃内管饲病人难辨梭菌感染的患病率低,是因为胃酸可拮抗难辨梭菌感染,起到屏障保护的作用。


糖尿病:研究显示,有8%~22%的胰岛素依赖型糖尿病病人(病史超过8年)发生腹泻。其他引起糖尿病病人腹泻的原因包括人工甜剂(如山梨糖醇或木糖醇)的摄入、细菌过度生长、外分泌性胰腺功能不足和胆汁酸所致的导泻作用等。


④乳糖:对乳糖酶缺乏或乳糖不耐受病人使用乳糖时,腹泻发生率高。


2.药物因素


①滥用抗生素。相关研究证实,经EN并接受抗生素治疗的病人中腹泻发生率为20%~50%。引起腹泻的常用抗生素有头孢类抗生素、氨苄青霉素、阿莫西林、克林霉素等。因为使用抗生素可改变肠道内正常菌群的分布,抑制正常菌群对病原微生物的抵抗,造成细菌易位,抵抗力下降。研究发现,滥用抗生素使肠道内的梭状芽胞杆菌增生,产生的毒素导致伪膜性结肠炎,可引发较严重的腹泻。


②药物的渗透性。钾制剂导致EN相关性腹泻亦是其危险因素。临床上将注射用氯化钾加入EN液中或经喂养管推注枸橼酸钾从而导致腹泻。EN不耐受还与服用高渗药物有关。高渗溶液进入小肠导致大量电解质和水进入肠腔,造成腹泻。


③其他药物。有文献报道,抗酸药和胃动力药亦可引发EN治疗病人腹泻。这是因为病人在应用H2受体阻断药和质子泵抑制药时,使胃内pH值升高,改变消化道内环境,使细菌繁殖,引发胃肠内细菌易位,发生肠源性感染。细菌的增殖导致吸收不良,从而加重腹泻。


3.营养液因素


①营养液温度过低,进入胃肠道后损伤正常蠕动功能,可引起腹泻。


②营养液为高渗性饮食时,刺激大量水分进入胃肠道,刺激肠蠕动加速而发生腹泻。


③当营养液中脂肪含量过高或脂肪酸比例失调时,可引起脂肪痢。


④营养液配制时间过长,发生污染可导致腹泻。


⑤鼻饲速度过快,使短时间内大量营养液进入肠道也可导致腹泻。


⑥EN液渗透浓度过高,短期内快速大量输入EN液,肠道内吸收大量液体,产生腹泻。一般标准配方营养液的渗透浓度为225~330mmol/L。>400mmol/L 的营养液可引起渗透性腹泻。


肠内营养并发腹泻的预防


1.早期肠内营养 


在病人胃肠道允许的情况下,可早期进行EN支持。最初可从50ml/d 开始,若病人无不良反应后,在2~3d可达到所需的总量8368kJ(2000kcal)/d。早期喂养腹泻的发生率显著低于7d以后的鼻饲喂养。


2.应用益生菌 


有研究结果发现,应用益生菌干预治疗,可减少EEN腹泻的发生。其主要机制有两个方面: 一是通过肠道内源性防御屏障,提高肠黏膜的通透性和改变肠道微生态,并激活内源性细菌的代谢; 另一方面是通过改善肠黏膜的免疫屏障,减轻肠道免疫球蛋白A(IgA) 反应和消除肠道的炎性反应。


3.应用膳食纤维


膳食纤维在结肠被细菌分解后产生短链脂肪酸,对结肠黏膜的生长和细胞增殖有促进作用,起到防治EN 治疗时腹泻和便秘的作用。


4.应用谷氨酰胺


谷胺酰胺是人体内含量最丰富、具有多种生理功能的条件必需氨基酸,是肠道的主要供能物质。在应激状态下,谷氨酰胺的需要量和利用率迅速增加,是肠上皮细胞和各种迅速生长、分化细胞的主要原料。研究发现,谷氨酰胺呱仑酸钠颗粒(谷氨酰胺含量99%) 联合EN乳剂鼻饲,可改善肠道的免疫功能,提高肠道分泌型IgA的水平,从而减少腹泻的发生。


肠内营养并发腹泻的治疗和护理


1.合理用药


应根据病人的药敏结果选用有针对性的抗生素。有研究显示,接受单种抗生素治疗的病人,腹泻的发生率不明显。但某些特别的抗生素,如氯林霉素、头孢菌素或甲氧苄胺与甲基异恶唑联合使用,是腹泻发生的确定因素。胰岛素依赖型糖尿病病人,或其他原因胰岛功能不全的病人腹泻后,小肠细菌过度生长的危险性高。若该类病人的腹泻是肠道细菌过度生长所致时,Lysy等人推荐试验性地应用抗生素治疗。


2.纠正低蛋白血症 


低蛋白血症或禁食时间较长的病人,可先行PN支持,待血浆蛋白> 35g/L时再给予EN液。若明确腹泻的原因为血浆蛋白减少所致,可给予富含肽类的营养液,也可适当给予外源性清蛋白,以增加胃肠功能。


3.选择合适的营养液


EN混悬液、EN乳剂或针对糖尿病病人的EN乳剂等,渗透浓度为250mmol/L,接近人体的血浆渗透浓度,可减轻对肠道的刺激,从而减少腹泻。同时,对乳糖酶缺乏的病人还可选择低脂肪含量、不含乳糖的营养液。


4.EN实施的监测


对EN治疗的病人应每天检查腹部,监测肠鸣音,并注意病人的不适主诉。若病人出现腹痛、腹胀、腹泻、恶心、呕吐、营养液反流等情况,应立即停止输注EN 液。护士应及时向医师提供病人相关病情记录,迅速查找原因并处理。观察粪便颜色、性状和量,并留取标本行常规检查和培养。观察病人有无皮肤、口唇干燥,尿量减少,血压下降等脱水现象,并协助医师处理。


5.EN输注的护理


控制EN输注的速度、浓度和温度。遵循从少到多,由慢到快,由稀到浓的原则。管饲器、输注管路每24h更换一次,喂养前后冲洗导管。同时做好口腔护理,保持口腔清洁,减少细菌繁殖。每瓶500ml营养液悬挂输注时间不超过8h。营养液开启后立即使用,若暂不输注,需置于冰箱内保存,并在24h内使用,防止细菌污染。

(有删节)


原始出处:


肠外与肠内营养,2016;22(4):254-256

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    2017-05-22 丁鹏鹏
  2. [GetPortalCommentsPageByObjectIdResponse(id=1757728, encodeId=8fad1e57728d9, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon May 22 10:05:00 CST 2017, time=2017-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1997736, encodeId=121a199e736c0, content=<a href='/topic/show?id=f0c059434f3' target=_blank style='color:#2F92EE;'>#早期肠内营养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59434, encryptionId=f0c059434f3, topicName=早期肠内营养)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f65b226, createdName=circumcision, createdTime=Thu Dec 15 19:05:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108826, encodeId=78141088267a, content=学习了,收藏了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160616/IMG5762A3665DC7B3997.jpg, createdBy=df0a1649089, createdName=ys2323, createdTime=Thu Sep 01 11:51:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=104366, encodeId=0ab510436663, content=这篇资讯写的真好,带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Fri Aug 26 10:59:00 CST 2016, time=2016-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=103085, encodeId=7d5d1030852e, content=;这个得记下来了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Aug 24 15:18:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=103086, encodeId=83f510308643, content=值得学习!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Aug 24 15:18:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102540, encodeId=b0b910254004, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160822/IMG57BAFB62DCBFE5970.jpg, createdBy=81de1940731, createdName=红尘笑楚, createdTime=Tue Aug 23 13:23:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102526, encodeId=98dc1025260d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Tue Aug 23 11:23:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102525, encodeId=10d110252577, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Tue Aug 23 11:22:00 CST 2016, time=2016-08-23, status=1, ipAttribution=)]
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    2016-09-01 ys2323

    学习了,收藏了!

    0

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    2016-08-26 李东泽

    这篇资讯写的真好,带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。

    0

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    2016-08-24 1e0d99ddm02(暂无匿称)

    ;这个得记下来了!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1757728, encodeId=8fad1e57728d9, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon May 22 10:05:00 CST 2017, time=2017-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1997736, encodeId=121a199e736c0, content=<a href='/topic/show?id=f0c059434f3' target=_blank style='color:#2F92EE;'>#早期肠内营养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59434, encryptionId=f0c059434f3, topicName=早期肠内营养)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f65b226, createdName=circumcision, createdTime=Thu Dec 15 19:05:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108826, encodeId=78141088267a, content=学习了,收藏了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160616/IMG5762A3665DC7B3997.jpg, createdBy=df0a1649089, createdName=ys2323, createdTime=Thu Sep 01 11:51:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=104366, encodeId=0ab510436663, content=这篇资讯写的真好,带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Fri Aug 26 10:59:00 CST 2016, time=2016-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=103085, encodeId=7d5d1030852e, content=;这个得记下来了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Aug 24 15:18:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=103086, encodeId=83f510308643, content=值得学习!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Aug 24 15:18:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102540, encodeId=b0b910254004, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160822/IMG57BAFB62DCBFE5970.jpg, createdBy=81de1940731, createdName=红尘笑楚, createdTime=Tue Aug 23 13:23:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102526, encodeId=98dc1025260d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Tue Aug 23 11:23:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102525, encodeId=10d110252577, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Tue Aug 23 11:22:00 CST 2016, time=2016-08-23, status=1, ipAttribution=)]
    2016-08-24 1e0d99ddm02(暂无匿称)

    值得学习!!!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1757728, encodeId=8fad1e57728d9, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon May 22 10:05:00 CST 2017, time=2017-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1997736, encodeId=121a199e736c0, content=<a href='/topic/show?id=f0c059434f3' target=_blank style='color:#2F92EE;'>#早期肠内营养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59434, encryptionId=f0c059434f3, topicName=早期肠内营养)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f65b226, createdName=circumcision, createdTime=Thu Dec 15 19:05:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108826, encodeId=78141088267a, content=学习了,收藏了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160616/IMG5762A3665DC7B3997.jpg, createdBy=df0a1649089, createdName=ys2323, createdTime=Thu Sep 01 11:51:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=104366, encodeId=0ab510436663, content=这篇资讯写的真好,带给我们新知识,启发新思维,不论是科研还是临床工作都有很大的帮助。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Fri Aug 26 10:59:00 CST 2016, time=2016-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=103085, encodeId=7d5d1030852e, content=;这个得记下来了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Aug 24 15:18:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=103086, encodeId=83f510308643, content=值得学习!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Aug 24 15:18:00 CST 2016, time=2016-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102540, encodeId=b0b910254004, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160822/IMG57BAFB62DCBFE5970.jpg, createdBy=81de1940731, createdName=红尘笑楚, createdTime=Tue Aug 23 13:23:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102526, encodeId=98dc1025260d, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Tue Aug 23 11:23:00 CST 2016, time=2016-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=102525, encodeId=10d110252577, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Tue Aug 23 11:22:00 CST 2016, time=2016-08-23, status=1, ipAttribution=)]
    2016-08-23 红尘笑楚

    继续学习

    0

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    2016-08-23 doctorJiangchao

    继续关注

    0

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