隔离预防准则:防止医疗机构病原体传播

2015-01-16 张鹤美 MedSci原创

医疗保健感染控制措施咨询委员会(Healthcare Infection Control Practices Advisory Committee HICPAC)防止传染性病原体传播措施要点包括以下六点:III A. 标准防护标准防护措施适用于所有患者,不论疑似病例或确诊感染患者,且适用于任何情况下。标准防护措施包括手卫生;根据预期的暴露使用手套、衣服、面罩、眼防护或脸防护;以及安全注射防护。

医疗保健感染控制措施咨询委员会(Healthcare Infection Control Practices Advisory Committee HICPAC)防止传染性病原体传播措施要点包括以下六点:


III A. 标准防护

标准防护措施适用于所有患者,不论疑似病例或确诊感染患者,且适用于任何情况下。标准防护措施包括手卫生;根据预期的暴露使用手套、衣服、面罩、眼防护或脸防护;以及安全注射防护。另外,可能被体液污染的设备及物品必须予以处理,以防传染性病原体传播(如,在接触被污染的设备或可重复使用的设备时需戴上手套,并且此类设备使用后需进行正确的清洁和消毒,以防另一名患者出现交叉感染)。标准防护中医护人员的防护是由其与病人接触性质、暴露于病人血液、体液中病原体的程度决定的。

III. A. 1. 标准防护的新要点

根据以往的感染控制措施尚不足以满足防控感染的要求,提示需要加入新的感染防控措施以保护病人。此新标准补充了三个要点,包括呼吸道卫生/咳嗽礼节、安全注射规范以及脊髓或硬膜外穿刺或注射药物(如脊髓造影、脊髓或硬膜外麻醉)时的防护。绝大多数标准防护的要点是对通用防护措施改良而确立的,且通用防护措施主要是保护医护人员,而新加入的防护要点是出于保护受试患者的角度考虑。

III. A. 1. a 呼吸道卫生/咳嗽礼节

在2003年SARS大流行时期,SARS冠状病毒主要通过病人及其家属传播,这强调了卫生医疗机构需要提高警惕,并且在接待病人的第一时间就要启动感染防护措施,这里所述的第一时间,例如急诊的接待处和分诊处、门诊及医生办公室。此防护策略已经被命名为呼吸道卫生/咳嗽礼节,并且作为标准防护的一个新部分纳入到感染控制措施中。该防护策略是针对确诊的传染性呼吸道感染病例及其随行的家人、朋友,并适用于任何一个出现传染性呼吸道感染临床表现而到医疗机构就诊的人,包括咳嗽、鼻噻、流涕或呼吸道分泌物增多。咳嗽礼节这一防控策略来自结核分枝杆菌的控制措施。

呼吸道卫生/咳嗽礼节的要素包括以下内容:

(1) 对医疗卫生机构人员、患者及访客进行教育;
(2) 为病人及其随行的家属及朋友张贴标语、提供适当说明服务;
(3) 传染源控制,例如咳嗽时用纸巾捂住口鼻,并及时处理用过的纸巾,必要的时候使用手术用口罩;
(4) 接触呼吸道分泌物后洗手;
(5) 保持距离,与呼吸道感染者接触时在等候区,必要时要保持1米(3英尺)左右距离(1英尺=30.48厘米)。

打喷嚏或咳嗽时捂住口鼻,咳嗽的病人带上口罩,这是防止感染者的分泌物散布到空气中。以上防护措施将有效降低通过大液滴传播传染性病原体的几率,这些病原体包括流感病毒、腺病毒、百日咳博德特氏菌和肺炎支原体。

医护人员在检查和照顾有呼吸道感染症状和体征的病人时,应注意做好飞沫传播预防措施(即戴口罩)以及手部卫生防护。处理呼吸道感染患者的医务人员应尽量避免裸露皮肤直接接触病人,尤其是对高危患者。

III. A. 1. b安全注射规范

美国发生的四起大型HBV和HCV暴发说明有必要加强安全注射操作。以下2点是常见的违规操作,易造成感染暴发:

(1) 安插盛装药物的容器(常见的是多剂量小瓶的药物)时重复使用注射器或针头,例如生理盐水袋;

(2) 多人共用注射器或针头;

只要可能,尽量使用单剂量小瓶装替代多剂量小瓶药物,特别是一瓶药物要多人共用时。

III. A. 1. c特殊腰椎穿刺的感染控制措施在脊髓相关操作过程中,是否需要佩戴口罩防

止口腔液滴菌群污染是一直争论不休的问题。在2005年10月,医疗保健感染控制实践咨询委员会(HICPAC)作出结论,他们有足够的证据证明,戴口罩会对放置导管或注入药物进入椎管或外膜外腔的过程有进一步的保护作用。

III. B. 针对传染病传播的防护

针对传染病传播的防护,主要用于单独使用标准防护不能完全阻断病原体传播的情况下,因为传染病的传播通常是多途径的,标准防护尚不能满足要求,如SARS。但这一防护一旦启动,必须努力减少对患者的不利因素。针对传染病传播的防护分为三类,如下:

III. B. 1. 接触防护

接触防护的目的在于防止病原体通过接触传播,包括流行病学中提到的重要的微生物,这类病原体通过直接和/或间接接触病人或病人起居环境而传播。接触防护也适用于出现过量的伤口引流、大便失禁,或其他提示增加潜在环境污染及运输风险的身体排泄物。单人病房是需要进行接触防护病人的首选方法。当单人病房措施不可用时,需要进行感染控制人员咨询,以评估其他患者放置(如照护、病人室友等)相关因素的各种风险。在多人病房,要求床位距离在1米(3英尺)左右,以防止感染者及其他患者无意间的共用一些物品。根据接触防护的要求,医护人员照顾患者时,接触病人周围可能污染环境、污染物品的全过程均需穿大褂并佩戴手套。进入病房前穿上个人防护设备(PPE),离开病房前脱掉,特别是对那些提示有通过环境污染进行传播的病原体。

III. B. 2. 飞沫传播防护

飞沫传播防护是为了防止病原体通过呼吸道传播或粘膜接触呼吸道分泌物引起的感染。对于需要进行飞沫传播防护的病人首选使用单人病房。当单人病房无法实现时,需要进行感染控制人员咨询,以评估与其他患者共室时放置方式有关的各种风险(如照护、患者室友等)。床位之间间隔1米左右,病床之间设置帘子,可有效降低飞沫传播的风险。飞沫传播防护中,医护人员与感染者密切接触时需佩戴口罩(呼吸器是没有必要的),在进入病房时戴上口罩。飞沫传播防护中,病人在室内外转运过程中需佩戴口罩,如果可以,病人需实行标准防护中的呼吸道卫生/咳嗽礼节。
III. B. 3. 空气防护

空气防护是防控悬浮在远距离空气中的病原体传播。对于需要空气防护的患者首选空气感染隔离室(AIIR)。空气感染隔离室是单人病房,每个空气感染隔离室配备空气净化和通风的设备,并满足美国建筑师协会/基金知道协会(AIA/FGI)对AIIRs的标准,即房内负压,对于新建和新改造的设备要求每小时换气次数超过12次,现有设备需要每小时换气次数超过6次,空气直接排出室外,或进行HEPA过滤循环后再排出。任何AIIRs需要进行呼吸道保护计划,其中包括了对呼吸机使用、fit-testing以及用户密封检查(user seal checks)有关的培训。由于有限的工程资源(如医生办公室),空气防护不能实施时,给患者佩戴口罩,并置于单独房间,关闭房门,医护人员佩戴N95口罩或更高级别的呼吸器,直到患者送回AIIRs病房或不再具有传染性,以减少病原体在空气中传播的可能性。在空气防护中,医护人员进入病房照顾病人时需佩戴口罩或呼吸器,这是根据疾病防控的具体需要而选择。只要有可能,对空气传播疾病中那些现已有疫苗的疾病(如麻疹、水痘、天花)感染者,如果医护人员无免疫力不可照顾该类患者。

III. C. 综合征及经验性诊断中针对传播途径的防护

在实验室结果尚未确定病原体而临床症状已出现时,是不确诊病例,但在患者出现一系列症状、传播感染,或在医疗机构接受治疗时,仍需执行防护传播的措施,此时需采用适当的针对传播途径的防护,以减少传播感染机会。

III. D. 针对传播途径防护的终止

对于一些疾病(如咽或皮肤白喉,RSV),直到病原体消灭即病原体培养或抗体检测为阴性,针对传播途径的防护依然有效。另外一些疾病(如结核分枝杆菌)国家法律法规和医疗机构的政策可能会要求采用预防措施的持续时间。一些免疫功能低下的患者,病毒排出时间相对延长,会传播感染,因此解除和/或液滴防护需要延长几周的时间。

III. E. 针对传播途径的防护在救护车及家庭护理机构中的应用

需进一步完善。

III. F. 室内环境防护

室内环境防护的目的是为了预防同种异体造血干细胞移植患者感染,减少空气中真菌孢子数,以降低侵入环境的真菌感染患者危险。造血干细胞移植患者病房的空气质量需要环境控制,包括:
(1)送入病房的空气需要进行HEPA过滤;(2)保持室内空气流通;(3)相对于走廊,室内保持正压;(4)良好的密闭性(包括密封墙、地板、天花板、窗口、电源插座),防止室外空气流入;(5)通风,每小时换气次数超过12次;(6)减少尘埃的措施;(7)室内禁止摆放干花、鲜花或盆栽。患者离开此环境时,需佩戴高效呼吸防护设备如N95口罩。


原始出处:

Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007;35(10 Suppl 2):S65-164.

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    2016-01-11 medsic

    0

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    2016-01-11 medsic

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=55863, encodeId=bd475586382, content=嗯, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55864, encodeId=8d7255864a8, content=嗯, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55865, encodeId=405d558653c, content=感谢分享~, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55860, encodeId=4bcf558600e, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55861, encodeId=3a685586136, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55862, encodeId=56625586291, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15570, encodeId=3709155e00b, content=是啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=928e1615200, createdName=jianlion, createdTime=Sun Feb 15 20:57:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15571, encodeId=a68e155e1c8, content=是啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=928e1615200, createdName=jianlion, createdTime=Sun Feb 15 20:57:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820099, encodeId=a16e182009932, content=<a href='/topic/show?id=d8ae100290c4' target=_blank style='color:#2F92EE;'>#预防准则#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100290, encryptionId=d8ae100290c4, topicName=预防准则)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7f52347, createdName=soongzhihua, createdTime=Fri Feb 06 10:35:00 CST 2015, time=2015-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1298317, encodeId=889d129831e9a, content=<a href='/topic/show?id=ac55350442f' target=_blank style='color:#2F92EE;'>#医疗机构#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35044, encryptionId=ac55350442f, topicName=医疗机构)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=63a4277, createdName=cy0324, createdTime=Sun Jan 18 09:35:00 CST 2015, time=2015-01-18, status=1, ipAttribution=)]
    2016-01-11 medsic

    感谢分享~

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=55863, encodeId=bd475586382, content=嗯, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55864, encodeId=8d7255864a8, content=嗯, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55865, encodeId=405d558653c, content=感谢分享~, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55860, encodeId=4bcf558600e, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55861, encodeId=3a685586136, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55862, encodeId=56625586291, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15570, encodeId=3709155e00b, content=是啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=928e1615200, createdName=jianlion, createdTime=Sun Feb 15 20:57:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15571, encodeId=a68e155e1c8, content=是啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=928e1615200, createdName=jianlion, createdTime=Sun Feb 15 20:57:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820099, encodeId=a16e182009932, content=<a href='/topic/show?id=d8ae100290c4' target=_blank style='color:#2F92EE;'>#预防准则#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100290, encryptionId=d8ae100290c4, topicName=预防准则)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7f52347, createdName=soongzhihua, createdTime=Fri Feb 06 10:35:00 CST 2015, time=2015-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1298317, encodeId=889d129831e9a, content=<a href='/topic/show?id=ac55350442f' target=_blank style='color:#2F92EE;'>#医疗机构#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35044, encryptionId=ac55350442f, topicName=医疗机构)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=63a4277, createdName=cy0324, createdTime=Sun Jan 18 09:35:00 CST 2015, time=2015-01-18, status=1, ipAttribution=)]
    2016-01-11 medsic

    标准防护,

    0

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    2016-01-11 medsic

    标准防护,

    0

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    2016-01-11 medsic

    标准防护,

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=55863, encodeId=bd475586382, content=嗯, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55864, encodeId=8d7255864a8, content=嗯, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55865, encodeId=405d558653c, content=感谢分享~, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:53:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55860, encodeId=4bcf558600e, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55861, encodeId=3a685586136, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55862, encodeId=56625586291, content=标准防护,, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Mon Jan 11 15:51:00 CST 2016, time=2016-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15570, encodeId=3709155e00b, content=是啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=928e1615200, createdName=jianlion, createdTime=Sun Feb 15 20:57:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15571, encodeId=a68e155e1c8, content=是啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=928e1615200, createdName=jianlion, createdTime=Sun Feb 15 20:57:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820099, encodeId=a16e182009932, content=<a href='/topic/show?id=d8ae100290c4' target=_blank style='color:#2F92EE;'>#预防准则#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100290, encryptionId=d8ae100290c4, topicName=预防准则)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7f52347, createdName=soongzhihua, createdTime=Fri Feb 06 10:35:00 CST 2015, time=2015-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1298317, encodeId=889d129831e9a, content=<a href='/topic/show?id=ac55350442f' target=_blank style='color:#2F92EE;'>#医疗机构#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35044, encryptionId=ac55350442f, topicName=医疗机构)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=63a4277, createdName=cy0324, createdTime=Sun Jan 18 09:35:00 CST 2015, time=2015-01-18, status=1, ipAttribution=)]
    2015-02-15 jianlion

    是啊

    0

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    2015-02-15 jianlion

    是啊

    0

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