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雾化吸入药物,你选择对了吗?

2018-04-22 ivy 医学之声

看似简单的雾化吸入,其实隐藏着大学问,是否每种激素或抗生素都可用作雾化吸入药物呢?

看似简单的雾化吸入,其实隐藏着大学问,是否每种激素或抗生素都可用作雾化吸入药物呢?

临床上,雾化吸入凭着直接作用于病灶局部,起效快,全身副作用小,广收患者以及医生欢迎,呼吸科的治疗哮喘、咳嗽的得力助手,耳鼻喉科治疗咽喉炎的常用武器,看似简单的雾化吸入,其实隐藏着大学问,是否每种激素或抗生素都可用作雾化吸入药物呢?其实不然,用的好可致病,用的不好可引发巨大副作用,雾化吸入药物只能对使用以下四类药物发挥作用。

(一)吸人性糖皮质激素(ICS)

布地奈德(BUD)和丙酸倍氯米松(BDP)ICS 是目前最强的气道局部抗炎药物,它通过对炎症反应所必需的细胞和分子产生影响而发挥抗炎作用。

特点: ICS 安全性好,不良反应发生率低于全身给予糖皮质激素。研究显示,ICS 对下丘脑一垂体一肾上腺轴无明显抑制作用,对血糖、骨密度影响小。局部不良反应包括声嘶、溃疡、咽部疼痛不适、舌部和口腔刺激、口干、反射性咳嗽和口腔念珠菌病,通过吸药后清水漱口可减少其发生。其中, 布地奈德是美国食品药品管理局(FDA)批准可用于4岁以下儿童使用的雾化吸人激素,也是妊娠安全分级为 B 类的糖皮质激素(包括鼻用和吸人制剂)。

临床应用:

(1)ICS是当前治疗哮喘最有效的抗炎药物。在哮喘发作或症状加重的初期,雾化吸入支气管舒张剂联合大剂量的ICS可以替代或部分替代全身应用激素。BUD混悬液为临床应用最早和最广泛的ICS。

(2) 应用于慢阻肺患者,雾化吸入高剂量的ICS可降低慢阻肺急性加重炎症水平,缓解急性加重症状,改善肺功能。

(3)应用于急性咽喉炎、急性会厌炎、急性喉炎等耳鼻喉相关疾病的雾化吸入,以及儿科呼吸系统疾病的雾化吸入治疗。

(二)支气管舒张剂

1.选择性β2 受体激动剂:特布他林和沙丁胺醇

β2 受体激动剂是临床最常用的支气管舒张剂,根据其起效时间和持续时间的不同可分为 SABA 与长效β2 受体激动剂(LABA)两种。目前临床上雾化吸人所用制剂主要为 SABA。 SABA 制剂的共同特点是起效迅速、维持时间短,代表药物有特布他林和沙丁胺醇。有文献报道,特布他林对β2 受体选择性及对肥大细胞膜的稳定作用均强于沙丁胺醇。

特点:不良反应主要有:骨骼肌震颤、头痛、外周血管舒张及轻微的代偿性心率加速。罕见过敏反应包括血管神经性水肿、荨麻疹、支气管痉挛、低血压、虚脱等。

临床应用:

(1)是哮喘患者预防或缓解症状所必须,对于轻中度哮喘急性发作,重复吸入SABA通常是最有效的治疗方法。

(2) 反复给予雾化吸入短效的支气管舒张剂是慢阻肺急性加重的有效治疗方法。

(3) 用于支气管扩张症以及慢性支气管炎

2. 胆碱受体拮抗剂:异丙托溴铵

异丙托溴铵为常用的 SAMA 吸人制剂,该药为非选择性胆碱 M 受体拮抗剂,由于其阻断突触前膜上 M2 受体可促使神经末梢释放乙酰胆碱,因而部分削弱了阻断 M3 受体所带来的支气管舒张作用。

特点:胆碱 M 受体拮抗剂不良反应主要有:头痛、恶心、口干、心动过速、心悸、眼部调节障碍、胃肠动力障碍和尿潴留等。和其他吸人性支气管舒张剂一样,有时可能引起咳嗽、局部刺激,极少情况下出现吸人刺激产生的支气管痉挛。

注意:临床有吸人性复方异丙托溴铵制剂,其 2.5 ml 溶液内含有异丙托溴铵 0.5 mg 和硫酸沙丁胺醇 3.0 mg(相当于沙丁胺醇碱 2.5 mg)。复方异丙托溴铵不能与其他药品混在同一雾化器中使用。

(三) 抗菌药物

临床上用于雾化吸人的抗菌药物有氨基糖苷类的阿米卡星、庆大霉素、妥布霉素,B-内酰胺类的氨曲南、头孢他定,黏菌素,抗真菌药物二性霉素等。

特点:吸人后肺部浓度高,全身不良反应少。抗菌药物雾化吸人多应用于长期有铜绿假单胞菌感染的支气管扩张症和多重耐药菌感染的院内获得性肺炎,如呼吸机相关性肺炎(VAP)等。

临床应用:美国FDA已批准妥布霉素用于雾化吸入治疗囊性纤维化疾病,也可用于支气管扩张症急性加重期。

(四)祛痰药

1.N-乙酰半胱氨酸:可降低痰的黏滞性,并使之液化而易于排出。近年来,多项研究结果提示,雾化吸人 N-乙酰半胱氨酸可用于特发性肺纤维化的治疗,可改善患者肺功能,尤其适用于早期患者。

2.盐酸氨溴索:可降低痰液黏稠度,增强支气管上皮纤毛运动,增加肺泡表面活性物质的分泌,使痰容易咳出。此外,还有镇咳作用。盐酸氨溴索雾化剂型在国内尚未上市。

临床应用:对于痰多黏稠不易咳出的慢阻肺急性加重患者以及慢性支气管炎患者,联合使用ASBA与祛痰药雾化吸入可协调排痰。

传统的雾化吸入“呼三联”(地塞米松、庆大霉素、α-糜蛋白酶),由于在气道停留时间短,不良反应大,可产生耐药,故不适合雾化!

因此,我们临床上需明确各种雾化吸入药物的临床使用以及安全性,才能游刃有余的使用药物对症治疗!避免盲目将药物一通用于雾化吸入,效果适得其反。

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    2018-04-24 xiaogan8479

    非常好.谢谢分享

    0

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  3. [GetPortalCommentsPageByObjectIdResponse(id=308904, encodeId=a146308904db, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Tue Apr 24 19:57:21 CST 2018, time=2018-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457732, encodeId=c036145e7328d, content=<a href='/topic/show?id=e2d1988611e' target=_blank style='color:#2F92EE;'>#雾化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98861, encryptionId=e2d1988611e, topicName=雾化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Mon Apr 23 15:20:00 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308518, encodeId=e18f3085186d, content=不错的.很好.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Mon Apr 23 12:11:46 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308216, encodeId=5dd93082163e, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:10:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308179, encodeId=583a3081e9f9, content=很全面.好文., beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22319044, createdName=122468b8m89(暂无昵称), createdTime=Sun Apr 22 09:02:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308147, encodeId=866630814e05, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Apr 22 07:41:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308133, encodeId=1bf1308133cb, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Sun Apr 22 07:32:21 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308108, encodeId=89753081087c, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:45:09 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308104, encodeId=8387308104d7, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sun Apr 22 06:38:11 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308068, encodeId=25c530806863, content=非常全面 感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Sun Apr 22 05:55:47 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-23 易水河

    不错的.很好.学习学习

    0

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    2018-04-22 执着追梦

    学习.谢谢分享

    0

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    2018-04-22 122468b8m89(暂无昵称)

    很全面.好文.

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=308904, encodeId=a146308904db, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Tue Apr 24 19:57:21 CST 2018, time=2018-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457732, encodeId=c036145e7328d, content=<a href='/topic/show?id=e2d1988611e' target=_blank style='color:#2F92EE;'>#雾化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98861, encryptionId=e2d1988611e, topicName=雾化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Mon Apr 23 15:20:00 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308518, encodeId=e18f3085186d, content=不错的.很好.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Mon Apr 23 12:11:46 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308216, encodeId=5dd93082163e, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:10:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308179, encodeId=583a3081e9f9, content=很全面.好文., beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22319044, createdName=122468b8m89(暂无昵称), createdTime=Sun Apr 22 09:02:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308147, encodeId=866630814e05, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Apr 22 07:41:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308133, encodeId=1bf1308133cb, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Sun Apr 22 07:32:21 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308108, encodeId=89753081087c, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:45:09 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308104, encodeId=8387308104d7, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sun Apr 22 06:38:11 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308068, encodeId=25c530806863, content=非常全面 感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Sun Apr 22 05:55:47 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 三生有幸9135

    学习一下谢谢分享

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=308904, encodeId=a146308904db, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Tue Apr 24 19:57:21 CST 2018, time=2018-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457732, encodeId=c036145e7328d, content=<a href='/topic/show?id=e2d1988611e' target=_blank style='color:#2F92EE;'>#雾化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98861, encryptionId=e2d1988611e, topicName=雾化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Mon Apr 23 15:20:00 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308518, encodeId=e18f3085186d, content=不错的.很好.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Mon Apr 23 12:11:46 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308216, encodeId=5dd93082163e, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:10:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308179, encodeId=583a3081e9f9, content=很全面.好文., beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22319044, createdName=122468b8m89(暂无昵称), createdTime=Sun Apr 22 09:02:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308147, encodeId=866630814e05, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Apr 22 07:41:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308133, encodeId=1bf1308133cb, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Sun Apr 22 07:32:21 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308108, encodeId=89753081087c, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:45:09 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308104, encodeId=8387308104d7, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sun Apr 22 06:38:11 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308068, encodeId=25c530806863, content=非常全面 感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Sun Apr 22 05:55:47 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 wzb521zf

    一起学习学习

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=308904, encodeId=a146308904db, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Tue Apr 24 19:57:21 CST 2018, time=2018-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457732, encodeId=c036145e7328d, content=<a href='/topic/show?id=e2d1988611e' target=_blank style='color:#2F92EE;'>#雾化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98861, encryptionId=e2d1988611e, topicName=雾化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Mon Apr 23 15:20:00 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308518, encodeId=e18f3085186d, content=不错的.很好.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Mon Apr 23 12:11:46 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308216, encodeId=5dd93082163e, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:10:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308179, encodeId=583a3081e9f9, content=很全面.好文., beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22319044, createdName=122468b8m89(暂无昵称), createdTime=Sun Apr 22 09:02:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308147, encodeId=866630814e05, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Apr 22 07:41:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308133, encodeId=1bf1308133cb, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Sun Apr 22 07:32:21 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308108, encodeId=89753081087c, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:45:09 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308104, encodeId=8387308104d7, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sun Apr 22 06:38:11 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308068, encodeId=25c530806863, content=非常全面 感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Sun Apr 22 05:55:47 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 张新亮1853311252142e2fm

    好文献学习了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=308904, encodeId=a146308904db, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Tue Apr 24 19:57:21 CST 2018, time=2018-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457732, encodeId=c036145e7328d, content=<a href='/topic/show?id=e2d1988611e' target=_blank style='color:#2F92EE;'>#雾化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98861, encryptionId=e2d1988611e, topicName=雾化)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b79433, createdName=jiangjun073, createdTime=Mon Apr 23 15:20:00 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308518, encodeId=e18f3085186d, content=不错的.很好.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Mon Apr 23 12:11:46 CST 2018, time=2018-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308216, encodeId=5dd93082163e, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:10:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308179, encodeId=583a3081e9f9, content=很全面.好文., beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22319044, createdName=122468b8m89(暂无昵称), createdTime=Sun Apr 22 09:02:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308147, encodeId=866630814e05, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Sun Apr 22 07:41:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308133, encodeId=1bf1308133cb, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Sun Apr 22 07:32:21 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308108, encodeId=89753081087c, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:45:09 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308104, encodeId=8387308104d7, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sun Apr 22 06:38:11 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308068, encodeId=25c530806863, content=非常全面 感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Sun Apr 22 05:55:47 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

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    2018-04-22 871538379

    非常全面 感谢分享

    0

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