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心脏移植:450万心衰患者的希望

2018-03-01 韦川南 毛圆圆 健康时报

医学上,有个词叫“冷缺血时间”,是指从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间。各器官耐受冷缺血时间上限肾脏约为24小时、肝脏为12小时、肺脏为8~12小时、心脏只有6~8小时。缺血时间越长,器官的质量及器官接受者的预后越差,生存率越低。常规时隔25年,当年在国人看来十分新奇的手术现在已经成为了常规手术。孟旭教授介绍,心脏移植手术本身早已不属于高难度手术了,现在手术的规定

医学上,有个词叫“冷缺血时间”,是指从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间。各器官耐受冷缺血时间上限肾脏约为24小时、肝脏为12小时、肺脏为8~12小时、心脏只有6~8小时。缺血时间越长,器官的质量及器官接受者的预后越差,生存率越低。

常规

时隔25年,当年在国人看来十分新奇的手术现在已经成为了常规手术。孟旭教授介绍,心脏移植手术本身早已不属于高难度手术了,现在手术的规定、原则都非常规范。

攻坚

孟旭教授和团队正在进行一项新的尝试,在进行心脏移植时,同时将供体的骨髓抽取出来,移植给接受心脏移植的患者,这种新方法可以使患者形成免疫耐受,“目前我们已经成功施行了9例,这些患者用药量目前只是正常移植患者的三分之一。”

惋惜

去年,孟旭教授为一位心衰患者找到了合适的移植供体,孟旭教授团队第一时间通知这位患者,患者却觉得,现在自己好多了,放弃了这个供体。结果,当天晚上,患者病情突然加重,改变主意,但捐献的供体却已经无法再使用了。没过几天,这位心衰患者因为病情恶化离开了人世。

“收拾东西,现在就买去新疆的机票,抓紧通知患者,随时等通知出发去新疆。”

北京安贞医院心脏外科主任孟旭在接到新疆一家医院心脏捐献者脑死亡通知后,立刻告知了团队其他六位成员。孟旭主任也马上收拾东西,赶往机场。

这个时候,才刚刚凌晨三点。

这就是心脏移植团队的日常。他们眼中,白天和黑夜的界限并不明晰,所有的事情都让步于四个字:心脏移植。

心脏移植 让频临死亡的患者重生

心脏移植,俗称换心术。当各种办法都不能挽回病人心脏,预计患者一年生存期低于75%,心脏移植,是救治终末期心脏病人的唯一办法。

从1967年12月3日南非Bernard医师为一位缺血性心肌病患者成功施行人类第一例心脏移植手术,迄今人体心脏移植已跨过了50年。

而今,心脏移植技术在我国也走过了25个春秋。

早在1978年4月,上海瑞金医院就开展了亚洲第一例心脏移植术。上海瑞金医院张世泽医师为一例38岁风湿性心脏瓣膜病患者施行首例心脏移植术,术后存活109天,死于排斥反应。遗憾的是,此后国内心脏移植就一直处于空白阶段,因为手术难度和复杂围术期管理使得众多医院对于心脏移植技术望而却步。

1992年,在中国胸心血管外科和心血管病流行学的奠基人之一、北京安贞医院老院长吴英恺院士组织下,北京安贞医院心外科陈宝田教授和孟旭教授成功进行全国第二例心脏移植,打破心脏移植在中国多年的沉寂。

时隔25年,当年在国人看来十分新奇的手术现在已经成为了常规手术。孟旭教授介绍,心脏移植手术本身早已不属于高难度手术了,现在手术的规定、原则都非常规范。

我国在2010年建立了心脏移植注册系统,系统数据显示,从注册系统开始登记数据截止到2016年12月31日,中国大陆在这六年间的心脏移植注册登记例数一共达到2149例,其中国内心脏移植开展比较好的医院有六家,他们在这六年间心脏移植的总量都超过了100例,包括阜外医院、北京安贞医院、华中科技大学同济医学院附属协和医院、复旦大学附属中山医院、华中科技大学同济医学院附属同济医院、福建协和医院。

华中科技大学同济医学院附属协和医院心血管外科主任董念国教授介绍:“目前,国内存活时间最长的心脏移植患者存活了20多年,我们医院心脏移植存活时间最长的患者已经达到了17年,而且依旧健在。”

免疫新技术 解决心脏移植排斥难题

其实,对于心脏移植患者来说,手术关不是最难闯的,术后的免疫排斥关才是决定他们心脏移植成功与否的关键。

“现在,心脏移植患者10年生存率60%,也就是说100位心脏移植患者中有40位10年内可能死亡,主要原因就是慢性免疫排斥反应,目前还没有一个一劳永逸的解决方法。”孟旭主任解释:“免疫排斥,就像我们的身体里原本住着一家人,移植来的心脏就像突然闯进家里来的陌生人,身体细胞会联合起来抵抗这个入侵者。”

所有做完心脏移植的患者都会发生免疫排斥,只是发生免疫排斥的级别不同。有的患者心脏移植后,会发生急性免疫反应,炎症发作后马上会损害器官,有的心脏移植患者会发生慢性免疫排斥反应,炎症会慢慢损害器官,所以必须终身使用药物,抑制这种免疫反应。

要观察心脏移植的患者是否发生免疫反应,医学上叫检测排异,“过去检测排异是通过导管式活检钳取心脏上一部分组织来判断,但这项检查费用高,病人也痛苦,一般都不愿意做。”2003年,安贞医院研发了新的免疫检测技术,心肌内心电图术后免疫监测,将心脏起搏器的导线缝在病人心脏上,医生可以通过起搏器的心电图来观察病人,如果心电图高度下降20%,就意味着可能出现了免疫排异,这时再进行活检来确诊。这个方法创伤小恢复快,既省钱还能达到监测目的。

孟旭教授和团队还进行了一项新的尝试,在世界上首次开展了心脏移植后骨髓腔内骨髓移植诱导免疫耐受的临床试验。

孟旭主任介绍,这种新方法就是在进行心脏移植时,同时将供体的骨髓抽取出来,移植给接受心脏移植的患者,可以使患者形成免疫耐受。“骨髓信息随着心脏一起给了患者后,就像在患者的免疫系统里安插了内应一般,免疫系统会认为,这个移植来的心脏是我们的朋友,逐渐就不排斥了,也就是形成免疫耐受,目前我们已经成功施行了9例,这些患者用药量目前只是正常移植患者的三分之一。”

而且心脏移植同时进行的骨髓移植是半相合,只要骨髓配对有两个基因相同就可以做骨髓移植。孟旭主任介绍,以前骨髓移植对配型要求高,为了心脏移植的成功,在做骨髓移植时都要清髓。“既然我要给你一种新的东西进来,就要把你原来的土地全翻一遍,也就是把原来骨髓细胞都杀死,完了以后再放进去新的骨髓,危险性非常高。现在我们根本不需要这样做了,只要给予一些低毒性的药物就可以实现骨髓移植,这项技术在国际上都处于领先地位。”

中国心脏移植 远低于国际平均值

尽管攻克了一个个技术难题,但我国心脏移植发展速度还远远落后于发达国家。据孟旭主任介绍,国际平均每年心脏移植的病例有5000例,中国平均每年心脏移植的病例只有三四百例。以2016年最新数据为例,中国心脏移植注册系统数据显示,我国2016全年的移植例数共计368例。

据中国心血管病报告2017概要的数据显示,中国现有心衰病人450万,需要做心脏移植的病人并不在少数。但目前,中国心脏供体源的数量并不能满足中国心脏移植的要求,基本上四五个病人在等一颗心。

华中科技大学同济医学院附属协和医院心血管外科主任董念国介绍,“从2012年开展了脑死亡自愿捐献心脏移植工作开始,到现在武汉协和医院已经是全国脑死亡自愿捐献心脏移植最多的医院。即便这样,很多患者也要等待半年左右才能有供源。还有一些患者在等待中去世。”

约心脏移植发展的一个重要因素是心脏利用率不高。

2015年,中国公民自愿捐献成为器官移植唯一来源。目前,中国器官捐献有三类,一类是脑死亡,一类是心死亡,第三类是心脑死亡,只有脑死亡患者的心脏才具有移植价值。但脑死亡只占整个器官捐献的15%左右,而在这部分脑死亡病人中,还有一些因为心脏存在问题而不能进一步使用。

目前,在供体分配上,国外75%供体都可以用于心脏移植;而中国这一比例仅约12.5%,有很多心脏没有利用起来,主要就是没有统一的供体管理规则。

孟旭主任解释,供体捐献最重要的问题是维护供体质量。北京安贞医院是国内最早加入到和肝肾肺等其他移植团队合作的医院,到现在已经探索出了一套供体共同管理的方法,并成立了中国心脏移植多中心协作体。这个过程非常不容易,因为以往供体都是由肝肾移植医生来维护,心脏不能确保使用,只有让心脏科医生加入进来进行供体维护,才能确保移植的心脏质量。但心脏科医生要加入供体维护中,必须确保供体血压和用药不影响肝肾移植正常使用。这就需要统一的供体管理规则,使肝肾心肺四大移植团队都可以顺利使用供体。

长途转运也是制约心脏移植的一个因素。由于心脏移植的供体和接受心脏移植的患者经常是身处两地,有些患者由于身体原因,无法耐受长途奔波,所以心脏器官的长途转运也是必不可少。

董念国主任介绍,医学上,有个词叫“冷缺血时间”,是从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间。各器官耐受冷缺血时间上限肾脏约为24小时、肝脏为12小时、肺脏为8~12小时、心脏只有6~8小时。缺血时间越长,器官的质量及器官接受者的预后(根据经验预测的疾病发展情况)越差,生存率越低。

“产生移植的供体是随时的,一旦有了适合患者的心脏,不论白天还是黑夜,心脏手术都要赶快进行,患者不能等,时间就是生命。”

好在这个问题现在逐步得到了改善,国家卫生计生委、公安部、交通运输部、中国民用航空局、中国铁路总公司、中国红十字会总会于2016年5月6日联合印发了《关于建立人体捐献器官转运绿色通道的通知》,明确了各方职责,确保了器官转运的通畅,将转运环节对移植质量的影响减少到最低。

通知中,设立了器官转运绿色通道24小时应急电话,并规定:卫生计生行政部门负责制定人体捐献器官运输技术规范与标准,公安部门负责保障运送人体捐献器官的救护车优先通行,交通运输部门负责保障便捷快速通过收费公路收费站,民航部门负责保障运送器官的人员优先安检、快速登机,铁路部门负责保障火车站安检快速过检,红十字会负责提供人体器官运输专用标志。

别轻易放弃 心脏移植供体

即便如此,心脏移植还面临很多不可把控的未知。内蒙古唐先生第一次接到哈尔滨的供体通知后,和孟旭主任团队第一时间赶到哈尔滨,然而由于体重等原因,供体并不适合唐先生,只得抱憾而返;第二次接到广东的供体通知,上午刚接到,下午就赶到,结果捐献供体的患者从死亡线上被抢救了过来。第三次,接到广西供体通知,到了之后发现,供体有一项化验不合格,直到新疆供体这一次,全部都符合接受心脏移植的条件,唐先生才顺利完成了心脏移植手术。

而最令医生惋惜的,是反复犹豫而错过的患者。去年,孟旭教授为一位心衰患者找到了合适的移植供体,孟旭主任团队第一时间通知这位患者,患者却觉得,现在自己好多了,认为没必要花这个钱了,放弃了这个供体。

结果,当天晚上,患者病情突然加重,家属连忙给孟旭主任打电话,接受心脏移植,孟旭主任夜里立刻联系供体单位,然而为时已晚,捐献的供体已经无法再使用了。没过几天,这位心衰患者因为病情恶化离开了人世。

“其实对于每一位我们建议移植心脏的患者来说,都是经过严谨而科学的诊断,移植对他们来说,一定都是必要的,是挽救生命最后的方法。”每每碰到这样反复叮咛却又临时拒绝的患者,孟旭主任都觉得不无可惜。

而像心脏移植后所需用的药物未纳入医保、药物的副作用较大等问题也一直是中国心脏移植界面临的挑战。

不过,对于未来,董念国主任说:“心脏移植技术的瓶颈目前已经被突破,抗排斥药物的应用效果已经有了很大的提升,器官捐献管理与规范会进一步完善,我对中国心脏移植的未来充满了信心。”

孟旭主任介绍,十三五计划已经正式立项国家器官异种移植心脏领域专项研究,开展基因猪的研究,让猪具备人的基因,使基因猪的心脏可以成功移植到人的身上,这个项目未来可以成为解决供体不足的方法之一,使更多患者得到挽救。当然,这个项目的临床实现还有很长的路要走,不过异种移植未来对于异种组织的利用会有先行的突破。

心脏移植,让全国450万频临死亡的心衰患者,都拥有了和唐先生一样重生的可能。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=292574, encodeId=92aa2925e432, content=学习了.很不错哟, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Mar 03 10:20:08 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373400, encodeId=a2ff13e3400a9, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Sat Mar 03 08:55:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292469, encodeId=f96329246966, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sat Mar 03 07:18:02 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292251, encodeId=b88f29225170, content=学习了很多先进的医学知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Fri Mar 02 09:28:21 CST 2018, time=2018-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292069, encodeId=157e29206907, content=医学上.有个词叫[冷缺血时间".是指从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间., beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 01 19:35:08 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292060, encodeId=3024292060be, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Thu Mar 01 19:31:47 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292047, encodeId=45c629204e65, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Mar 01 18:55:49 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292043, encodeId=d318292043ca, content=缺血时间越长.器官的质量及器官接受者的预后越差.生存率越低, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Thu Mar 01 18:18:58 CST 2018, time=2018-03-01, status=1, ipAttribution=)]
    2018-03-03 owlhealth

    学习了.很不错哟

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=292574, encodeId=92aa2925e432, content=学习了.很不错哟, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Mar 03 10:20:08 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373400, encodeId=a2ff13e3400a9, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Sat Mar 03 08:55:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292469, encodeId=f96329246966, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sat Mar 03 07:18:02 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292251, encodeId=b88f29225170, content=学习了很多先进的医学知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Fri Mar 02 09:28:21 CST 2018, time=2018-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292069, encodeId=157e29206907, content=医学上.有个词叫[冷缺血时间".是指从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间., beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 01 19:35:08 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292060, encodeId=3024292060be, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Thu Mar 01 19:31:47 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292047, encodeId=45c629204e65, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Mar 01 18:55:49 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292043, encodeId=d318292043ca, content=缺血时间越长.器官的质量及器官接受者的预后越差.生存率越低, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Thu Mar 01 18:18:58 CST 2018, time=2018-03-01, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=292574, encodeId=92aa2925e432, content=学习了.很不错哟, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Mar 03 10:20:08 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373400, encodeId=a2ff13e3400a9, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Sat Mar 03 08:55:00 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292469, encodeId=f96329246966, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sat Mar 03 07:18:02 CST 2018, time=2018-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292251, encodeId=b88f29225170, content=学习了很多先进的医学知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Fri Mar 02 09:28:21 CST 2018, time=2018-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292069, encodeId=157e29206907, content=医学上.有个词叫[冷缺血时间".是指从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间., beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 01 19:35:08 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292060, encodeId=3024292060be, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Thu Mar 01 19:31:47 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292047, encodeId=45c629204e65, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Mar 01 18:55:49 CST 2018, time=2018-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=292043, encodeId=d318292043ca, content=缺血时间越长.器官的质量及器官接受者的预后越差.生存率越低, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJUlbw1Mf1vppicGcaWPx1YUOgLgKccao77Rykbx3jiazqzwcyXMdzRIZkhFyBPqknibeuOGhXI1VzVg/0, createdBy=7f162154630, createdName=沙漠浪人, createdTime=Thu Mar 01 18:18:58 CST 2018, time=2018-03-01, status=1, ipAttribution=)]
    2018-03-03 yfjms

    学习

    0

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    2018-03-02 雅文博武

    学习了很多先进的医学知识

    0

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    2018-03-01 有备才能无患

    医学上.有个词叫[冷缺血时间".是指从器官离开供体冷灌注(冷保存)时开始到移植后供血开始的这段时间.

    0

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    2018-03-01 changjiu

    学习一下谢谢

    0

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    2018-03-01 131****1460

    学习了受益匪浅

    0

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    2018-03-01 沙漠浪人

    缺血时间越长.器官的质量及器官接受者的预后越差.生存率越低

    0

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