霍勇教授访谈——介入治疗准入制度及规范化管理任重而道远
发布于:2009-12-07 15:28
医心：霍主任您好，此次敦煌心血管病论坛上您的讲课内容为“中国心血管介入治疗准入制度及规范化管理”，您能谈谈该准入制度及规范化管理对于我国介入医生来说有哪些益处？该准入制度对于甘肃省的介入医生来说又有哪些特殊的意义？
霍勇教授：我们国家心血管介入诊疗规范化的工作启动于2003年，正式开始于2007年，卫生部公布了222号文件——《心血管疾病介入诊疗技术管理规范》，正是这个文件的颁布，全国各个地区都开展了心血管介入诊疗的规范化管理的工作。应当说我们国家无论是心血管介入诊疗的发展还是规范化工作的开展，都具有地区的不平衡性。在西北地区，可能这些工作总体上慢于内地的一些省份。在甘肃省，尽管从医生或者医院层面上也做了大量的工作，但是与行政管理部门还存在衔接问题。所以，以目前看来甘肃省心血管介入诊疗最基本的医疗机构和医生的准入到目前为止都没有完全开展，所以从这个角度来说还需要做一些工作。但是现在看来我们总体只要是按照卫生部的安排，应当说今年年底完成心血管介入诊疗第一步资质的准入应当是没有问题的，全国都要完成，我相信甘肃省也没有问题。但是在此次会议上介绍“中国心血管介入治疗准入制度及规范化管理”，总体来说对于甘肃省的心血管介入治疗的发展乃至对全国的发展都有意义。甘肃省现在正是处于心血管介入诊疗发展比较快的一个时期，医院开展的例数越来越多，医院从事这项工作的医生也越来越多，从这个层面上很好地进行规范化管理，对于该专业长久健康的发展有着重要的意义。
医心：目前这一制度已经颁布，相关工作的进展如何？对于如何能够让全国的介入医生严格地遵照制度的规定进行操作，您有哪些好的建议？卫生部对违反规定进行操作的医生将采取哪些惩罚措施呢？
霍勇教授：目前看来，按照卫生部心血管介入诊疗规范化管理的安排，全国已经逐渐在建立三项规范化的制度：一个是认证制度，对于医疗机构和人员进行资质认证；第二个是培训制度，对于要进入这个行业、从事这个行业的人员进行正规的规范化的培训；第三个是质量控制和指标监控的一个质控制度。这三个制度的建立显然为我们国家心血管介入诊疗规范化的总体工作构成了一个很好的框架，应当说到目前为止全世界没有任何一个国家能够像中国这样从国家层面上做到规范化管理。我相信卫生部和卫生部医政司，对于这些工作的开展是很积极认真很严肃的，实际上对于这三项制度的建立和以后工作的开展都有一个详细的计划，当然这个工作不可能一蹴而就。对于心血管介入而言又是一个相对专业性很强的行业，对于卫生部来说有些工作还是要慎重地、逐渐地推进。当然，要有严格的奖惩制度，做得好的要奖励，做得不好的要进行一定的惩戒或者处罚。但是到目前为止，我相信由于中国地域发展的不平衡，各个省的这种情况都有，因此，我们应当逐渐的把工作稳步的推展开。但是不是没有底线，实际上从现在来看要求各个省今年年底要完成所有的心血管介入诊疗准入的工作，明年的上半年重点要完成质量控制的工作，明年下半年重点完成第一期心血管介入诊疗培训基地的培训工作。这三步的安排为我们近期完善这个工作提供了重要的部署。
医心：随着药物洗脱支架的不断发展，广泛应用于冠心病患者，但是很多患者同时还合并糖尿病，因此，药物洗脱支架在糖尿病患者中应用的安全性成了大家讨论的热点问题，近期雅培公司的XIENCE PRIMETM和XIENCE V®获得欧盟的批准可以用于糖尿病患者，您是如何评价药物洗脱支架对于糖尿病患者的安全性问题？
霍勇教授：实际上对糖尿病患者无论任何一种介入的治疗方法比起那些没有糖尿病的患者它的效果都是差的，到目前为止无论是金属裸支架、药物洗脱支架，其对糖尿病的效果显然劣于没有糖尿病的患者，这和疾病本身是有关系的。但是，糖尿病患者不治疗预后更差，在药物洗脱支架这个层面上，许多的药物洗脱支架尽管与金属裸支架相比在非糖尿病的一些病变中显示很显著的优越性，但是一旦在糖尿病的患者中，它的优势就显著地减少或者说它的优势就不太明显。当然这里我认为更重要的是我们从总体来说，药物洗脱支架无论对有糖尿病还是没有糖尿病的患者都是适合的，总体的事件率是降低的，但只是糖尿病的患者获益相对小。鉴于这种情况的产生，应当说我们对糖尿病本身、对于糖尿病血管病变的这种认识可能还有值得探讨的地方。对于糖尿病的患者如何选择更适合的药物洗脱支架可能还是一个值得探讨的问题。XIENCE V®依维莫司洗脱支架的推出也同样反映这个问题，就是说它本身对于糖尿病的治疗效果也还是好的，只是于SPIRIT Ⅲ和SPIRIT Ⅳ这两项研究里面都能看出来对于糖尿病患者它和紫杉醇涂层的TAXUS支架相比得益差别不大。但这个事情要从两方面看，一方面是XIENCE V®包括所有的药物洗脱支架对于糖尿病的效果是比较差的，就像我刚才已经提到的。但是另一方面，在以往的研究中，我们不难发现TAXUS支架在糖尿病的患者中比起其他支架比如CYPHER支架，还是有自己的优势。在这两个研究中，XIENCE V®和TAXUS相比在糖尿病患者中差别不大，提示XIENCE V®支架在糖尿病患者中比起其它支架如CYPHER支架，也可能有其一定优势。但是对糖尿病的患者到底怎么治疗，尤其是牵扯到应用药物洗脱支架的时候哪种药物洗脱支架更为有效安全，这确实是值得进一步研究的问题。
来源： 医心网
上一篇：围手术期抗凝和抗血小板治疗的桥接
下一篇：黄从新教授专访
相关文章:
评论列表：（评论 6233 ）以下网友评论只代表网友个人观点，不代表本站观点。 2011-03-24 07:56:37 by: 匿名用户
comment2, <a href="http://wexd.nickfollx.cc.im/">Sheer performance three rivers michigan</a>, [url="http://wexd.nickfollx.cc.im/"]Sheer performance three rivers michigan[/url], http://wexd.nickfollx.cc.im/ Sheer performance three rivers michigan, 60901, <a href="http://elia.roldiskp.cc.im/">Forsythia county north carolina</a>, [url="http://elia.roldiskp.cc.im/"]Forsythia county north carolina[/url], http://elia.roldiskp.cc.im/ Forsythia county north carolina, :]]], <a href="http://ltja.nickfollx.cc.im/#wiki_#.html">Lake lanier bible chapel buford georgia</a>, [url="http://ltja.nickfollx.cc.im/#wiki_#.html"]Lake lanier bible chapel buford georgia[/url], http://ltja.nickfollx.cc.im/#wiki_#.html Lake lanier bible chapel buford georgia, 68931, <a href="http://ktml.harid.cc.im/">Alta utah hotels condos</a>, [url="http://ktml.harid.cc.im/"]Alta utah hotels condos[/url], http://ktml.harid.cc.im/ Alta utah hotels condos, >:-), <a href="http://bxjr.noiregf.cc.im/#wiki_#.html">Exotic cars of pompano beach florida</a>, [url="http://bxjr.noiregf.cc.im/#wiki_#.html"]Exotic cars of pompano beach florida[/url], http://bxjr.noiregf.cc.im/#wiki_#.html Exotic cars of pompano beach florida, ees, <a href="http://oeyo.gertuab.cc.im/">Bozeman camping kampground koa montana</a>, [url="http://oeyo.gertuab.cc.im/"]Bozeman camping kampground koa montana[/url], http://oeyo.gertuab.cc.im/ Bozeman camping kampground koa montana, vyro, <a href="http://dgaa.harid.cc.im/#wiki_#.html">Lonnie ward st george utah</a>, [url="http://dgaa.harid.cc.im/#wiki_#.html"]Lonnie ward st george utah[/url], http://dgaa.harid.cc.im/#wiki_#.html Lonnie ward st george utah, sxt, <a href="http://rnlv.rimworkz.cc.im/#wiki_#.html">United christian academy newport vermont</a>, [url="http://rnlv.rimworkz.cc.im/#wiki_#.html"]United christian academy newport vermont[/url], http://rnlv.rimworkz.cc.im/#wiki_#.html United christian academy newport vermont, >:D, <a href="http://ywsb.actov.cc.im/">T l lease service alvin texas</a>, [url="http://ywsb.actov.cc.im/"]T l lease service alvin texas[/url], http://ywsb.actov.cc.im/ T l lease service alvin texas, jfwhoj, <a href="http://efha.gertuab.cc.im/">Homes for rent minnesota</a>, [url="http://efha.gertuab.cc.im/"]Homes for rent minnesota[/url], http://efha.gertuab.cc.im/ Homes for rent minnesota, niri, <a href="http://fsvu.chesstingj.cc.im/#wiki_#.html">Isle casino hotel iowa</a>, [url="http://fsvu.chesstingj.cc.im/#wiki_#.html"]Isle casino hotel iowa[/url], http://fsvu.chesstingj.cc.im/#wiki_#.html Isle casino hotel iowa, chycw, <a href="http://dhxp.roetej.cc.im/#wiki_#.html">Texas fossils paleontology lessons</a>, [url="http://dhxp.roetej.cc.im/#wiki_#.html"]Texas fossils paleontology lessons[/url], http://dhxp.roetej.cc.im/#wiki_#.html Texas fossils paleontology lessons, %O, <a href="http://fynz.mesguep.cc.im/#wiki_#.html">History of parrots creek middlesex virginia</a>, [url="http://fynz.mesguep.cc.im/#wiki_#.html"]History of parrots creek middlesex virginia[/url], http://fynz.mesguep.cc.im/#wiki_#.html History of parrots creek middlesex virginia, :PP, <a href="http://kcdl.esalp.cc.im/#wiki_#.html">Donny anderson texas tech univesity</a>, [url="http://kcdl.esalp.cc.im/#wiki_#.html"]Donny anderson texas tech univesity[/url], http://kcdl.esalp.cc.im/#wiki_#.html Donny anderson texas tech univesity, 654, <a href="http://dwwt.mesguep.cc.im/">Garbage collection seguin texas</a>, [url="http://dwwt.mesguep.cc.im/"]Garbage collection seguin texas[/url], http://dwwt.mesguep.cc.im/ Garbage collection seguin texas, >:P, <a href="http://mgfm.wakoj.cc.im/#wiki_#.html">Victor idaho real estate listings</a>, [url="http://mgfm.wakoj.cc.im/#wiki_#.html"]Victor idaho real estate listings[/url], http://mgfm.wakoj.cc.im/#wiki_#.html Victor idaho real estate listings, =DDD, <a href="http://updv.wakoj.cc.im/#wiki_#.html">Sex toys fort worth texas</a>, [url="http://updv.wakoj.cc.im/#wiki_#.html"]Sex toys fort worth texas[/url], http://updv.wakoj.cc.im/#wiki_#.html Sex toys fort worth texas, 41080, <a href="http://fttl.rimworkz.cc.im/#wiki_#.html">Clermont county ohio auditors office</a>, [url="http://fttl.rimworkz.cc.im/#wiki_#.html"]Clermont county ohio auditors office[/url], http://fttl.rimworkz.cc.im/#wiki_#.html Clermont county ohio auditors office, >:[[, <a href="http://bdrg.rimworkz.cc.im/">Attractions in lake buena vista florida</a>, [url="http://bdrg.rimworkz.cc.im/"]Attractions in lake buena vista florida[/url], http://bdrg.rimworkz.cc.im/ Attractions in lake buena vista florida, =-DDD, <a href="http://kyji.rimworkz.cc.im/#wiki_#.html">Massachusetts mounted police 1908</a>, [url="http://kyji.rimworkz.cc.im/#wiki_#.html"]Massachusetts mounted police 1908[/url], http://kyji.rimworkz.cc.im/#wiki_#.html Massachusetts mounted police 1908, 302, <a href="http://njkt.harid.cc.im/#wiki_#.html">Hawaii department of revenur</a>, [url="http://njkt.harid.cc.im/#wiki_#.html"]Hawaii department of revenur[/url], http://njkt.harid.cc.im/#wiki_#.html Hawaii department of revenur, 3399, <a href="http://spjx.diotaic.cc.im/">Brush colorado real estate realtor</a>, [url="http://spjx.diotaic.cc.im/"]Brush colorado real estate realtor[/url], http://spjx.diotaic.cc.im/ Brush colorado real estate realtor, ufwivd, <a href="http://vtdw.roldiskp.cc.im/#wiki_#.html">Loss of the maine</a>, [url="http://vtdw.roldiskp.cc.im/#wiki_#.html"]Loss of the maine[/url], http://vtdw.roldiskp.cc.im/#wiki_#.html Loss of the maine, usp, <a href="http://vwfd.roldiskp.cc.im/#wiki_#.html">Virginia beach wheelchair rental</a>, [url="http://vwfd.roldiskp.cc.im/#wiki_#.html"]Virginia beach wheelchair rental[/url], http://vwfd.roldiskp.cc.im/#wiki_#.html Virginia beach wheelchair rental, wos, <a href="http://jpyb.chesstingj.cc.im/#wiki_#.html">1 350 uss massachusetts</a>, [url="http://jpyb.chesstingj.cc.im/#wiki_#.html"]1 350 uss massachusetts[/url], http://jpyb.chesstingj.cc.im/#wiki_#.html 1 350 uss massachusetts, 065604, <a href="http://wyzs.gertuab.cc.im/#wiki_#.html">Mail and more morgantown west virginia</a>, [url="http://wyzs.gertuab.cc.im/#wiki_#.html"]Mail and more morgantown west virginia[/url], http://wyzs.gertuab.cc.im/#wiki_#.html Mail and more morgantown west virginia, 036145, <a href="http://dpxp.diotaic.cc.im/#wiki_#.html">Brooklyn ohio rec cener</a>, [url="http://dpxp.diotaic.cc.im/#wiki_#.html"]Brooklyn ohio rec cener[/url], http://dpxp.diotaic.cc.im/#wiki_#.html Brooklyn ohio rec cener, 571134, <a href="http://ynld.wakoj.cc.im/">Teenren in texas foster care</a>, [url="http://ynld.wakoj.cc.im/"]Teenren in texas foster care[/url], http://ynld.wakoj.cc.im/ Teenren in texas foster care, =-(, <a href="http://ulcn.actov.cc.im/">Southern oaks apartments pensacola florida</a>, [url="http://ulcn.actov.cc.im/"]Southern oaks apartments pensacola florida[/url], http://ulcn.actov.cc.im/ Southern oaks apartments pensacola florida, anoyed,
2011-03-24 07:56:41 by: 匿名用户
comment6, <a href="http://aadl.diotaic.cc.im/#wiki_#.html">Cevil war reeactment units in texas</a>, [url="http://aadl.diotaic.cc.im/#wiki_#.html"]Cevil war reeactment units in texas[/url], http://aadl.diotaic.cc.im/#wiki_#.html Cevil war reeactment units in texas, 1323, <a href="http://jmck.ostar.cc.im/#wiki_#.html">Hamilton county nebraska ims</a>, [url="http://jmck.ostar.cc.im/#wiki_#.html"]Hamilton county nebraska ims[/url], http://jmck.ostar.cc.im/#wiki_#.html Hamilton county nebraska ims, zklmgc, <a href="http://jdik.diotaic.cc.im/#wiki_#.html">Property listings louisiana commercial real estate</a>, [url="http://jdik.diotaic.cc.im/#wiki_#.html"]Property listings louisiana commercial real estate[/url], http://jdik.diotaic.cc.im/#wiki_#.html Property listings louisiana commercial real estate, yvyhd, <a href="http://btlk.diotaic.cc.im/#wiki_#.html">Ohio jobs in portsmouth and chillicothe</a>, [url="http://btlk.diotaic.cc.im/#wiki_#.html"]Ohio jobs in portsmouth and chillicothe[/url], http://btlk.diotaic.cc.im/#wiki_#.html Ohio jobs in portsmouth and chillicothe, =[[, <a href="http://iykh.chesstingj.cc.im/#wiki_#.html">Bremerton washington city streets</a>, [url="http://iykh.chesstingj.cc.im/#wiki_#.html"]Bremerton washington city streets[/url], http://iykh.chesstingj.cc.im/#wiki_#.html Bremerton washington city streets, =-(, <a href="http://muxe.roetej.cc.im/">Daewoo car dealer in valley nebraska</a>, [url="http://muxe.roetej.cc.im/"]Daewoo car dealer in valley nebraska[/url], http://muxe.roetej.cc.im/ Daewoo car dealer in valley nebraska, %-O, <a href="http://hgog.mesguep.cc.im/#wiki_#.html">Washington dc dim sum</a>, [url="http://hgog.mesguep.cc.im/#wiki_#.html"]Washington dc dim sum[/url], http://hgog.mesguep.cc.im/#wiki_#.html Washington dc dim sum, 927670, <a href="http://cxlx.roldiskp.cc.im/#wiki_#.html">743 pennsylvania music store</a>, [url="http://cxlx.roldiskp.cc.im/#wiki_#.html"]743 pennsylvania music store[/url], http://cxlx.roldiskp.cc.im/#wiki_#.html 743 pennsylvania music store, >:-]], <a href="http://wrse.roldiskp.cc.im/#wiki_#.html">Ohio laser tattoo removal</a>, [url="http://wrse.roldiskp.cc.im/#wiki_#.html"]Ohio laser tattoo removal[/url], http://wrse.roldiskp.cc.im/#wiki_#.html Ohio laser tattoo removal, irhbt, <a href="http://ptug.rimworkz.cc.im/">Alliance ohio soccer travel team</a>, [url="http://ptug.rimworkz.cc.im/"]Alliance ohio soccer travel team[/url], http://ptug.rimworkz.cc.im/ Alliance ohio soccer travel team, 3960, <a href="http://nxdf.juehak.cc.im/#wiki_#.html">Georgia section 8 hud homes</a>, [url="http://nxdf.juehak.cc.im/#wiki_#.html"]Georgia section 8 hud homes[/url], http://nxdf.juehak.cc.im/#wiki_#.html Georgia section 8 hud homes, tkxht, <a href="http://ysle.rimworkz.cc.im/">Kern county california music educators association</a>, [url="http://ysle.rimworkz.cc.im/"]Kern county california music educators association[/url], http://ysle.rimworkz.cc.im/ Kern county california music educators association, yydc, <a href="http://juzh.noiregf.cc.im/#wiki_#.html">Ford dealership in pasadena california</a>, [url="http://juzh.noiregf.cc.im/#wiki_#.html"]Ford dealership in pasadena california[/url], http://juzh.noiregf.cc.im/#wiki_#.html Ford dealership in pasadena california, ktcl, <a href="http://zniy.chesstingj.cc.im/#wiki_#.html">Nevada highway patrol accidents</a>, [url="http://zniy.chesstingj.cc.im/#wiki_#.html"]Nevada highway patrol accidents[/url], http://zniy.chesstingj.cc.im/#wiki_#.html Nevada highway patrol accidents, :DDD, <a href="http://fvgz.mesguep.cc.im/">Maine vacation rental hot tub beach</a>, [url="http://fvgz.mesguep.cc.im/"]Maine vacation rental hot tub beach[/url], http://fvgz.mesguep.cc.im/ Maine vacation rental hot tub beach, 0530, <a href="http://jlre.nickfollx.cc.im/">Hot air balloon lincoln illinois</a>, [url="http://jlre.nickfollx.cc.im/"]Hot air balloon lincoln illinois[/url], http://jlre.nickfollx.cc.im/ Hot air balloon lincoln illinois, vitjw, <a href="http://myvp.diotaic.cc.im/#wiki_#.html">Shell branded lubricant oil illinois</a>, [url="http://myvp.diotaic.cc.im/#wiki_#.html"]Shell branded lubricant oil illinois[/url], http://myvp.diotaic.cc.im/#wiki_#.html Shell branded lubricant oil illinois, 028790, <a href="http://uuzn.wakoj.cc.im/#wiki_#.html">Winona texas real estate</a>, [url="http://uuzn.wakoj.cc.im/#wiki_#.html"]Winona texas real estate[/url], http://uuzn.wakoj.cc.im/#wiki_#.html Winona texas real estate, 903629, <a href="http://rvrb.juehak.cc.im/">Haunted hotels in des moines iowa</a>, [url="http://rvrb.juehak.cc.im/"]Haunted hotels in des moines iowa[/url], http://rvrb.juehak.cc.im/ Haunted hotels in des moines iowa, geoca, <a href="http://xrbz.esalp.cc.im/">10162 new york ny address</a>, [url="http://xrbz.esalp.cc.im/"]10162 new york ny address[/url], http://xrbz.esalp.cc.im/ 10162 new york ny address, =-DDD, <a href="http://lyzr.nickfollx.cc.im/">Past postmasters for garland county arkansas</a>, [url="http://lyzr.nickfollx.cc.im/"]Past postmasters for garland county arkansas[/url], http://lyzr.nickfollx.cc.im/ Past postmasters for garland county arkansas, cjgue, <a href="http://albp.esalp.cc.im/#wiki_#.html">Charter school lewisville texas</a>, [url="http://albp.esalp.cc.im/#wiki_#.html"]Charter school lewisville texas[/url], http://albp.esalp.cc.im/#wiki_#.html Charter school lewisville texas, oeexdb, <a href="http://untl.mesguep.cc.im/">California king mattress collection</a>, [url="http://untl.mesguep.cc.im/"]California king mattress collection[/url], http://untl.mesguep.cc.im/ California king mattress collection, 650117, <a href="http://pykd.actov.cc.im/#wiki_#.html">Plumbing supply maryland baltimore</a>, [url="http://pykd.actov.cc.im/#wiki_#.html"]Plumbing supply maryland baltimore[/url], http://pykd.actov.cc.im/#wiki_#.html Plumbing supply maryland baltimore, 8))), <a href="http://pjvm.harid.cc.im/#wiki_#.html">Wilson shannon and snow newark ohio</a>, [url="http://pjvm.harid.cc.im/#wiki_#.html"]Wilson shannon and snow newark ohio[/url], http://pjvm.harid.cc.im/#wiki_#.html Wilson shannon and snow newark ohio, :-]], <a href="http://dczs.ostar.cc.im/">Adult sex meet in scotia california</a>, [url="http://dczs.ostar.cc.im/"]Adult sex meet in scotia california[/url], http://dczs.ostar.cc.im/ Adult sex meet in scotia california, hzzf, <a href="http://hiwx.noiregf.cc.im/#wiki_#.html">Medical college of georgia oncology</a>, [url="http://hiwx.noiregf.cc.im/#wiki_#.html"]Medical college of georgia oncology[/url], http://hiwx.noiregf.cc.im/#wiki_#.html Medical college of georgia oncology, =PP,
2011-03-24 07:56:44 by: 匿名用户
comment5, <a href="http://qfmd.mesguep.cc.im/#wiki_#.html">Fishing boat for sale california</a>, [url="http://qfmd.mesguep.cc.im/#wiki_#.html"]Fishing boat for sale california[/url], http://qfmd.mesguep.cc.im/#wiki_#.html Fishing boat for sale california, setvl, <a href="http://hdkd.mesguep.cc.im/">Destin florida harley davidson dealers</a>, [url="http://hdkd.mesguep.cc.im/"]Destin florida harley davidson dealers[/url], http://hdkd.mesguep.cc.im/ Destin florida harley davidson dealers, wcydh, <a href="http://iuyq.mesguep.cc.im/">Geo cashing in minnesota</a>, [url="http://iuyq.mesguep.cc.im/"]Geo cashing in minnesota[/url], http://iuyq.mesguep.cc.im/ Geo cashing in minnesota, 7465, <a href="http://rpgb.diotaic.cc.im/">Turtle rescue ventura california</a>, [url="http://rpgb.diotaic.cc.im/"]Turtle rescue ventura california[/url], http://rpgb.diotaic.cc.im/ Turtle rescue ventura california, =-], <a href="http://lpuk.mesguep.cc.im/#wiki_#.html">Mai tai hawaii recipe</a>, [url="http://lpuk.mesguep.cc.im/#wiki_#.html"]Mai tai hawaii recipe[/url], http://lpuk.mesguep.cc.im/#wiki_#.html Mai tai hawaii recipe, 8-], <a href="http://eiuu.ostar.cc.im/">Yogi bear and warrens wisconsin</a>, [url="http://eiuu.ostar.cc.im/"]Yogi bear and warrens wisconsin[/url], http://eiuu.ostar.cc.im/ Yogi bear and warrens wisconsin, :DDD, <a href="http://ddlh.mesguep.cc.im/">Kennel training dog south carolina</a>, [url="http://ddlh.mesguep.cc.im/"]Kennel training dog south carolina[/url], http://ddlh.mesguep.cc.im/ Kennel training dog south carolina, 949, <a href="http://cfvn.mesguep.cc.im/">Penrose hospital colorado springs co jobs</a>, [url="http://cfvn.mesguep.cc.im/"]Penrose hospital colorado springs co jobs[/url], http://cfvn.mesguep.cc.im/ Penrose hospital colorado springs co jobs, 189, <a href="http://nusc.roldiskp.cc.im/#wiki_#.html">Richard moore idaho falls</a>, [url="http://nusc.roldiskp.cc.im/#wiki_#.html"]Richard moore idaho falls[/url], http://nusc.roldiskp.cc.im/#wiki_#.html Richard moore idaho falls, zur, <a href="http://xfda.ostar.cc.im/#wiki_#.html">Patio fireplace design illinois</a>, [url="http://xfda.ostar.cc.im/#wiki_#.html"]Patio fireplace design illinois[/url], http://xfda.ostar.cc.im/#wiki_#.html Patio fireplace design illinois, snxhzl, <a href="http://ntff.gertuab.cc.im/#wiki_#.html">Historic building dolores colorado</a>, [url="http://ntff.gertuab.cc.im/#wiki_#.html"]Historic building dolores colorado[/url], http://ntff.gertuab.cc.im/#wiki_#.html Historic building dolores colorado, =-PP, <a href="http://makr.chesstingj.cc.im/">Eye exam and eyeglasses maryland</a>, [url="http://makr.chesstingj.cc.im/"]Eye exam and eyeglasses maryland[/url], http://makr.chesstingj.cc.im/ Eye exam and eyeglasses maryland, 411, <a href="http://ncgr.rimworkz.cc.im/#wiki_#.html">House explosion in highland indiana</a>, [url="http://ncgr.rimworkz.cc.im/#wiki_#.html"]House explosion in highland indiana[/url], http://ncgr.rimworkz.cc.im/#wiki_#.html House explosion in highland indiana, 4414, <a href="http://syil.nickfollx.cc.im/">Oklahoma reasonable tangible net benefit</a>, [url="http://syil.nickfollx.cc.im/"]Oklahoma reasonable tangible net benefit[/url], http://syil.nickfollx.cc.im/ Oklahoma reasonable tangible net benefit, 8-), <a href="http://vhie.wakoj.cc.im/#wiki_#.html">Bethpage tennessee real estate</a>, [url="http://vhie.wakoj.cc.im/#wiki_#.html"]Bethpage tennessee real estate[/url], http://vhie.wakoj.cc.im/#wiki_#.html Bethpage tennessee real estate, >:))), <a href="http://erld.diotaic.cc.im/#wiki_#.html">Marathon station kokomo indiana</a>, [url="http://erld.diotaic.cc.im/#wiki_#.html"]Marathon station kokomo indiana[/url], http://erld.diotaic.cc.im/#wiki_#.html Marathon station kokomo indiana, jkvy, <a href="http://kket.diotaic.cc.im/#wiki_#.html">State of colorado statement of lien</a>, [url="http://kket.diotaic.cc.im/#wiki_#.html"]State of colorado statement of lien[/url], http://kket.diotaic.cc.im/#wiki_#.html State of colorado statement of lien, 8-DD, <a href="http://gfuh.harid.cc.im/#wiki_#.html">Suburban for sale for parts florida</a>, [url="http://gfuh.harid.cc.im/#wiki_#.html"]Suburban for sale for parts florida[/url], http://gfuh.harid.cc.im/#wiki_#.html Suburban for sale for parts florida, >:-(, <a href="http://ndor.ostar.cc.im/">Northbrook homes livermore california</a>, [url="http://ndor.ostar.cc.im/"]Northbrook homes livermore california[/url], http://ndor.ostar.cc.im/ Northbrook homes livermore california, bxmlz, <a href="http://ixah.harid.cc.im/">Disney games hannah montana</a>, [url="http://ixah.harid.cc.im/"]Disney games hannah montana[/url], http://ixah.harid.cc.im/ Disney games hannah montana, >:-P, <a href="http://oqxn.nickfollx.cc.im/">Southern arkansas university human resources</a>, [url="http://oqxn.nickfollx.cc.im/"]Southern arkansas university human resources[/url], http://oqxn.nickfollx.cc.im/ Southern arkansas university human resources, 340, <a href="http://xmru.wakoj.cc.im/#wiki_#.html">Marathon florida tide table</a>, [url="http://xmru.wakoj.cc.im/#wiki_#.html"]Marathon florida tide table[/url], http://xmru.wakoj.cc.im/#wiki_#.html Marathon florida tide table, =-OO, <a href="http://bdyv.juehak.cc.im/#wiki_#.html">Iowa used dump trucks</a>, [url="http://bdyv.juehak.cc.im/#wiki_#.html"]Iowa used dump trucks[/url], http://bdyv.juehak.cc.im/#wiki_#.html Iowa used dump trucks, wys,
2011-03-24 07:56:50 by: 匿名用户
comment5, <a href="http://yllh.ostar.cc.im/#wiki_#.html">2001 texas alcoholic beverage code</a>, [url="http://yllh.ostar.cc.im/#wiki_#.html"]2001 texas alcoholic beverage code[/url], http://yllh.ostar.cc.im/#wiki_#.html 2001 texas alcoholic beverage code, =-))), <a href="http://ukjz.gertuab.cc.im/">South carolina state administration web site</a>, [url="http://ukjz.gertuab.cc.im/"]South carolina state administration web site[/url], http://ukjz.gertuab.cc.im/ South carolina state administration web site, hlzz, <a href="http://edve.mesguep.cc.im/#wiki_#.html">Florida boat prime lift</a>, [url="http://edve.mesguep.cc.im/#wiki_#.html"]Florida boat prime lift[/url], http://edve.mesguep.cc.im/#wiki_#.html Florida boat prime lift, %-OO, <a href="http://zryc.gertuab.cc.im/#wiki_#.html">Kenosha county wisconsin condos</a>, [url="http://zryc.gertuab.cc.im/#wiki_#.html"]Kenosha county wisconsin condos[/url], http://zryc.gertuab.cc.im/#wiki_#.html Kenosha county wisconsin condos, mqjpiu, <a href="http://qykp.harid.cc.im/#wiki_#.html">Bayside florist eastpoint florida</a>, [url="http://qykp.harid.cc.im/#wiki_#.html"]Bayside florist eastpoint florida[/url], http://qykp.harid.cc.im/#wiki_#.html Bayside florist eastpoint florida, %], <a href="http://mmeo.esalp.cc.im/#wiki_#.html">Radio contests columbia missouri</a>, [url="http://mmeo.esalp.cc.im/#wiki_#.html"]Radio contests columbia missouri[/url], http://mmeo.esalp.cc.im/#wiki_#.html Radio contests columbia missouri, smwean, <a href="http://xcjm.esalp.cc.im/">Used cell phones in northwest arkansas</a>, [url="http://xcjm.esalp.cc.im/"]Used cell phones in northwest arkansas[/url], http://xcjm.esalp.cc.im/ Used cell phones in northwest arkansas, 474, <a href="http://lovf.wakoj.cc.im/#wiki_#.html">Cruise air fare packages california</a>, [url="http://lovf.wakoj.cc.im/#wiki_#.html"]Cruise air fare packages california[/url], http://lovf.wakoj.cc.im/#wiki_#.html Cruise air fare packages california, 4392, <a href="http://ekuk.nickfollx.cc.im/">Optical laser distributors edison new jersey</a>, [url="http://ekuk.nickfollx.cc.im/"]Optical laser distributors edison new jersey[/url], http://ekuk.nickfollx.cc.im/ Optical laser distributors edison new jersey, 8((, <a href="http://oqeh.nickfollx.cc.im/">Foreclose in rapid city south dakota</a>, [url="http://oqeh.nickfollx.cc.im/"]Foreclose in rapid city south dakota[/url], http://oqeh.nickfollx.cc.im/ Foreclose in rapid city south dakota, 603, <a href="http://aiww.noiregf.cc.im/#wiki_#.html">Zamora turf farm california</a>, [url="http://aiww.noiregf.cc.im/#wiki_#.html"]Zamora turf farm california[/url], http://aiww.noiregf.cc.im/#wiki_#.html Zamora turf farm california, 8-)), <a href="http://popu.ostar.cc.im/#wiki_#.html">Sedalia missouri divorce attorney</a>, [url="http://popu.ostar.cc.im/#wiki_#.html"]Sedalia missouri divorce attorney[/url], http://popu.ostar.cc.im/#wiki_#.html Sedalia missouri divorce attorney, sat, <a href="http://zzmz.mesguep.cc.im/#wiki_#.html">Henderson county tx texas</a>, [url="http://zzmz.mesguep.cc.im/#wiki_#.html"]Henderson county tx texas[/url], http://zzmz.mesguep.cc.im/#wiki_#.html Henderson county tx texas, %-D, <a href="http://sygu.mesguep.cc.im/">Hannaha montana nude uncencered</a>, [url="http://sygu.mesguep.cc.im/"]Hannaha montana nude uncencered[/url], http://sygu.mesguep.cc.im/ Hannaha montana nude uncencered, 83427, <a href="http://ncok.roldiskp.cc.im/">Madison elementary oklahoma city</a>, [url="http://ncok.roldiskp.cc.im/"]Madison elementary oklahoma city[/url], http://ncok.roldiskp.cc.im/ Madison elementary oklahoma city, >:OO, <a href="http://vdbf.nickfollx.cc.im/#wiki_#.html">Kentucky crime jeremy brown</a>, [url="http://vdbf.nickfollx.cc.im/#wiki_#.html"]Kentucky crime jeremy brown[/url], http://vdbf.nickfollx.cc.im/#wiki_#.html Kentucky crime jeremy brown, 980070,
2011-03-24 08:32:57 by: 匿名用户
comment2, <a href="http://opqx.gertuab.cc.im/#wiki_#.html">Pharmacy technician employmnent rate new jersey</a>, svmey, <a href="http://xxqf.roetej.cc.im/#wiki_#.html">Strength and conditioning clinic northern colorado</a>, vyv, <a href="http://neod.wakoj.cc.im/#wiki_#.html">Golf trips in uniontown ohio</a>, 264, <a href="http://sdzz.actov.cc.im/">Arch bishop ohara kansas city</a>, :O, <a href="http://pldf.rimworkz.cc.im/#wiki_#.html">Taylor farm london dairy vermont</a>, 09422, <a href="http://lycx.noiregf.cc.im/#wiki_#.html">Boarding kennel bountiful utah</a>, hsi, <a href="http://vdya.harid.cc.im/">Red cross layton utah</a>, fognv, <a href="http://jdhj.harid.cc.im/">Remax associates hal grant athens georgia</a>, 5584, <a href="http://btwb.gertuab.cc.im/">New york pro mandolin logo</a>, 892, <a href="http://wyyv.wakoj.cc.im/">Hannah montana autograph pics</a>, =DD, <a href="http://ezhj.actov.cc.im/#wiki_#.html">Worcester county maryland berlin md</a>, 38213, <a href="http://dumb.rimworkz.cc.im/#wiki_#.html">Wisconsin real estate remax</a>, 848, <a href="http://kfay.juehak.cc.im/#wiki_#.html">Mental health tennessee sanatorium clinic hospital</a>, 83257, <a href="http://wqlu.harid.cc.im/#wiki_#.html">Reliable contractors minnesota forum</a>, kltv, <a href="http://ddlh.mesguep.cc.im/#wiki_#.html">Psychiatric master in nursing program pennsylvania</a>, igdr, <a href="http://onkk.esalp.cc.im/#wiki_#.html">Boat launch ottawa county michigan</a>, 027090, <a href="http://sugm.noiregf.cc.im/">Animal advocates and massachusetts</a>, irdsin,
最短5个字
医心微信 >
京公网安备 11010102002968号