5个常见神经科急症的处理方法

2016-09-14 佚名 中国神经时讯综合整理

-wrap: break-word !important;">② 了解既往内科系统病史,糖尿病、肝、肾疾病病史、呼吸系统疾病、营养障碍、酗酒、服药史等;③ 询问患者平时的意识水平、智能、言语、与家人的交流、尿便、肢体活动情况。2. 查体及辅助检查:① 神经系统查体: 意识障碍水平的判断、瞳孔改变、眼球位置或活动异常、眼底、脑膜刺激征等;② 内科系统查体:呼吸模式的改变、体温的变化、血压、气味等;③


② 维持循环功能,纠正心衰、休克,心脏骤停时应紧急心肺复苏;


③ 建立静脉通路,纠正酸碱平衡失调和电解质紊乱;


④ 纠正脑水肿与脑疝(甘露醇、甘油果糖静滴、呋塞米静推等);


⑤ 急性期降低脑代谢,减少脑耗氧量,保护大脑;


⑥ 其他对症治疗:如抗癫痫,预防血管痉挛和再出血,控制高热,营养神经等;


⑦ 必要时请相关科室会诊。


5. 注意事项:意识障碍的处理难点是内科疾病导致的继发意识障碍,通过详细的病史、查体和相关辅助检查一般能够明确诊断。内科系统疾病导致的意识障碍一般不伴有局灶性的症状和体征而仅表现意识水平的下降(延髓梗死、反复二氧化碳潴留的患者),但不是绝对的,特别是低血糖表现花样繁多,可能以偏袒等脑血管病的形式发病。

一、头痛


一般是指眉弓、耳轮上缘和枕外隆突连线以上的头颅上半部之疼痛。急性头痛是神经内科急症中最常见的症状。


1. 采集病史:


应详细了解头痛发生的诱因和形式、部位、性质及伴随症状,要注意以下几个方面。


① 年龄与性别:50岁以后首次发生头痛者,则不大可能是偏头痛、紧张性头痛或精神性头痛。小儿偏头痛时头痛多不严重而眩晕症状更为突出。女性患者头痛与月经期有关多提示为偏头痛;


② 头痛的部位、时间、性质、程度、发生的速度及影响因素、头痛的伴随症状;


③ 询问患者的性格及精神状态;


④ 既往史、家族史及尚需注意全身其他系统器官受损的病史,用药史、外伤史、手术史、月经及烟酒嗜好等。


2. 查体:进行系统全面的体格检查、注重头部邻近器官的检查、神经系统专科检查(包括眼底检查、脑膜刺激症状、脑局部症状等)。


3. 辅助检查:血、尿常规、生化、头颅及颈椎X线检查;脑电图、头部CT、脑脊液检查、头部MRI、脑血管造影及根据症状需要做的不同的检查。


4. 头痛常见类型:


① 血管性头痛:包括偏头痛、丛集性头痛、脑血管性疾病的头痛,高血压性头痛;


② 紧张性头痛:是临床常见的慢性头痛,主要由精神紧张及颅周肌肉张力增高引起;


③ 颅内压变化引起的头痛:颅内压增高所致的头痛,低颅压性头痛;


④ 颅脑外伤性头痛:急性及慢性头部外伤均可伴有疼痛;


⑤ 炎症性头痛:指中枢神经系统或全身感染性疾病引起的头痛;


⑥ 五官疾病的头痛:指青光眼、虹膜炎及用眼时间过长等引起的头痛;


⑦ 精神性头痛:神经症、抑郁症等经常出现疼痛;


⑧ 神经痛:包括三叉神经痛、舌咽神经痛、枕神经痛。


5. 处理原则:


① 依据头痛的不同病因及类型对因、对症治疗;


② 对于轻度未有器官损伤、器质性变化的患者,加强宣教疏导,调节情绪,放松心情;


③ 部分患者可给予镇静剂等药物服用;


④ 对于处于头痛急性发作期的患者立即服用治疗性药物;


⑤ 对于发作次数频繁的患者可根据头痛程度等进行预防用药;


⑥ 针对其他伴随症状进行治疗。


二、眩晕


眩晕是一主观症状,是机体对于空间关系的定向感觉障碍或平衡感觉障碍,是一种运动错觉。


1. 采集病史:应详细了解眩晕的性质、程度、时间、诱发因素、伴随症状以及可能引起眩晕的有关病史(药物中毒、外伤史)以及询问神经科、内科、耳鼻喉科的有关疾病。


2. 体格检查:


① 神经系统方面:除一般神经系统检查外,特别注意有无自发性眼球震颤、共济失调、听力障碍及颅内压增高等;


② 内科:应检查血压、心脏,有无高血压、低血压、心率不齐、心功能不全,有无贫血、全身感染、中毒、代谢紊乱等;


③ 耳科方面:应检查外耳道、鼓膜、中耳、鼻咽部;


④ 听力学检查:应用表、音叉试验发可大致了解听力状况、听力障碍的性质及程度等;


⑤ 前庭功能检查:包括自发性眼症、倾倒、植物偏向、变温试验、位置试验等。


3. 辅助检查:可根据病情需要做必要的辅助检查,例:头颅X片、脑电图、CT、MRI 等。


4. 眩晕常见类型:


① 梅尼埃病:为中年以上阵发性眩晕的最常见的原因;临床表现为典型的三联症状,发作性眩晕、波动性、渐进性、感音性的听力减退和耳鸣;


② 良性发作性位置性眩晕:本病多见于中年以上患者;


③ 非良性位置性眩晕;


④ 前庭神经元炎:起病较急,表现为突起的剧烈的眩晕,伴有恶心、呕吐,但无而耳蜗症状;起病时常伴有感染(多为上呼吸道)症状,可能是一种病毒感染;


⑤ 迷路炎:单纯性中耳炎由于炎症刺激使迷路充血可引起眩晕。眩晕程度较轻,中耳炎好转后眩晕亦即减除;


⑥ 药物性眩晕:包括有耳毒性抗生素类、麻醉镇静和催眠药类、抗癫痫药等;


⑦ 血管性眩晕(椎-基底动脉血循环障碍):迷路卒中,小脑后下动脉血栓形成,椎-基底动脉供血不足;颈椎病变;


⑧ 颅内肿瘤:由于颅内肿瘤产生的眩晕有两种机制,一是由于肿瘤直接压迫,另一是由于颅内压增高;


⑨ 外伤性眩晕;


⑩ 精神性眩晕。


5. 处理原则:


① 一般处理:对于急性眩晕发作的患者,需卧床休息,饮食以流质为宜;


② 伴有明显恶心、呕吐者,应酌情给予补液,对于焦虑紧张患者,应适当给予解释与安慰,以解除顾虑;


③ 根据病因及发病的缓急程度进行对症处理,常见药物有镇静剂与安定剂、抗组胺药物、止吐剂等。


三、晕厥


又称昏厥,是因一时性大脑半球或脑干血液供应减少,导致发作性短暂意识丧失伴姿势性张力丧失综合征。晕厥的特征是发作突然,意识丧失时间短,不能维持正常姿势或倒地,在短时间内迅速恢复,罕有后遗症。


1. 病史采集:应了解发作的诱因、场所、体位、前驱症状和后期症状;尽可能了解发作时伴随的症状和体征。


2. 体格检查:特别注意:面色、血压、脉搏、呼吸、心率及心音改变,有无抽搐或神经系统局灶体征。


3. 晕厥分类:


① 反射性晕厥:包括血管迷走性晕厥、直立低血压性晕厥、颈动脉窦晕厥、咳嗽性晕厥、排尿性晕厥、舌咽神经痛性及吞咽性晕厥、低卧位低血压综合征;

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createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-10-22 cjingjuan

    值得学习

    0

  3. 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time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129981, encodeId=23c3129981d9, content=学习了,很好的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57DA21BC1A55A8545.jpg, createdBy=d57b1951356, createdName=cb @1216, createdTime=Sun Sep 18 08:42:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129022, encodeId=df3412902231, content=可以,但是不全, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Sat Sep 17 06:32:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), 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13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-10-03 1e0ece0dm09(暂无匿称)

    谢谢指点迷津

    0

  4. 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13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-09-26 正准备

    很好的嘛

    0

  5. 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13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-09-18 cb @1216

    学习了,很好的鉴别诊断

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1649272, encodeId=f3bf16492e2da, content=<a href='/topic/show?id=1c8152531f0' target=_blank style='color:#2F92EE;'>#急症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52531, encryptionId=1c8152531f0, topicName=急症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c33023794178, createdName=wjywjy, createdTime=Thu Aug 24 09:47:00 CST 2017, time=2017-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150397, encodeId=2c9415039e6d, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c3865018, createdName=cjingjuan, createdTime=Sat Oct 22 18:33:38 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139277, encodeId=394c1392e736, content=谢谢指点迷津, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Mon Oct 03 00:25:34 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135401, encodeId=16fa13540185, content=很好的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/373C274CBC6CDF6BC9056B319924AB54/100, createdBy=97a01924365, createdName=正准备, createdTime=Mon Sep 26 12:37:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129981, encodeId=23c3129981d9, content=学习了,很好的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57DA21BC1A55A8545.jpg, createdBy=d57b1951356, createdName=cb @1216, createdTime=Sun Sep 18 08:42:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129022, encodeId=df3412902231, content=可以,但是不全, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Sat Sep 17 06:32:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128682, encodeId=adff128682f1, content=这么不负责任啊小编, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151226/IMG567EB873985DE3928.jpg, createdBy=ea941622301, createdName=inter158, createdTime=Fri Sep 16 14:43:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443663, encodeId=0fde1443663c6, content=<a href='/topic/show?id=5b78e4414c7' target=_blank style='color:#2F92EE;'>#神经科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74414, encryptionId=5b78e4414c7, topicName=神经科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a4e5108341, createdName=12498f1em09(暂无昵称), createdTime=Fri Sep 16 13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-09-17 1e0daa8am11(暂无匿称)

    可以,但是不全

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1649272, encodeId=f3bf16492e2da, content=<a href='/topic/show?id=1c8152531f0' target=_blank style='color:#2F92EE;'>#急症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52531, encryptionId=1c8152531f0, topicName=急症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c33023794178, createdName=wjywjy, createdTime=Thu Aug 24 09:47:00 CST 2017, time=2017-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150397, encodeId=2c9415039e6d, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c3865018, createdName=cjingjuan, createdTime=Sat Oct 22 18:33:38 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139277, encodeId=394c1392e736, content=谢谢指点迷津, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Mon Oct 03 00:25:34 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135401, encodeId=16fa13540185, content=很好的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/373C274CBC6CDF6BC9056B319924AB54/100, createdBy=97a01924365, createdName=正准备, createdTime=Mon Sep 26 12:37:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129981, encodeId=23c3129981d9, content=学习了,很好的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57DA21BC1A55A8545.jpg, createdBy=d57b1951356, createdName=cb @1216, createdTime=Sun Sep 18 08:42:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129022, encodeId=df3412902231, content=可以,但是不全, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Sat Sep 17 06:32:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128682, encodeId=adff128682f1, content=这么不负责任啊小编, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151226/IMG567EB873985DE3928.jpg, createdBy=ea941622301, createdName=inter158, createdTime=Fri Sep 16 14:43:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443663, encodeId=0fde1443663c6, content=<a href='/topic/show?id=5b78e4414c7' target=_blank style='color:#2F92EE;'>#神经科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74414, encryptionId=5b78e4414c7, topicName=神经科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a4e5108341, createdName=12498f1em09(暂无昵称), createdTime=Fri Sep 16 13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-09-16 inter158

    这么不负责任啊小编

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1649272, encodeId=f3bf16492e2da, content=<a href='/topic/show?id=1c8152531f0' target=_blank style='color:#2F92EE;'>#急症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52531, encryptionId=1c8152531f0, topicName=急症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c33023794178, createdName=wjywjy, createdTime=Thu Aug 24 09:47:00 CST 2017, time=2017-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150397, encodeId=2c9415039e6d, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c3865018, createdName=cjingjuan, createdTime=Sat Oct 22 18:33:38 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139277, encodeId=394c1392e736, content=谢谢指点迷津, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Mon Oct 03 00:25:34 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135401, encodeId=16fa13540185, content=很好的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/373C274CBC6CDF6BC9056B319924AB54/100, createdBy=97a01924365, createdName=正准备, createdTime=Mon Sep 26 12:37:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129981, encodeId=23c3129981d9, content=学习了,很好的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57DA21BC1A55A8545.jpg, createdBy=d57b1951356, createdName=cb @1216, createdTime=Sun Sep 18 08:42:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129022, encodeId=df3412902231, content=可以,但是不全, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Sat Sep 17 06:32:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128682, encodeId=adff128682f1, content=这么不负责任啊小编, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151226/IMG567EB873985DE3928.jpg, createdBy=ea941622301, createdName=inter158, createdTime=Fri Sep 16 14:43:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443663, encodeId=0fde1443663c6, content=<a href='/topic/show?id=5b78e4414c7' target=_blank style='color:#2F92EE;'>#神经科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74414, encryptionId=5b78e4414c7, topicName=神经科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a4e5108341, createdName=12498f1em09(暂无昵称), createdTime=Fri Sep 16 13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1649272, encodeId=f3bf16492e2da, content=<a href='/topic/show?id=1c8152531f0' target=_blank style='color:#2F92EE;'>#急症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52531, encryptionId=1c8152531f0, topicName=急症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c33023794178, createdName=wjywjy, createdTime=Thu Aug 24 09:47:00 CST 2017, time=2017-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150397, encodeId=2c9415039e6d, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c3865018, createdName=cjingjuan, createdTime=Sat Oct 22 18:33:38 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139277, encodeId=394c1392e736, content=谢谢指点迷津, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Mon Oct 03 00:25:34 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135401, encodeId=16fa13540185, content=很好的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/373C274CBC6CDF6BC9056B319924AB54/100, createdBy=97a01924365, createdName=正准备, createdTime=Mon Sep 26 12:37:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129981, encodeId=23c3129981d9, content=学习了,很好的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57DA21BC1A55A8545.jpg, createdBy=d57b1951356, createdName=cb @1216, createdTime=Sun Sep 18 08:42:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129022, encodeId=df3412902231, content=可以,但是不全, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Sat Sep 17 06:32:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128682, encodeId=adff128682f1, content=这么不负责任啊小编, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151226/IMG567EB873985DE3928.jpg, createdBy=ea941622301, createdName=inter158, createdTime=Fri Sep 16 14:43:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443663, encodeId=0fde1443663c6, content=<a href='/topic/show?id=5b78e4414c7' target=_blank style='color:#2F92EE;'>#神经科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74414, encryptionId=5b78e4414c7, topicName=神经科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a4e5108341, createdName=12498f1em09(暂无昵称), createdTime=Fri Sep 16 13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-09-16 1decafd9m46(暂无匿称)

    怎么不全啊下文呢

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1649272, encodeId=f3bf16492e2da, content=<a href='/topic/show?id=1c8152531f0' target=_blank style='color:#2F92EE;'>#急症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52531, encryptionId=1c8152531f0, topicName=急症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c33023794178, createdName=wjywjy, createdTime=Thu Aug 24 09:47:00 CST 2017, time=2017-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150397, encodeId=2c9415039e6d, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c3865018, createdName=cjingjuan, createdTime=Sat Oct 22 18:33:38 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139277, encodeId=394c1392e736, content=谢谢指点迷津, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K46ZAxBHmHsph32KkfsWGwmickB6RsCUD8KruE4vo5CpvXfdu16GBpp4ibh6WJu1o9iatP1LWKDmvmic/0, createdBy=be6f1940165, createdName=1e0ece0dm09(暂无匿称), createdTime=Mon Oct 03 00:25:34 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135401, encodeId=16fa13540185, content=很好的嘛, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/373C274CBC6CDF6BC9056B319924AB54/100, createdBy=97a01924365, createdName=正准备, createdTime=Mon Sep 26 12:37:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129981, encodeId=23c3129981d9, content=学习了,很好的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160915/IMG57DA21BC1A55A8545.jpg, createdBy=d57b1951356, createdName=cb @1216, createdTime=Sun Sep 18 08:42:00 CST 2016, time=2016-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=129022, encodeId=df3412902231, content=可以,但是不全, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a531934983, createdName=1e0daa8am11(暂无匿称), createdTime=Sat Sep 17 06:32:00 CST 2016, time=2016-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128682, encodeId=adff128682f1, content=这么不负责任啊小编, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151226/IMG567EB873985DE3928.jpg, createdBy=ea941622301, createdName=inter158, createdTime=Fri Sep 16 14:43:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443663, encodeId=0fde1443663c6, content=<a href='/topic/show?id=5b78e4414c7' target=_blank style='color:#2F92EE;'>#神经科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74414, encryptionId=5b78e4414c7, topicName=神经科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a4e5108341, createdName=12498f1em09(暂无昵称), createdTime=Fri Sep 16 13:47:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128261, encodeId=c3741282612c, content=怎么不全啊下文呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRtNT7AWKboIfjpeY6Nw6lNxAc4w1aibutHSqCJ2c3AbwfqpRia4IrnzU2mK3Ojx2Har8AUUyhC0kl7/0, createdBy=ecc31722157, createdName=1decafd9m46(暂无匿称), createdTime=Fri Sep 16 01:50:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=128180, encodeId=1483128180af, content=学习了,赞一个!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Thu Sep 15 20:44:00 CST 2016, time=2016-09-15, status=1, ipAttribution=)]
    2016-09-15 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0