2021年最新毛细支气管炎临床路径.pdf

毛细支气管炎临床路径（2010 年版）一、毛细支气管炎临床路径标准住院流程（一）适用对象。第一诊断为毛细支气管炎（ICD-10：J21）。（二）诊断依据。根据临床诊疗指南小儿内科分册（中华医学会编著，人民卫生出版社）。本病诊断要点为：发病年龄小（2 岁），发病初期即出现明显喘憋，体检两肺闻及喘鸣音及细湿罗音；胸片提示明显肺气肿及小片状阴影。1.病史：多见于2 岁以内，尤其以6 个月左右婴儿最为多见。大多数有接触呼吸道感染病人的病史。2.症状：初始出现上呼吸道感染的症状，多表现为低热、流涕、鼻塞、咳嗽，部分可有高热、精神不振、食欲减退。23 天出现下呼吸道症状，症状轻重不等，咳嗽明显加重，并有喘息发作，重者出现发作性喘憋及紫绀。3.体征：大多数婴儿有发热，体温高低不一。喘憋发作时呼吸加速，呻吟并伴呼气延长和呼气性喘憋。胸部检查可见胸廓饱满，叩诊呈鼓音（或过清音），听诊可闻及哮鸣音。当喘憋缓解时，可有细湿罗音、中湿罗音。部分患儿可有明精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 1 页，共 7 页显呼吸困难，出现烦燥不安、鼻翼扇动、三凹征及口唇发绀。4.外周血象：外周血白细胞多偏低或正常，合并细菌感染时多增高。5.胸部 X 线：表现不均一，大部分病例变现为全肺程度不等的阻塞性肺气肿，约半数表现为肺纹理增厚，可出现小点片阴影，小部分病例出现肺不张。6.肺功能：患儿急性期小气道存在阻塞，在恢复期，小气道阻塞缓解。7.呼吸道病原学检测：本病可由不同病原所致，呼吸道合胞病毒（RSV）最常见，其次为副流感病毒、腺病毒等。8.血气分析：血气分析显示PaO2不同程度下降，PaCO2正常或增高，pH值与疾病严重性相关，病情较重的患儿可有代谢性酸中毒，可发生I 型或 II 型呼吸衰竭。（三）治疗方案的选择。根据临床诊疗指南小儿内科分册（中华医学会编著，人民卫生出版社）。1.吸氧：喘憋明显患儿应当给予鼻导管吸氧等方式。2.加强呼吸道护理：增加室内空气湿度，合理应用雾化吸入，雾化后及时予以拍背、吸痰，以保持呼吸道通畅。3.喘憋的治疗：喘憋较重者，根据病情吸入支气管扩张药物(如沙丁胺醇、博利康尼、溴化异丙托品等)和糖皮质激素。喘憋严重者可短期口服或静脉使用糖皮质激素。烦躁明显者精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 2 页，共 7 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ZZ4P8P6A6V2可酌情镇静。4.抗感染治疗：抗病毒药物可选用利巴韦林（病毒唑）、干扰素等；合并细菌感染时，可用相应抗生素（遵循儿科用药的方法）。5.对症治疗：脱水的治疗：可给予口服或静脉补液，如有代谢性酸中毒，可予碳酸氢钠补碱。心力衰竭、呼吸衰竭按相应危重症治疗，必要时行气管插管进行机械通气。（四）标准住院日为710 天。（五）进入路径标准。1.第一诊断必须符合 ICD-10：J21 毛细支气管炎疾病编码。2.当患儿同时具有其他疾病诊断，但在住院期间不需要特殊处理也不影响第一诊断的临床路径流程实施时，可以进入路径。3.不存在下列情况：（1）年龄小于3 个月；（2）胎龄小于34 周的早产儿；（3）伴有基础疾病，如先天性心脏病、支气管肺发育不良、先天免疫功能缺陷。（六）入院后第12 天。1.必需的检查项目：（1）血常规与CRP、尿常规、粪常规；（2）心肌酶谱及肝肾功能；精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 3 页，共 7 页文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 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ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4（3）呼吸道病毒检测；（4）呼吸道细菌培养及药敏；（5）血支原体、衣原体检测；（6）胸片检查；（7）心电图；（8）血气分析检测。2.必要的告知：入选临床路径、加强拍背等护理、注意观察肺部症状变化。（七）入院后第35 天。1.根据患者病情可选择的检查项目：（1）血气分析检测；（2）肺功能测定；（3）心电图复查；（4）血清过敏原检查；（5）超声心动图；（6）复查血支原体、衣原体；（7）支气管镜检查。2.必要的告知：如出现心力衰竭、呼吸衰竭等并发症时应当及时出毛细支气管炎临床路径。（八）出院标准。1.喘息消失，咳嗽明显减轻。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 4 页，共 7 页文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 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ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z42.连续 3 天腋温 37.5。3 肺部体征明显改善。（九）变异及原因分析。毛细支气管炎患儿住院经综合治疗10 天，仍有反复咳、喘发作，迁延难愈，称为难治性毛细支气管炎，应当及时退出毛细支气管炎临床路径。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 5 页，共 7 页文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4二、毛细支气管炎临床路径表单适用对象：第一诊断为 毛细支气管炎（ICD-10：J21）患者姓名：性别：年龄：门诊号：住院号：住院日期：年月日 出院日期：年月日标准住院日：710 天日期住院第 1 天住院第 2 天住院第 3 天主要诊疗工作 询问病史及体格检查 上级医师查房 上级医师查房 收集并追问各类实验室检查报告，向上级医师汇报重要实验室检查结果 上级医师查房重要医嘱长期医嘱：儿内科一级护理常规 饮食 抗病毒药物 止咳平喘剂 吸氧 吸痰 压缩雾化吸入 其他治疗临时医嘱：血尿便常规 胸片 血气分析 心肌酶谱及肝肾功能 呼吸道病毒检测、呼吸道细菌培养和药敏 血支原体、衣原体检测 其他检查长期医嘱：儿内科一级护理常规 饮食 抗病毒药物 止咳平喘剂 吸氧 吸痰 压缩雾化吸入 其他治疗临时医嘱：酌情肺功能检查 复查血气分析（必要时）其他检查长期医嘱：儿内科一级护理常规 饮食 抗病毒药物 抗生素（必要时）止咳平喘剂 吸氧 吸痰 压缩雾化吸入 其他治疗临时医嘱：胸片拍摄（必要时）血清过敏原检查（必要时）心电图（必要时）其他检查主要护理工作 入院护理评估 入院宣教 叮嘱患儿卧床休息，定时测量体温 观察体温波动 观察咳嗽和喘息程度保持呼吸道畅通，及时清除呼吸道分泌物 协助患儿排痰 观察体温波动保持皮肤清洁、口腔清洁鼓励患儿少食多餐，多饮水，保证液体摄入量病情变异记录无有，原因：1.2.无有，原因：1.2.无有，原因：1.2.护士签名医师签名精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 6 页，共 7 页文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4时间住院第 4 天住院第 5 9 天住院第 10 天（出院日）主要诊疗工作 观察患儿病情（体温波动、肺部体征）分析各项实验室检查结果 详细记录实验室检查结果 根据病情变化给予进一步处理（营养心肌、保护肝脏等）完成病程录，详细记录医嘱变动情况（原因和更改内容）上级医师查房 进行体格检查 完成出院小结 向患儿及其家长交代出院后注意事项，如来院复诊时间、预防交叉感染等重要医嘱长期医嘱：儿内科护理常规 饮食 抗病毒 止咳平喘剂 吸氧 压缩雾化吸入 其他治疗临时医嘱：复查血尿便常规（必要时）复查心电图（必要时）其他检查长期医嘱：儿内科护理常规 饮食 抗病毒 止咳平喘剂 保护肝脏（必要时）营养心肌（必要时）其他治疗临时医嘱：复查肝肾功能、呼吸道病毒检测、细菌培养（必要时）其他检查出院医嘱：出院带药主要护理工作 观察体温波动 观察药物副作用（皮疹、胃肠道反应）观察患者一般状况 观察体温波动 观察咳嗽、喘息程度 详细告知各注意事项（勤洗手、减少公众地带活动、如咳嗽和喘息加剧等及时就诊）告知药物使用方法 出院宣教病情变异记录无有，原因：1.2.无有，原因：1.2.无有，原因：1.2.护士签名医师签名精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 7 页，共 7 页文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 ZF8O1S2L8Z4文档编码:CK9A1I8O10A4 HO9H6N5V2R9 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