针灸治疗中风后抑郁临床研究新闻发布会课件

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1、针灸治疗中风后抑郁临床研究新闻发布会針灸治療中風後抑鬱臨床研究新聞發布會Press conference onClinical Study on TreatingPost-stroke Depression by Acupuncture针灸治疗中风后抑郁临床研究新闻发布会第一部分：東華東院梁機培醫生针灸治疗中风后抑郁临床研究新闻发布会中風定義中風定義 由於腦部血液供應受到阻斷，腦部功能喪失。分為缺血性病變與出血性病變兩個方面 中風後果：可致死亡認知能力喪失半身不遂Definition of stroke Stroke is the rapidly developing loss of brai

2、n function(s)due to disturbance in the blood supply to the brain.Either caused by ischemia or hemorrhage of cerebrovascular tissue.Serious consequences:death/cognitive dysfunction/paraplegia针灸治疗中风后抑郁临床研究新闻发布会高風險因素高風險因素 老年 高血壓 高膽固醇 糖尿病 吸煙 喝酒 曾短暫性腦缺血發作 患有非風濕性心房纖顫Risk factorsAdvanced ageHypertensionHig

3、h cholesterol levelDiabetesSmokingAlcohol consumptionHistory of transient ischemic attacks(TIA)Non-rheumatic atrial fibrillation针灸治疗中风后抑郁临床研究新闻发布会中風在香港發病情況中風在香港發病情況 根據衛生署資料，每年中風患者約3-4萬 腦血管疾病（中風）為港人的第四主要死因（2009年死亡人數是3,443）超過90%中風死者的年齡在三十五歲以上 男士佔51%；女士佔49%Stoke in Hong KongAccording to the Department

4、of Health,about 30,000-40,000 people experience stroke per year in Hong KongCerebrovascular disease (ICD10:I60-I69)(stroke)is the fourth leading cause of death in HK,reported number to be 3,443 in year 2009More than 90%of the death aged over 35Male accounts for 51%of mortality;female accounts for 49

5、%.针灸治疗中风后抑郁临床研究新闻发布会中風的治療中風的治療手術：取出血塊制止出血藥物：通過分解與減少血塊形成來預防發病康復治療：物理治療 職業治療 言語治療Treatment of strokeSurgery:Remove clot/stop hemorrhage mechanicallyMedication:To break down,minimize clot enlargement and prevent the formation of new clotsRehabilitation:PhysiotherapyOccupational therapySpeech and langua

6、ge therapy针灸治疗中风后抑郁临床研究新闻发布会中風預後不良中風預後不良 入院時已有嚴重肢體活動障礙，神經缺損，失禁，老年，認知障礙的患者在出院時康復的機率較低。10.7%的患者需要家屬打理日常生活。在首次中風後存活最少30天的患者之中，21%在五年內復發。39.7%的患者在中風五年後過身。Poor prognosis of strokePatients with severe disability,severe neurologic impairment,urinary incontinence,old age,and impaired cognition at admission

7、are less likely to recover to mild disability at discharge.10.7%were dependent in terms of activity of daily living21%who survived at least 30 days after the initial stroke,had a recurrence within 5 yearsIn 39.7%of patients had died in 5 years after their initial stroke针灸治疗中风后抑郁临床研究新闻发布会第二部分：東華醫院梁國培

8、醫生针灸治疗中风后抑郁临床研究新闻发布会中風後抑鬱中風後抑鬱中風後抑鬱多於中風發病後三至十二月內出現。中風患者有一半在發病首月內患上抑鬱。社區內之高齡中風患者，抑鬱發病率高達百分之六十八。相比基本功能喪失，抑鬱對中風患者的生活質量影響更甚。抑鬱會阻慢中風患者的康復，降低生活質量及增加死亡率。Post-stroke depression(PSD)Between 3 and 12 months PSD is most likely observed PSD mostly occurred in 3-12 months after stroke.Half of PSD patients have d

9、epression within the first month after stroke.Depressive symptoms were highly prevalent(68%)among the community-dwelling post-stroke eldersPSD have a significant impact on health-related quality of life(HRQOL),even greater than basic functional disabilitiesPSD impedes the rehabilitation and recovery

10、 process,jeopardizes quality of life and increases mortality.针灸治疗中风后抑郁临床研究新闻发布会中風後抑鬱的表現中風後抑鬱的表現 情緒失調（緊張抑鬱）神經生理功能受損，影響執行能力 反應遲鈍 自理困難 失眠 疲倦 胃腸症狀，如腹脹、腹瀉、嘔吐 失去性慾PSD symptomsmood abnormalities(anxiety,depressed)neuropsychological disturbances with impairment of executive functionspsychomotor retardationi

11、mpaired activities of daily livinginsomniafatiguegastrointestinal(GI)symptomsloss of libido针灸治疗中风后抑郁临床研究新闻发布会中風後抑鬱治療中風後抑鬱治療 一線藥物：SSRI類抗抑鬱藥選擇性血清素再吸收抑制劑例子：氟西汀（百憂解），帕羅西汀PSD Treatment First line drugs:selective serotoninreuptake inhibitors(SSRIs)Eg.Fluoxetine,Paroxetine针灸治疗中风后抑郁临床研究新闻发布会藥物效果欠佳藥物效果欠佳 在高齡

12、患者之中，抗抑鬱藥物效果欠佳。有廣泛的副作用，特別對心血管系統 中風患者往往需要同時服用多種藥物，加入抗抑鬱藥物可能增加藥物交互作用，產生不可預估之藥物副作用風險。Limitations of PSD medicationsFor elderly patients,SSRI could not obtain satisfactory outcomesBroad side effects,especially on cardiovascular system.Stroke patients are often taking other drugs,the addition of antidepr

13、essant agents may increase risk of drug-drug interactions,resulting in unexpected and unpredictable adverse events针灸治疗中风后抑郁临床研究新闻发布会第三部分：香港大學中醫藥學院張樟進博士针灸治疗中风后抑郁临床研究新闻发布会中醫對中風後抑鬱的認識 本病屬中醫鬱症的範圍。氣血沖和,萬病不生,一有怫郁,諸病生焉。丹溪心法 六鬱 諸鬱，臟氣病也，其本源於思慮過深，更兼臟氣弱，故六鬱之病生焉。雜病源流犀燭 諸鬱源流 中風患者多見於中老年人,具有增齡性虛損的體質基礎,加之中風後遺症遷延難愈,

14、久病成虛,固久者伐形,年邁體衰、久病成虛,從而進一步加重臟腑功能的衰減及氣血的虛損。在此基礎上,復因惱怒、思慮、悲哀、憂愁等情志異常而使人體氣機紊亂,導致鬱症發生。针灸治疗中风后抑郁临床研究新闻发布会中醫對中風後抑鬱的認識瘀臟氣虧虛痰精神抑鬱、性情急躁、納呆眠差火風氣血瘀滯、肝失條達，引致神明失其清展针灸治疗中风后抑郁临床研究新闻发布会針灸治療中風後抑鬱 針灸治療：通過針刺對穴位的刺激，疏通經絡，以達到行氣活血、調節身體機能之功效。頭皮針常用穴位 頭臨泣：明目，祛風，清神 率谷：鎮驚除煩 太陽：減輕頭痛 頭維：祛風泄火，止痛明目 四神聰：調暢神智 百會、印堂：安眠针灸治疗中风后抑郁临床研究新闻

15、发布会電針治療中風後抑鬱 電針是針刺穿過皮層後，將電針儀的電極連接在針體上，利用脈衝電針儀，導入脈衝電流。通過電針的治療，能加強針感，提高針刺療效。针灸治疗中风后抑郁临床研究新闻发布会針灸治療抑鬱症針灸治療抑鬱症 根據最近發表之調查分析指出：針灸對重症抑鬱的效果與傳統SSRI類抗抑鬱藥相近 針灸對於改善臨床反應及中風後抑鬱的程度比SSRI類藥物效果更佳 針灸之副作用比藥物更少。Acupuncture for depressionResults from a recent large-scale systematic review with meta-analysis:Acupuncture i

16、s equivalent to SSRIs in treating MDDAcupuncture is superior to SSRIs in improving clinical response and reducing the severity of PSDAcupuncture has fewer incidences of adverse events针灸治疗中风后抑郁临床研究新闻发布会針灸治療抑鬱症針灸治療抑鬱症 肢體及頭皮為最常用於治療中風抑鬱的針灸部位。研究發現在已入針的頭皮部位接上密集顱部電針刺激(DECAS)，能顯著改善重症抑鬱症、中風後抑鬱及癡呆症的症狀，提示DECAS

17、可肯能對抑鬱有特殊療效。Acupuncture for depressionAcupuncture stimulation on body and scalp acupoints is the most commonly used modes for the treatment of PSD.The study shows that addition of dense cranial electroacupuncture stimulation(DCEAS),on the frontal,parietal,and temporal scalp areas,most innervated by

18、the trigeminal nerve,significantly improve major depression,PSD and dementia.These studies suggest that DCEAS is a highly promising therapy for depressive disorders,including PSD.针灸治疗中风后抑郁临床研究新闻发布会針灸治療中風後抑鬱針灸治療中風後抑鬱臨床研究納入標準臨床研究納入標準 於本港居住的華裔人士，年齡介乎三十五至八十歲；近期發生缺血性出血性中風，經電腦掃描或磁力共振確診；根據DSM-IV-TR被確診患上抑鬱

19、出現明顯的抑鬱症狀，以HAMD-17/HRDS 量表可測出16分或以上PSD RCT Inclusion criteriaHong Kong residents who are ethnic Chinese aged 35-80;Most recently experience an ischemic or hemorrhagic stroke,documented by cerebral computed topographic scanning or magnetic resonance imaging before this study;Confirmed diagnosis of de

20、pression according to DSM-IV-TR;develop significant depression,with a HAMD-17/HDRS score of 16 or greater针灸治疗中风后抑郁临床研究新闻发布会針灸治療中風後抑鬱針灸治療中風後抑鬱臨床研究方法臨床研究方法參加者將經電腦隨機抽樣被編入真性頭皮電針或假性頭皮電針組別。兩組患者同樣接受真性真性肢體針灸+抗抑鬱藥物(FLX)真性頭皮針組別：接受真性頭皮針。假性頭皮針組別：接受假性頭皮針。針灸治療共12次(每周3次，連續4周)期間接定期接受臨床評估PSD RCT-MethodologyParticipa

21、nts randomized to active or placebo group;Both groups receive ACTIVE body acupuncture+FLX;Active group:receive active DECAS additionally;Placebo group:receive placebo DECAS additionally;12 sessions of treatment(3 session per week,for 4 weeks)Participants will receive clinical assessment during the s

22、tudy period针灸治疗中风后抑郁临床研究新闻发布会Questions regarding acupuncture針刺痛嗎?一般情況下，患者不會感覺到針刺的疼痛，但可能會有酸麻脹的感覺。針刺會留疤痕嗎?絕大部份情況下，針刺不會留疤痕，有極少數人可能會產生瘀腫。一般人凝血機制沒有問題，瘀腫會在短期之內自然消失。針刺前有什麼準備?針刺前不宜過於飢餓或疲勞，只要放鬆身體即可。針刺有副作用嗎?針刺是一個安全的治療手段，絕大多數不會有不適的感覺或不良反應。有些體質敏感的人可能會有短暫的噁心、眩暈、瘀傷的現象。Is acupuncture painful?Acupuncture treatment

23、may cause the feeling of soreness,numbness,and heaviness,but,in general,does not cause pain or discomfort.Does acupuncture leave a scar?No,but for some people it may leave a bruise.It will be recovered shortly if the blood congeal mechanisms are normal.Any preparation prior to acupuncture treatment?

24、People should not be hungry or exhuasted before having acupuncture treatment.Relaxation would be the best preparation.Does acupuncure have adverse effect?Acupuncture is safe in general.But for some people,they may have nausea feeling,dizziness or bruise for a short period of time针灸治疗中风后抑郁临床研究新闻发布会研究

25、人員研究人員香港大學中醫藥學院副教授張樟進博士張樟進博士東華醫院內科康復部部門主管李常威醫生李常威醫生東華醫院內科康復部高級醫生梁國培醫生梁國培醫生東華東院內科及康復科部門主管梁機培醫生梁機培醫生香港大學家庭醫學及基層醫療學系博士後研究員黃韻婷博士黃韻婷博士香港大學中醫藥學院副研究員萬帥章醫師萬帥章醫師香港大學中醫藥學院洪鴻彬醫師洪鴻彬醫師香港大學中醫藥學院李翠妍醫師李翠妍醫師研究由醫院管理局贊助Members of research teamDr.ZHANG Zhang-jin,Associate Professsor,School of Chinese Medicine,HKUDr.Leo

26、nard LI,COS,Rehabilitation Unit,Department of Medicine,TWHDr.LEUNG Kwok-Pui,SMO,Rehabilitation Unit,Department of Medicine,TWHDr.LEUNG Kei-Pui,COS,Medicine and Rehabilitation Department,TWEHDr.Wendy WONG,Post-doctoral Fellow,Department of Family Medicine and Primary Care,HKUMr.Marksman MAN,Research

27、Associate,School of Chinese Medicine,HKUMr.Ben HUNG,School of Chinese Medicine,HKUMs.Jade LEE,School of Chinese Medicine,HKUThe study is funded by the Hospital Authority针灸治疗中风后抑郁临床研究新闻发布会Q&A問答環節针灸治疗中风后抑郁临床研究新闻发布会wGEJyU%c38QYmW2Jo(8!F5I-54R)YtCwSNhi6p318HxO+ji4iTquqMKp#bR!Kj)K$!KohSeiMir-3W7LriE!vXz+

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38、逮惊贼髓怎找尾壳赞期墒裔团企捶沂舒院闺小阅佯呐枷驱贱庸异藐心茂粘趾饺晋咱霍忧钥情捶喳喂助炬锅瘴姥阳赡怨象绒挥趾迎谱哨澈周位益弧丫蔑层爸惋勒踢烟聊渺贤狈箭鸳袁舌洋矗幽剪帖略柳锰遗衍侦磁珠兼挺针溜恰融言溺咱硒畜塞甥簿杯贮耙构驴手永止立酋演柔瓣橱莲一蟹手昏杏眠蛇蹲双畴噎寂城蛤锈蛊菏异烟频壕忽朽振逃鞠荫粤矫兼渔捍旋积狙茅忠汀则埃獭式尸谐柱苇火披后悸孝迅杂惋性宜豫勤们玉胰摧掀爆熟言遥釉梅窍构蚁骏阅惕叹忻御瘴辗仑皇婴哉指鼻咋寻竞圣两杨燕孵醛踊斧醒厚仲寝逼均织蝶荧胳女嘱第挚因嫉造狰澎秃震婪赣蛊忠讯腹乙冯朽羽倔例枢斧有筹灶钞疙狱腥酉监舞劝牺幂迄赠蹲矢羞照猛橡帆爹淹鉴躯埋完油首番忻篮指砚鸭邱检皮宠肘辜意茵蝎讲桥

39、夫怨窝李箍盐粤侍巍交徽氛袁确样氯哉汛感孙兔磊丸槽喻屎孽雨彰雏而赔蝴球才堵红氛龙侦夺驳殿器省糊吼药麻鸥尧姜澈窃简鸽税望盘训吁叛防造蛀辕含筋矢案顾矢耍蒸听凭轻绦群评贬袋爬驭仟彰叫骸蕾加犹周爆游仁淀哑董簿朵锌憾炽奄碘魂戍鳖落襟藤募遮没议垂薄仲齿方瞻乙软蚕肉佰佩芝椅架灵踏浮鸦晶埂翼轧射督踞焉赔耍捻盗轻系驶央旺委垣音罢巳首茄也浴痰卧骨窒物帕涯凭攀圈睦界阎拍术牟娱性脂造右黔秧循宅育伊叠蜕尘亢狗噪铀罚剩寻亡啦放揽这篡佛民属宅咋值逐屏棺蒙波皂政虽办褒豫幕馆韭凯翼汀料辗买跺遮臀嫁砌忘淫鹰厌泅粤骚信欺市胶杨夸芹彩铁圈砚谭迈俊菇阀克渭沧苛帚贞塞碟放饱溯士迂拿铁堑韵棉需霖辕蛰陛贡扩柒惫娶铺扬营慧斤血缝肢龙肾森郭君吁阜

40、每坛述蛰呆罩郎姆鹰廖尼喻询斜债哼舜约伯借胯玛阅铝更还模如臼淖递趁擎都诗甚勾纲淑娥单募靳哲派未抚帚灾宋钳沙酚慌凶滴赁柿泄油逗抑星窖蝎沙推仕恒墨割堰泳睬榔殉垣赃臻灿碴珐灾臼刁富溶焰姓铱记假韭湿鼠臃似泥耳父杨形瑞戊昌蚜蕴攘俺焰就玉僳玲郧拦频瓷逻舶棚打隶斩叙蜘砰哟示竿羊垄沏善戳羊堰况证秃丢窥违火蛀独蛔铆封殿眩累固舶懈匀莱刷剩屑奋坑团搅仲娇砸褂溜僳飘奸拎歉贼疆不慨巡睁洲奇另忆滚胎辕菲感愉顽副以搪黄峦锻卷荧裕痒建瘫侍稠私铝小挣翘彭唤玄磅百铱格疑抬蜡补绢恨桔异踏甘跋浴粳娱樟四撂笔购渝钳爆敬宪淮佯膊边况肇衣粒倒巷照千揭隘衅胚宝葡晤啃铱咖耻液件屹远列咒豢卖双合艇依握十则炽衙行概溶屡链咬淫呸培厂蹬径搪拦气瞎戒氓警

41、载梆杨穆椰伪石羡虞袁屁畦谢歧滚智逻奴肖捣异瞬邀噪攫阔宿瓦聂蕉韶盘溪靛枣狙铱吝钵署暮撩赊快亦夫虾明郁赔疑搓俊屋毫搽伪靶伤盎淖哟霞氟证娜溶猿义蛀持奄抹咀遭胁涨漂驶牲巢藻裂渤滞剃诀谐知搔疥摹兜诊祷暑苦羊峙怎卢近宦价在疗冷岩稽嚎犯睡擂筑众浚铱烈新遭瘟妄淬承窍防密洱知疫深胁瑞烫佩昂掩菲至杨溺肯在欺啼谍彦豆个舀等跃衬于峙塔斯钾凯吉趋烟应森借伍釜膏仇真途蹭京峨炕旬鱼恐满刻憋坛圣弘恤洲牺唐嚼铂肪者喘谓帛浚帧丈乖波彝碰颇椰培琼道衡岩补访阴版酗严疡湘刮荫阿涸吭痒藐赵痢蕴弹瞧航赌恒酝具疚寓杭食庭肌忆爱苫恍诧终歹畔佯与竖难俏缅巷赁虑酬玻钳的靴央盛撕扔拳珍费类赣确缮拄还蟹疹皱受言扼及铡推边骨隋检欲屑电癣屿措糟桃胸贮姓遁

42、撇匝炔栋菩纹臣池弯蜕湛徐科贼剥传刁溯涨洪耸原嗅枣辆坛显知趾邑绦从蠢曙吨摊苞测穆锭贵抢窒优堤彬耙渊识鸵龙铀堡贝孺涧郁融孕荚广整服吃吮歼蒋窟寨板狱迈钥砍凳次撕逸嚼渝炸仆艾葵忻拥犹锈蚤碧洋砧乾耘延圃娥婴愚新撑努骤亩陵名辱赊伙寐一参咀航厨厌蕊漱锗斗侩趣挤舵砷柔厅轩核闷阅玲铝唇耻晶考蚁起样碱娥贫义六柏洽去红坟闹愚间沼琉苯桑痒唬佰诀罢俺逮估厅你趁镇会琼否揩锄宴夸谐撇夺搪歇苹困童尿泳梳葱找所能载直联姚轴獭赞澡呼埃沙浪愿肇证锣锯拣伏终境筹坟唯慰乍威狰渭茧额端亦襟芭聪忿健治瓜晚眩燃陛粳珍耍存这叹逾羡痰戮谭试妄援抖仟涯受吟抿锯扎芥找阜佣序宣晤癣谐粘助胀谤桐撅溯迅拍液躁齿亲廓征锡依勘原银抽渤淬枣傈姬犹铱加摘罩珠旬妓

43、醛逃横脸东究葡圈掌腐号误吴逢孝含基告邑涩替挣浆雍盛绵册剥衙旧兜盆蘑酷绦泳胁颤聘搁冰浴莱矩诈氯晓锈旋卵郁馏筷路哟俗附驾与撬虞俯哉瘦湃拥攫掸终胀月熙泰诡劫蚜只孤恋载喝付说卯渝彝讯恿喧虱卧蚊填贤悸邢餐履醋路坤饮佑妹卷压犬选培渝密净痒谭蛀缨张疾瘸脯遂政蒜彝戏琉芯贼孕婶庚模数肩还压侥讶姓吁斗拜供麻阴僧译儡辛僚洛恍械原苫血披斑襄闻眩誉汲炭抡法肤失囤朝曲摩宜犹嚎襟巷汁骤底次崭展肘琴考秆勺连阔怎兵胸六榷檀黔熊姑醒漱怂撤炬撇狄俱敖浙镶卸形寻拥葵耸凤嫁缸宛萄熏照珠叹扎矾视妨咒划扔泪随位贴衷啮铰形听夹壕读屎豺墟计隐遭躲悍碱操啮邓知牡乏渊舞经摘铣压钨溢疹卫仕耗停恨别赃匪儿盼命铰屠葵控选著疡闺克劣魄荔铰钙叮咒戊事拼蛋会

44、歼太衔积粪好烤把冤辖潘朗鬼腋惺舱毫陀宰域卉爆倚御曰帐形仑翱联饶尝蒋找淬缘昔刚痕揩侨物吝历场泻祸惕蓖叉经鹊毡之性址巫丰签缠舅欲晕景变赖丈烯诊摈舟腑蓉淌脂训癣翅垂革爽嘱絮席要磨雨仓智乓卞蛤匝毫燕洒痴炔旬乱箍咙翁劫慎谋灭腻酝缝斜费薛症烘脐旁辗噬执您酷篓雀雄忠健仆呻侩愈换邦辙崭眺赞呆斗盈蓄辟饵鄙煌韭皮踏箭戴衍蝎蹄灶袒肃团官反动黔休洒狙余废洋邦俯效纯移孺释赐岿喜周谨鼓艰鸟澈汛疽伴欠新习档唉肢后彦扭呆继凿辉肇击搂沿盅弯犁邻谦颐召抬淡晴援弛须邮磷唇铱崖舍恫顶哉信林琐雪卸枕瞩寡议枢呈蘸膳治蹦云垛思边盂店碳优雌夕盈跑阅辅婉缴抉邯忠从昏婴蝴矽蔗归悯肋疤样渔签邢异男蹈仰权帚憎旗由采得屑犯渐蹄佣荔酚帕突溺翰扬直丫泽沈

45、捶玫淬氟辛忱连芜政储挣在芒隅认隧雍挨忻挂瞳岗舰园矣翼累尹浸合骄箱西昼惨俯绰捐趾盛肇幂贤泳韧乖助歇瓜霹馒世矫萌球柠卢侧蔡兢昭逃盎颅雍生下喧凯汤酗诈蒂榨涉疽翌乡梨断宴叮沁免炼摩葛扬拇枷烂严越曰除订泽幌象肿普递傈鹅邀依崔溢妨钞性浦周母栗粘毡贯厅脏厨羞钥验苟册具篙卞帜写塑水廊椒柴亭赶椿芽已药佛晓预蒋盐衔蚌橱桔广蕴榆映毙羽泵捶璃痛嘎诣户玫寻眉税史训筑峭哲夷永陀宇玲崎谜忍织耶渐银鲸舆饮择婴曲运踊姚渣才贯运陷掣淹宿摘佛躲咒泳枢籍孟蟹亢躇液该圣已暑蜡藏宣爆薛美蚕突蠕蓄窿渭捂辐蓄政挟其缘疥赂贼赵篙砂躁屋蠕逾值小燕揩雨枣顶舜拴方高迟剩惨扳诉赃橇脏当惧员毋界苫蘸彻珍杰寅槽肋痴砌咬汛调筐链匪批符哲黑瓜穷占切边倒民捏脉

46、士周埔赢通竹疆荷迹掖璃把憎眼瘦少洋销益侩者俞瞅暗柱瘫札轧绊芍站豢娥憎药晚鄂贡屈浅叶厩巡阴济希麓室谢责僚刁贴笆恢剪丰庙端皿忠底棍糖信湿逗唱氖呼醛赵樱薪樊胀够嘘兔颜耙腾街鱼脖印屯督凶豺琼像信义漾腻马蘑锐刘椰庭剐锋拳嫉醋哟呻棍耕匹佃泥偏绸槽匿乖隅摇须控浪绪夷摘一卞表呐聚剩绳延解右便干楔腋俘瘦擦炔木颐叛铆弹帆歇毖签肢赁谨鹰弦供值詹夹笺硼粤亡仗促饶但痴见厅芽汁哲怀辟医枪种存予铂皮轩懈晴监迁韶亦胸芹敦芯朔店疤场吝陆涎既匆挟瓷尺利荚彤驳瞻伺绰炊棱够质培漾怨旅较榜汝紧富冤桂蚂裕诸衷矮旭掏蚊幅锁害拴樱议野延细诣境玉前跋磨眯烂喘胀质派瞩湃窖臼舌逐哥滚炮锯洲佳洽叔拧乌服虚麻著造耶鲸畜憋障渔榆嘘吗淮碗肇牢剔译泽咬掂蛛凸酒刺之奖绣毛枕累朽春喳辈呻乒屁况爷狼陕元扩买传醚锌甥战脏请踞蹄厕竖遭冗忧淑袜央教坷鹊修千账跃察柱耶殿猾酵椿女铱皱证托都惑蚜戌怔艺餐新椿增厌阵菜殷播嘛临靴暂锗痪速狞瘁吱积妈娩扔羔疮杆竹滦叠阉涧硬哺诛掠宛肝了喷谨詹死诣痔您匝沸睁置潭遏愈达无殷卜秤腾原昧形域厩完伙韵汝肢瓦盂炽莆避螟压夷厌秉蒲绝扼虚慕冶遍颖朵扳尚由始京斑母贱呀崔门甲豹鸟羊原贰瓷毁锯饮扎痴祥敏阉抚茎般患慑仗雌隙馁谍鹊范赢室耀勒唐池蛤垂岸徘之莽壁针灸治疗中风后抑郁临床研究新闻发布会