高血压的终身治疗方案(建议收藏)

2017-01-11 佚名 《中国慢性疾病防治基层医生诊疗手册》

临床上90%以上的高血压患者均属于原发性高血压,难以确定其确切病因。对于此类患者,目前尚无根治方法,因此多数患者需要终身治疗。1 高血压患者的血压管理按照我国现行的高血压防治指南,一般高血压患者应在4~12周内将血压控制在140/90mmHg以下;合并糖尿病、肾病、既往有心肌梗死或脑卒中病史的患者,若其能够耐受应将其血压控制在130/80mmHg以下;年龄≥65岁的老年高血压患者可将收缩压降至

临床上90%以上的高血压患者均属于原发性高血压,难以确定其确切病因。对于此类患者,目前尚无根治方法,因此多数患者需要终身治疗。

1 高血压患者的血压管理

按照我国现行的高血压防治指南,一般高血压患者应在4~12周内将血压控制在140/90mmHg以下;合并糖尿病、肾病、既往有心肌梗死或脑卒中病史的患者,若其能够耐受应将其血压控制在130/80mmHg以下;年龄≥65岁的老年高血压患者可将收缩压降至150mmHg以下,如能耐受还可进一步降低。

积极改善生活方式适合于每位高血压患者,应被视为控制高血压的基石。有效地改善生活方式可能使血压下降10~20mmHg,可以使部分轻度血压增高者免于服用降压药物。对于血压显著升高、必须服药治疗的患者,改善生活方式则有助于增进降压药物的疗效、减少所需药物的剂量与种类。

2 选择降压药物应该考虑哪些因素

目前常用的降压药物主要有以下5类:利尿剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)、钙通道阻滞剂(CCB)以及β受体阻滞剂(BB)。由于α受体阻滞剂(如哌唑嗪、特拉唑嗪等)不良反应较多,并且靶器官保护作用较差,所以不再用作一线降压药物,但在某些患者(如难治性高血压、妊娠高血压、前列腺增生症者)仍可考虑使用。

若患者血压增高幅度较小(<160/100mmHg),起始治疗可选用一种降压药物。若治疗2~4周后血压控制不满意,可以考虑联合用药。如果患者血压就诊时明显升高(超过目标值20/10mmHg以上),初始治疗即应选择2种降压药或选用新型固定复方制剂,这是因为在一般情况下单药治疗的最大降压幅度约为20/10mmHg,此时应用一种药物很难使血压达标。临床研究证实,大多数患者需要联合应用降压药物。

联合用药的基本原则是作用机制互补、降压作用相加、不良反应抵销。我国高血压防治指南推荐以下6种联合用药方案作为首选:ACEI与利尿剂,ARB与利尿剂,ACEI与二氢吡啶类CCB,ARB与二氢吡啶类CCB,二氢吡啶类CCB与利尿剂,二氢吡啶类CCB与BB。

一般不宜联合使用的组合包括:ACEI与ARB,ACEI与BB,ARB与BB,非二氢吡啶类CCB与BB,中枢降压药物与BB。这些组合方式或不能起到降压效果相加的作用,或容易发生严重不良反应,故应避免。部分患者经过两种药物联合治疗后血压仍不能达标,可考虑3种药物联合,此时ACEI/ARB与二氢吡啶类CCB和利尿剂的组合方式适合于大多数患者。

3 哪些患者需要转上级医院诊治?

患者是否坚持进行了有效的生活方式干预?如前所述,减轻体重与限制食盐摄入量是降低血压的有效措施。如果患者不能有效改善生活方式,可能会在很大程度上降低降压药物的疗效。经过上述处理后若患者血压仍不能满意控制,应建议患者去上级医院或高血压专科进一步诊治。

以下患者病情较复杂或危重,应考虑转诊:

①难治性高血压;

②疑诊继发性高血压患者往往需要特殊检查或治疗措施;

③高血压合并心脏、脑、肾脏、外周血管等严重疾患(例如不稳定性心绞痛、心肌梗死、心力衰竭、脑梗死或脑出血、肾衰竭、动脉闭塞性脉管炎等)时;

④高血压急症和亚急症。高血压急症是指血压严重升高(一般>180/120mmHg)并伴发进行性靶器官损害的表现,如高血压脑病、颅内出血、急性心肌梗死、急性左心功能衰竭、不稳定性心绞痛、主动脉夹层等;高血压亚急症是指血压严重升高但不伴靶器官损害。

紧急处理措施主要包括静脉应用降压药物(如硝普钠、硝酸甘油、乌拉地尔等),使患者血压尽快降低,但每小时血压下降不超过25%,并在以后的2~6h内将血压降至约160/(100~110)mmHg。急性缺血性卒中患者不宜紧急降低血压,应迅速转诊。很多医生常为患者舌下含服硝苯地平(心痛定)治疗高血压急症和亚急症,这是很危险的做法,可因血压迅速而显著的降低而导致心绞痛、心肌梗死或脑卒中,故不应采用这种给药方法。

老年高血压常以收缩压增高为主要表现,舒张压不高甚至偏低,即单纯收缩期高血压。因此在降压治疗时应强调收缩压达标,同时避免舒张压过度降低。老年高血压患老年高血压与妊娠期高血压者的血压应降至150/90mmHg以下,如能耐受可降至140/90mmHg以下。若患者表现为单纯收缩期高血压,当舒张压<60mmHg时,如收缩压<150mmHg,可暂不用降压药物治疗;如收缩压150~179mmHg,可谨慎用小剂量降压药;如收缩压≥180mmHg,则用小剂量降压药;

妊娠期高血压主要包括两种类型,即妊娠期高血压疾病与妊娠合并慢性高血压。这里的高血压是指两次测量收缩压≥140mmHg和/或舒张压≥90mmHg,且至少相隔6h。妊娠合并慢性高血压是指妊娠20周前(包括未妊娠时)所发生的高血压。这两种类型的高血压处理原则基本相同。血压轻度升高的孕妇(血压<150/100mmHg)可密切观察,暂不应用降压药物治疗。只有当收缩压≥150mmHg和/或舒张压≥100mmHg或出现靶器官受损时方考虑应用药物治疗。

4 高血压合并其他疾病时如何降压?

当高血压患者同时存在糖尿病或慢性肾病时,应更为积极地控制血压。此类患者的血压目标值为<130/80mmHg。对于高龄、一般健康状况较差、存在明显靶器官损害的患者,其目标值可放宽至<140/90mmHg。在药物选择方面,应首选ARB或ACEI,必要时可联合CCB或噻嗪类利尿剂。

病情稳定的卒中患者的血压控制目标为<140/90mmHg,降压药物可选择利尿剂、CCB、ACEI/ARB单用或联合应用。但高龄患者、双侧颈动脉或颅内动脉严重狭窄患者、严重体位性低血压患者应谨慎降压治疗。此时降压药应从小剂量开始,密切观察血压水平与不良反应,根据患者耐受性调整降压药及其剂量。

在出现头晕等明显不良反应时,应减少剂量或停用降压药。尽可能将血压控制在安全范围(160/100mmHg内)。急性卒中患者的降压治疗策略较为复杂,建议转上级医院。

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    2017-02-14 1e0d9c7am75(暂无匿称)

    严谨一点啊!贝塔受体阻滞影响的是啥系统?

    0

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    2017-01-12 匿名用户

    百普乐和萘哌地尔博帝联用,为啥没人提出,雪莲可以降低高尿酸,代表产品香港中科的酸速清,北京协和制药厂的双环醇片可以引起大量皮疹,藏药青鹏软膏轻松搞定,建议增加结核病方面的信息,目前感染率太吓人,医院停车位都堆满了车。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1904978, encodeId=1c5b19049e85f, content=<a href='/topic/show?id=21f66464823' target=_blank style='color:#2F92EE;'>#治疗方案#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64648, encryptionId=21f66464823, topicName=治疗方案)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ee4187, createdName=zhangjiqing, createdTime=Tue Aug 15 15:19:00 CST 2017, time=2017-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805460, encodeId=ae6a1805460d7, content=<a href='/topic/show?id=a35fe8201ee' target=_blank style='color:#2F92EE;'>#终身治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78201, encryptionId=a35fe8201ee, topicName=终身治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49cf452, createdName=xsm918, createdTime=Fri Apr 28 08:19:00 CST 2017, time=2017-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176061, encodeId=61c61e6061dc, content=严谨一点啊!贝塔受体阻滞影响的是啥系统?, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9d1934723, createdName=1e0d9c7am75(暂无匿称), createdTime=Tue Feb 14 09:08:24 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169907, encodeId=f8ee16990e0b, content=百普乐和萘哌地尔博帝联用,为啥没人提出,雪莲可以降低高尿酸,代表产品香港中科的酸速清,北京协和制药厂的双环醇片可以引起大量皮疹,藏药青鹏软膏轻松搞定,建议增加结核病方面的信息,目前感染率太吓人,医院停车位都堆满了车。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=, createdTime=Thu Jan 12 20:01:55 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169770, encodeId=e8f6169e7073, content=笔者很用心,为我们总结了各种高血压用药方案,??, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160814/IMG57B04B04A03228221.jpg, createdBy=622a1684503, createdName=蜗小牛的天空, createdTime=Thu Jan 12 07:47:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169584, encodeId=4354169584fb, content=收藏吧,虽然看不太懂, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Jan 11 13:24:18 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169559, encodeId=e5bd169559a3, content=特别的好,收藏起来, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Jan 11 10:57:27 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169552, encodeId=ddf1169552a9, content=收藏了,好文,值得点赞,值得收藏,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jan 11 10:27:40 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
    2017-01-12 蜗小牛的天空

    笔者很用心,为我们总结了各种高血压用药方案,??

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1904978, encodeId=1c5b19049e85f, content=<a href='/topic/show?id=21f66464823' target=_blank style='color:#2F92EE;'>#治疗方案#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64648, encryptionId=21f66464823, topicName=治疗方案)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ee4187, createdName=zhangjiqing, createdTime=Tue Aug 15 15:19:00 CST 2017, time=2017-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805460, encodeId=ae6a1805460d7, content=<a href='/topic/show?id=a35fe8201ee' target=_blank style='color:#2F92EE;'>#终身治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78201, encryptionId=a35fe8201ee, topicName=终身治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49cf452, createdName=xsm918, createdTime=Fri Apr 28 08:19:00 CST 2017, time=2017-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176061, encodeId=61c61e6061dc, content=严谨一点啊!贝塔受体阻滞影响的是啥系统?, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9d1934723, createdName=1e0d9c7am75(暂无匿称), createdTime=Tue Feb 14 09:08:24 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169907, encodeId=f8ee16990e0b, content=百普乐和萘哌地尔博帝联用,为啥没人提出,雪莲可以降低高尿酸,代表产品香港中科的酸速清,北京协和制药厂的双环醇片可以引起大量皮疹,藏药青鹏软膏轻松搞定,建议增加结核病方面的信息,目前感染率太吓人,医院停车位都堆满了车。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=, createdTime=Thu Jan 12 20:01:55 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169770, encodeId=e8f6169e7073, content=笔者很用心,为我们总结了各种高血压用药方案,??, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160814/IMG57B04B04A03228221.jpg, createdBy=622a1684503, createdName=蜗小牛的天空, createdTime=Thu Jan 12 07:47:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169584, encodeId=4354169584fb, content=收藏吧,虽然看不太懂, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Jan 11 13:24:18 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169559, encodeId=e5bd169559a3, content=特别的好,收藏起来, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Jan 11 10:57:27 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169552, encodeId=ddf1169552a9, content=收藏了,好文,值得点赞,值得收藏,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jan 11 10:27:40 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
    2017-01-11 Arthur M

    收藏吧,虽然看不太懂

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1904978, encodeId=1c5b19049e85f, content=<a href='/topic/show?id=21f66464823' target=_blank style='color:#2F92EE;'>#治疗方案#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64648, encryptionId=21f66464823, topicName=治疗方案)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ee4187, createdName=zhangjiqing, createdTime=Tue Aug 15 15:19:00 CST 2017, time=2017-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805460, encodeId=ae6a1805460d7, content=<a href='/topic/show?id=a35fe8201ee' target=_blank style='color:#2F92EE;'>#终身治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78201, encryptionId=a35fe8201ee, topicName=终身治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49cf452, createdName=xsm918, createdTime=Fri Apr 28 08:19:00 CST 2017, time=2017-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176061, encodeId=61c61e6061dc, content=严谨一点啊!贝塔受体阻滞影响的是啥系统?, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9d1934723, createdName=1e0d9c7am75(暂无匿称), createdTime=Tue Feb 14 09:08:24 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169907, encodeId=f8ee16990e0b, content=百普乐和萘哌地尔博帝联用,为啥没人提出,雪莲可以降低高尿酸,代表产品香港中科的酸速清,北京协和制药厂的双环醇片可以引起大量皮疹,藏药青鹏软膏轻松搞定,建议增加结核病方面的信息,目前感染率太吓人,医院停车位都堆满了车。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=, createdTime=Thu Jan 12 20:01:55 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169770, encodeId=e8f6169e7073, content=笔者很用心,为我们总结了各种高血压用药方案,??, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160814/IMG57B04B04A03228221.jpg, createdBy=622a1684503, createdName=蜗小牛的天空, createdTime=Thu Jan 12 07:47:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169584, encodeId=4354169584fb, content=收藏吧,虽然看不太懂, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Jan 11 13:24:18 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169559, encodeId=e5bd169559a3, content=特别的好,收藏起来, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Jan 11 10:57:27 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169552, encodeId=ddf1169552a9, content=收藏了,好文,值得点赞,值得收藏,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jan 11 10:27:40 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
    2017-01-11 四爷无名

    特别的好,收藏起来

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1904978, encodeId=1c5b19049e85f, content=<a href='/topic/show?id=21f66464823' target=_blank style='color:#2F92EE;'>#治疗方案#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64648, encryptionId=21f66464823, topicName=治疗方案)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ee4187, createdName=zhangjiqing, createdTime=Tue Aug 15 15:19:00 CST 2017, time=2017-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805460, encodeId=ae6a1805460d7, content=<a href='/topic/show?id=a35fe8201ee' target=_blank style='color:#2F92EE;'>#终身治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78201, encryptionId=a35fe8201ee, topicName=终身治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49cf452, createdName=xsm918, createdTime=Fri Apr 28 08:19:00 CST 2017, time=2017-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176061, encodeId=61c61e6061dc, content=严谨一点啊!贝塔受体阻滞影响的是啥系统?, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9d1934723, createdName=1e0d9c7am75(暂无匿称), createdTime=Tue Feb 14 09:08:24 CST 2017, time=2017-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169907, encodeId=f8ee16990e0b, content=百普乐和萘哌地尔博帝联用,为啥没人提出,雪莲可以降低高尿酸,代表产品香港中科的酸速清,北京协和制药厂的双环醇片可以引起大量皮疹,藏药青鹏软膏轻松搞定,建议增加结核病方面的信息,目前感染率太吓人,医院停车位都堆满了车。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=, createdTime=Thu Jan 12 20:01:55 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169770, encodeId=e8f6169e7073, content=笔者很用心,为我们总结了各种高血压用药方案,??, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160814/IMG57B04B04A03228221.jpg, createdBy=622a1684503, createdName=蜗小牛的天空, createdTime=Thu Jan 12 07:47:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169584, encodeId=4354169584fb, content=收藏吧,虽然看不太懂, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Jan 11 13:24:18 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169559, encodeId=e5bd169559a3, content=特别的好,收藏起来, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Jan 11 10:57:27 CST 2017, time=2017-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169552, encodeId=ddf1169552a9, content=收藏了,好文,值得点赞,值得收藏,值得推荐。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jan 11 10:27:40 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
    2017-01-11 ylzr123

    收藏了,好文,值得点赞,值得收藏,值得推荐。

    0

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