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告诉你美国住院医师值班多少小时

2017-06-08 翻译:艾慧坚 审校:肖明朝 健康界

美国新的住院医师通用项目岗位需求,延续了四周以上平均每周80小时的工作时限,但对第一年的住院医师,值班时间许可从16小时延长至了24小时,第二年及以上年限住院医师仍受之前限制的制约。

2017年3月10日,美国毕业后医学教育认证委员会(Accreditation Council for Graduate Medical Education,AGGME)修订了住院医师通用项目岗位需求(common program requirements for residents),并于今年7月生效。

该修订版强调了团队合作、灵活性、培训期间医生福利的重要性,但所有的关注点都在(未来也将在)住院医师工作时数(duty hours)的改变上。新的规则延续了四周以上平均每周80小时的工作时限,但对第一年的住院医师,值班时间许可从16小时延长至了24小时,第二年及以上年限住院医师仍受之前限制的制约。此外,只要满足了工作时数的限制,也允许更灵活的内部换班方式。这次政策转变的重要性在于,它是在一种发展和应用证据的基础上转变了政策的方向。

对于公众习惯的8小时日工作制和40小时周工作制来说,美国旧的住院医师工作时间长得难以置信。公众对住院医师工作时间的关注始于1984年,一位名叫LibbyZion的18岁大一新生死在了纽约医院(New York Hospital),表面上的原因是住院医师过于劳累并缺乏监管所致。纽约州大陪审团在调查这一事件时,了解了相关医生和医院的情况后,找到了根本原因并起诉了美国毕业后医学教育认证委员会(AGGME),起诉原因是它过长的工作时间且缺乏监管制度。从此,住院医师工作时数开始变成了AGGME的一个核心,且在接下来的30年间工作时数政策开始形成并不断修订,开始是基于意见而制定,后来则基于证据进行增订。

对于住院医师工作时数关注的重点在于住院医师会由于工作时间长而影响睡眠,而睡眠少的医生就容易犯错,对患者或他们自身造成伤害。而另一种观点则认为较少的工作时间会因为频繁交接,会将患者置于危险之中,较少的工作时间还意味着较少的教育,或社会化形成一种“换班心态(shift mentality)”而使其专业性降低。无论上述哪一种都会使医生在未来处理患者时缺乏胜任力或疏于职守。

关于住院医师工作时数的讨论已经演变为了另一种讨论,即医学教育所固守的传统是疲劳且带有虐待性质的,类似于军校的教育方式,或者真正重要的是钱,因为住院医师实际上是一种廉价劳动力。限制性规则的批判者指出,一个人可以控制工作时间,而不能控制睡眠,住院医师的疲劳可能更多是由于大量临床工作的压缩所致,而这种压缩又被工作时间的限制加剧了。但是,这些争论更像是在争吵,基于观点而不是基于证据的。

然而,科学也在关注这个问题,包括来自国家医学研究院(NationalAcademy of medicine)的一份报告。大量的文献都指出,睡眠缺乏会导致错误,而住院医师和其他人一样对这种效应很敏感。24小时周期内,每个人的表现会随生物钟有所不同。观察性研究表明,住院医师工作时限制度和患者死亡率及其它临床结果没有关系。正在改变的工作计划和提供的保护性小睡可以影响一天内的睡眠时间,而没法影响一段时间内的平均睡眠时间。住院医师的工作时间和教育、社会化、医生的表现没有明显关系。

将这一层面的证据与开发新药前的证据进行比较。在开发一种每年给20000名患者处方的新药前,需要进行一系列前瞻性研究,以评估该药的安全性与有效性,最后还需要进行随机试验以评价该药物与安慰剂及其他药物相比所具有的价值。住院医师每年会接触几百万患者,他们独立执业后会接触全部患者。医生的实践会持续几十年,而一种新药的有效生命周期却不到上述时间的一半。虽然医学教育政策对患者具有远大而持久的意义,我们却没有将之置于和新药上市前类似的严谨程度中。

关于最近的ACGME规则有意思的地方是,它们都是基于强烈的证据,这些证据也是基于严谨的方法得来的。外科受训者工作时数灵活性需求(Flexibility in Duty Hour Requirements for Surgical Trainees,FIRST)试验于2014年7月至2016年6月间实施,患者安全和住院医师教育优化模型有效性的个性化比较(Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education,iCOMPARE)于2015年7月至2016年6月施行。在这些程序化的随机试验中,研究者在自然情况下对政策进行研究。在上述两个研究项目中,一些美国住院医师培训项目,在机构层面上按照严格执行ACGME标准和不受限制的规则随机分配到不同的研究对象中。上述两个都是非劣效性试验,因此主要的结果是患者输出及同时测量的其他多种输出。FIRST试验包括119个外科住院医师培训项目,其研究的主要结果也已经发表,结果显示,灵活工作时间制并没有显示出劣效性。iCOMPARE试验包括63个医学住院医师项目,它的分析要等到干预期内保险数据(Medicare data)可用后才能得到。

在上述情况下,ACGME重设了住院医师的工作时数规则,延续了一周80小时的工作时数限制,也是两个试验所没有改变的,但是在灵活性方面有了较大改变。ACGME采用了FIRST所得出的较大改变的证据,但是时机对于认证机构而言无疑是尴尬的。ACGME抓住了老虎的尾巴,外科项目一直倡议灵活的工作时数标准,而ACGME的研究又显示新标准不比老标准差,但是iCOMPARE在内科项目上的研究结果却还要一年才能得以发表。

住院医师项目有可能会在部分时间针对部分临床轮转采用新的灵活性工作时数制度。一个原因是住院医师项目的现任负责人比30年前的负责人接受了更多关于疲乏工作的内容。第二个原因是负责人的期望改变了:FIRST研究中的住院医师希望有更多的灵活性,也可以接受更长的值班时间,但这不代表他们愿意回到1984年。那些与现行住院医师的期望相左的新项目是行不通的。事实上,程序化试验的中心价值在于它们揭示了政策在其它标准、期望改变时所带来的新影响。

尽管在另一项试验进行的时候,ACGME就做出了改变,但我们相信今天的医学教育不会完全依赖于任何大规模的随机研究项目。从那样的观点出发,现在执行都没有问题,因为还有一项随机研究项目在进行中。随机研究是回答狭窄问题的良好方式,比如一种新药相对于另一种药物的效果,值班时长对住院医师的影响等。FIRST和iCOMPARE就是设计来回答和今天政策讨论相关的狭窄问题的。还有一些问题需要通过对培训环境的研究进行解答。同时,ACGME也认识到影响深远的卫生政策应当基于和影响深远的治疗手段一样的科学证据等级而进行研究。

【备注】此文系美国毕业后医学教育认证委员会就美国住院医师培养规定,不一定符合我国国情, 参考而已。

原始出处:

David A. Asch, Karl Y. Bilimoria, Sanjay V. Desai et.al.Resident Duty Hours and Medical Education Policy — Raising the Evidence Bar.N Engl J Med 2017; 376:1704-1706May 4, 2017DOI: 10.1056/NEJMp1703690

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    2017-06-10 yinxm8305
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  3. [GetPortalCommentsPageByObjectIdResponse(id=1463400, encodeId=bb801463400dd, content=<a href='/topic/show?id=096a2e4865a' target=_blank style='color:#2F92EE;'>#值班#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27486, encryptionId=096a2e4865a, topicName=值班)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=391f6540675, createdName=yinxm8305, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486134, encodeId=8fca14861348d, content=<a href='/topic/show?id=1d1d2642342' target=_blank style='color:#2F92EE;'>#住院医师#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26423, encryptionId=1d1d2642342, topicName=住院医师)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20210911/083bd1e4f275987ec9d0acf672f9ae6e.jpg, createdBy=61d28082180, createdName=ms3025846204744509, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508801, encodeId=d81c15088012f, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208316, encodeId=95a120831629, content=学习了,可以借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo4aQ9o3mwLf8g71RU8wyNNNCPdJSZhENIsqBjKUicL8BJXLqL2NMl0MlhjIRlv5Bpg0M3UZKuDlwhwLH8B3v2yNy/0, createdBy=11a82069421, createdName=136****3321, createdTime=Thu Jun 08 23:09:11 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208249, encodeId=e84720824912, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuGx0Nj1tUEG8bCiclXBNCCfjGSeFLCtppUMLTdyCtkvyjxxXViaDnQv43w5VAuic6FGPuCicSgnNKBc3/0, createdBy=21f41994764, createdName=阿吴, createdTime=Thu Jun 08 19:34:18 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208226, encodeId=218c208226c0, content=学习了,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/icyLhIGqru6gIknBJqfuPhQkEvDREF6S2vZq3ZIpUYjdqicKVoAWaJSGoe8xNvS6o6QpmOlh2AQ7xuUpj8NiaDjJJgjbc7Xj3T6/0, createdBy=1c242047915, createdName=daiyaozu, createdTime=Thu Jun 08 17:37:21 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208223, encodeId=84b3208223f8, content=不错哦,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epr1MZHfgreGEFrpiapjCGIQGZhkpjicialc8h7VoU0AjNiaSgpaZjNuIqq1KVbmI19JwrN2sdwTdWVSw/132, createdBy=f6692009961, createdName=sy3923582, createdTime=Thu Jun 08 17:27:28 CST 2017, time=2017-06-08, status=1, ipAttribution=)]
    2017-06-10 saikp
  4. [GetPortalCommentsPageByObjectIdResponse(id=1463400, encodeId=bb801463400dd, content=<a href='/topic/show?id=096a2e4865a' target=_blank style='color:#2F92EE;'>#值班#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27486, encryptionId=096a2e4865a, topicName=值班)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=391f6540675, createdName=yinxm8305, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486134, encodeId=8fca14861348d, content=<a href='/topic/show?id=1d1d2642342' target=_blank style='color:#2F92EE;'>#住院医师#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26423, encryptionId=1d1d2642342, topicName=住院医师)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20210911/083bd1e4f275987ec9d0acf672f9ae6e.jpg, createdBy=61d28082180, createdName=ms3025846204744509, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508801, encodeId=d81c15088012f, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208316, encodeId=95a120831629, content=学习了,可以借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo4aQ9o3mwLf8g71RU8wyNNNCPdJSZhENIsqBjKUicL8BJXLqL2NMl0MlhjIRlv5Bpg0M3UZKuDlwhwLH8B3v2yNy/0, createdBy=11a82069421, createdName=136****3321, createdTime=Thu Jun 08 23:09:11 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208249, encodeId=e84720824912, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuGx0Nj1tUEG8bCiclXBNCCfjGSeFLCtppUMLTdyCtkvyjxxXViaDnQv43w5VAuic6FGPuCicSgnNKBc3/0, createdBy=21f41994764, createdName=阿吴, createdTime=Thu Jun 08 19:34:18 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208226, encodeId=218c208226c0, content=学习了,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/icyLhIGqru6gIknBJqfuPhQkEvDREF6S2vZq3ZIpUYjdqicKVoAWaJSGoe8xNvS6o6QpmOlh2AQ7xuUpj8NiaDjJJgjbc7Xj3T6/0, createdBy=1c242047915, createdName=daiyaozu, createdTime=Thu Jun 08 17:37:21 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208223, encodeId=84b3208223f8, content=不错哦,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epr1MZHfgreGEFrpiapjCGIQGZhkpjicialc8h7VoU0AjNiaSgpaZjNuIqq1KVbmI19JwrN2sdwTdWVSw/132, createdBy=f6692009961, createdName=sy3923582, createdTime=Thu Jun 08 17:27:28 CST 2017, time=2017-06-08, status=1, ipAttribution=)]
    2017-06-08 136****3321

    学习了,可以借鉴

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1463400, encodeId=bb801463400dd, content=<a href='/topic/show?id=096a2e4865a' target=_blank style='color:#2F92EE;'>#值班#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27486, encryptionId=096a2e4865a, topicName=值班)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=391f6540675, createdName=yinxm8305, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486134, encodeId=8fca14861348d, content=<a href='/topic/show?id=1d1d2642342' target=_blank style='color:#2F92EE;'>#住院医师#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26423, encryptionId=1d1d2642342, topicName=住院医师)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20210911/083bd1e4f275987ec9d0acf672f9ae6e.jpg, createdBy=61d28082180, createdName=ms3025846204744509, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508801, encodeId=d81c15088012f, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208316, encodeId=95a120831629, content=学习了,可以借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo4aQ9o3mwLf8g71RU8wyNNNCPdJSZhENIsqBjKUicL8BJXLqL2NMl0MlhjIRlv5Bpg0M3UZKuDlwhwLH8B3v2yNy/0, createdBy=11a82069421, createdName=136****3321, createdTime=Thu Jun 08 23:09:11 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208249, encodeId=e84720824912, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuGx0Nj1tUEG8bCiclXBNCCfjGSeFLCtppUMLTdyCtkvyjxxXViaDnQv43w5VAuic6FGPuCicSgnNKBc3/0, createdBy=21f41994764, createdName=阿吴, createdTime=Thu Jun 08 19:34:18 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208226, encodeId=218c208226c0, content=学习了,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/icyLhIGqru6gIknBJqfuPhQkEvDREF6S2vZq3ZIpUYjdqicKVoAWaJSGoe8xNvS6o6QpmOlh2AQ7xuUpj8NiaDjJJgjbc7Xj3T6/0, createdBy=1c242047915, createdName=daiyaozu, createdTime=Thu Jun 08 17:37:21 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208223, encodeId=84b3208223f8, content=不错哦,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epr1MZHfgreGEFrpiapjCGIQGZhkpjicialc8h7VoU0AjNiaSgpaZjNuIqq1KVbmI19JwrN2sdwTdWVSw/132, createdBy=f6692009961, createdName=sy3923582, createdTime=Thu Jun 08 17:27:28 CST 2017, time=2017-06-08, status=1, ipAttribution=)]
    2017-06-08 阿吴

    学习

    0

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    2017-06-08 daiyaozu

    学习了,不错

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1463400, encodeId=bb801463400dd, content=<a href='/topic/show?id=096a2e4865a' target=_blank style='color:#2F92EE;'>#值班#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27486, encryptionId=096a2e4865a, topicName=值班)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=391f6540675, createdName=yinxm8305, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486134, encodeId=8fca14861348d, content=<a href='/topic/show?id=1d1d2642342' target=_blank style='color:#2F92EE;'>#住院医师#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26423, encryptionId=1d1d2642342, topicName=住院医师)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20210911/083bd1e4f275987ec9d0acf672f9ae6e.jpg, createdBy=61d28082180, createdName=ms3025846204744509, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508801, encodeId=d81c15088012f, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584910012336, createdName=saikp, createdTime=Sat Jun 10 05:37:00 CST 2017, time=2017-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208316, encodeId=95a120831629, content=学习了,可以借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo4aQ9o3mwLf8g71RU8wyNNNCPdJSZhENIsqBjKUicL8BJXLqL2NMl0MlhjIRlv5Bpg0M3UZKuDlwhwLH8B3v2yNy/0, createdBy=11a82069421, createdName=136****3321, createdTime=Thu Jun 08 23:09:11 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208249, encodeId=e84720824912, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuGx0Nj1tUEG8bCiclXBNCCfjGSeFLCtppUMLTdyCtkvyjxxXViaDnQv43w5VAuic6FGPuCicSgnNKBc3/0, createdBy=21f41994764, createdName=阿吴, createdTime=Thu Jun 08 19:34:18 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208226, encodeId=218c208226c0, content=学习了,不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/icyLhIGqru6gIknBJqfuPhQkEvDREF6S2vZq3ZIpUYjdqicKVoAWaJSGoe8xNvS6o6QpmOlh2AQ7xuUpj8NiaDjJJgjbc7Xj3T6/0, createdBy=1c242047915, createdName=daiyaozu, createdTime=Thu Jun 08 17:37:21 CST 2017, time=2017-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=208223, encodeId=84b3208223f8, content=不错哦,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epr1MZHfgreGEFrpiapjCGIQGZhkpjicialc8h7VoU0AjNiaSgpaZjNuIqq1KVbmI19JwrN2sdwTdWVSw/132, createdBy=f6692009961, createdName=sy3923582, createdTime=Thu Jun 08 17:27:28 CST 2017, time=2017-06-08, status=1, ipAttribution=)]
    2017-06-08 sy3923582

    不错哦,学习了

    0

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