新闻中心 > 正文

官方公布游戏障碍防治的专家共识

2019-07-30 15:17:36 来源:环球亚博官网地址谁有

1

?
  • ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?官方公布游戏障碍防治的专家共识

    罗莎台风实时位置

    ????2019年5月25日,世界卫生大会审议通过《国际疾病分类第十一次修订本》(以下简称ICD-11)。其中,将“游戏障碍(gamingdisorder)”作为新增疾病,纳入“成瘾行为所致障碍”疾病单元中。国家卫生健康委疾控局组织专家对游戏障碍的定义、临床特征、评估、诊断、治疗、康复等进行系统梳理,形成专家共识如下。一、定义与临床特征根据ICD-11定义,游戏障碍是指一种持续或反复地使用电子或视频游戏的行为模式,表现为游戏行为失控,游戏成为生活中优先行为,不顾不良后果继续游戏行为,并持续较长时间。目前国内外尚缺乏根据ICD-11标准而开展的大样本流行病学调查数据。此前,不同国家和地区已有多项游戏相关问题的调查研究,因为对疾病的判断标准、筛查工具、人群等不同,所报告的疾病患病率差异较大(0.7%-27.5%)。中国多项相关调查研究显示,游戏相关问题患病率为3.5%-17%。综合既往相关研究结果,游戏障碍患病率平均约为5%,且保持相对稳定。游戏障碍者以男性、儿童青少年人群为主,亚洲国家患病率可能高于欧美国家。游戏障碍主要临床表现包括:对游戏行为的开始、频率、时长、结束、场合等失去控制;游戏优先于其他生活兴趣和日常活动;尽管已经因游戏产生了负面后果,但依然持续游戏甚至加大游戏强度。游戏障碍与物质成瘾有诸多相似之处,有研究者将游戏障碍者游玩时间越来越长、在游戏上花费金钱越来越多等类比于物质成瘾的耐受性增加,将停止游戏后产生的易激惹、抑郁、冲动等情绪及行为反应类比于物质成瘾的戒断反应。游戏障碍者可能主观上感知到对游戏的渴求,可能难以区分游戏中的虚拟世界与现实世界。游戏障碍可导致躯体问题、精神行为问题及社会功能损害。躯体问题包括睡眠不足、昼夜节律紊乱、营养不良、胃溃疡、癫痫发作等,严重者可因久坐形成下肢静脉栓塞,甚至引发肺栓塞而猝死;精神行为问题包括易怒、焦虑、攻击言行、抑郁、负罪感等;社会功能损害包括拒绝上学和社交活动,家庭冲突增多,重要关系丧失,学业成就、职业绩效受损等。游戏障碍常与注意缺陷与多动障碍、抑郁障碍、焦虑障碍、双相情感障碍、睡眠障碍、人格障碍、社交恐怖症等其他精神障碍共病。游戏障碍的自然病程尚未得到清晰认识,不同研究之间的结论差别较大。如有研究报告84%的患者在2年后的追踪调查中依然处于病理性状态;但也有一些研究提出,仅26.5%患者在2年之后随访中依然有游戏相关问题,在5年追踪中症状严重程度会发生中等程度的下降等。二、游戏障碍的影响因素国内外研究显示,游戏障碍与心理、社会、生物学等多种因素相关。(一)心理因素游戏障碍者可能具有高冲动性、高神经质、内向等性格特点。有些可能具有攻击性和暴力问题,还有的存在情绪调节不佳、孤独、低自尊、低自我效能感、低生活满意度、感知压力较大、有抑郁焦虑等问题。而较高的社交能力、自尊水平、主观幸福感等心理因素可能减少游戏障碍的发生。此外,个体对于自身能否控制游戏行为的感知可能是预测游戏障碍行为的重要因素。(二)社会和家庭因素在被欺凌者、欺凌者、有游戏成瘾朋友的人群中,游戏障碍发生率较高。社会支持和人际沟通不足,师生关系或同学关系不良,学校氛围较差等也与游戏障碍的发生相关。父母的受教育水平和教养方式与儿童青少年游戏障碍的发病风险有关;家庭关系不和谐,单身或离异等与成人的游戏障碍发病风险有关;监护人不能陪伴或监护不力的儿童青少年可能有更高的发病风险;良好的社会支持系统可能是游戏障碍的保护性因素。(三)生物学因素游戏障碍患者的脑影像表现类似于物质成瘾患者和赌博障碍患者,存在额叶多个区域、腹侧和背侧纹状体等脑区的结构和功能异常。相应的功能异常包括执行控制功能下降,对于损失的敏感性降低,对于游戏相关刺激的反应增强,在做出选择时具有更强的冲动性,奖赏相关的学习发生变化,认知灵活性降低等。一些游戏障碍患者对于自我概念以及游戏中化身角色的自我同一性加工发生改变。但这些脑功能异常与游戏障碍间的因果关系尚待进一步阐明。(四)游戏类型游戏障碍患者更为偏爱的游戏形式是在线游戏,而不是离线游戏;更为偏爱的游戏类别是大型多人在线角色扮演游戏、第一人称射击、格斗和即时战略游戏。三、诊断与评估早期识别、诊断、干预对游戏障碍的预防治疗至关重要。(一)游戏障碍筛查与评估在普通人群尤其是儿童青少年中对游戏障碍进行筛查评估,做到早期识别、早期诊断与早期干预,对于改善干预效果、提高成本效益、减少患者及其家庭的痛苦和负担、改善患者生活质量具有重要意义。为此,准确、可靠、易用的工具对于筛查、辅助诊断、评估严重程度等非常重要。在ICD-11发布前,学界已开发出多种问卷和量表用于筛查或评估过度游戏行为或游戏障碍,并对了解游戏障碍的发生率、典型特征等具有重要参考作用。但这些工具也存在诸多局限性,主要包括对于游戏障碍核心特征定义不一致、对临床状态分界不一致、缺乏时间维度、症状指征可靠度不足、侧重评估学生群体等。因此,世界卫生组织正在组织各国专家及合作机构针对游戏障碍开发普适性较高、标准清晰统一、易用性较好的筛查评估工具,以帮助医务人员及早识别游戏障碍的患病风险,减少漏诊、误诊或过度诊断,促进疑似患者及高风险个体及早转介到专业机构进一步诊断评估。游戏障碍者可能伴有多种躯体或精神行为问题,应对疑似患者进行全面系统评估。评估内容包括:(1)是否有游戏障碍及其严重程度;(2)是否有躯体健康问题或精神健康问题;(3)学业、职业、人际关系、家庭关系、生活质量等社会功能情况及相关背景信息;(4)游戏障碍合并其他精神行为障碍情况;(5)影响治疗及康复的保护因素和危险因素(如患者治疗依从性、自我效能感、家庭及社会支持情况、社会经济水平等);(6)对预后的判断等。(二)诊断与鉴别诊断对于游戏障碍疑似患者或高风险个体的临床诊断,需要规范的诊断指南保证医疗卫生机构诊断的准确性,避免过度诊断。ICD-11中提出游戏障碍的核心特征为:(1)持续或反复的游戏行为模式,具体表现为失控性游戏行为(如无法控制游戏行为的发生、频率、持续时间、终止时间等),游戏行为成为生活优先事项,尽管游戏造成负面后果(如人际关系破裂、职业或学业受影响、健康损害等)仍然无法停止;(2)游戏行为模式可以是持续性或发作性的,并持续12个月,但如果症状足够严重且满足其他诊断要点,持续时间可短于12个月;(3)游戏行为模式导致明显的个人、家庭、人际关系、学业、职业或其他重要功能领域损伤。根据游戏形式不同,游戏障碍包括在线游戏障碍、离线游戏障碍两种类型。需区分游戏障碍与正常游戏行为。如果反复游戏行为是以促进社交、缓解无聊、调节情绪等为目的,并且缺乏游戏障碍的其他必要特征,则不能诊断为游戏障碍。在特定的年龄或社会群体中(如青少年男性)或在特定情境中(如作为节假日娱乐活动),可能存在较长时间或较高频次的游戏行为,诊断时需要考虑文化、亚文化、同伴群体等因素的影响。此外,对于游戏产业相关个体而言,高强度的游戏行为可能是其职业内容的一部分,不应诊断为游戏障碍。游戏障碍是一个连续的发展过程,即由不玩游戏开始,经过娱乐性偶尔游玩至高频度游玩阶段,最终发展成失控性行为。因此,对游戏障碍的诊断不仅要判断是否达到疾病状态,还要在诊断工作中树立早期识别、早期干预的意识,对出现部分症状、但不完全满足诊断标准的个体提供专业意见,及时预防发展到游戏障碍。诊断游戏障碍也需要注意排除其他疾病。通常需要与以下情况相鉴别:(1)危害性游戏行为,指游戏行为带来健康损害风险,但尚未出现健康损害,可能需要干预或观察的一种状态;(2)赌博障碍,游戏障碍通常不涉及金钱赌博,但目前许多网络游戏也具有赌博形式(扑克、麻将等)或赌博成分(概率性的抽奖);(3)其他精神障碍,如焦虑障碍、抑郁障碍、双相情感障碍、人格障碍等,过度游戏行为可能出现在上述疾病发作时期,只有当过度游戏行为模式符合游戏障碍诊断要点,并且在不存在上述疾病精神症状的情况下,才考虑诊断游戏障碍;如果同时存在游戏障碍与其他精神障碍,应考虑游戏障碍共病其他精神障碍的诊断;(4)物质使用障碍,游戏行为常常与物质使用(特别酒精)共存,如果同时满足两种障碍的诊断标准,可以考虑共病诊断。四、综合干预原则与措施(一)总体原则除遵循物质使用及成瘾行为障碍的一般原则外,需结合游戏障碍的高发人群、疾病特征等进行预防与干预,坚持预防为主,进行基于证据、符合伦理的个体化的综合干预措施。1.预防为主。游戏障碍高发于儿童青少年群体,从娱乐性游戏行为发展成为游戏障碍有一定过程,针对高发人群进行预防性干预,可以显着减少游戏障碍发病率及疾病负担。2.基于证据。所有干预方案应当有相应的证据,不应该违背研究或临床实践证据。3.符合伦理。游戏障碍干预应当基于普遍的医学伦理道德,尊重人权和患者尊严,不损害患者健康及利益。4.综合干预。目前还没有针对游戏障碍的特效干预手段。由于患者常伴有躯体或精神疾病,需要心理治疗、药物治疗等多种手段结合进行个体化的综合干预。同时,游戏障碍类似于精神活性物质使用障碍,可能会复发或疾病慢性化,在综合干预过程中,需要医疗卫生、学校、家庭、社会等多方面的协调及监督。(二)预防建立包括普遍性预防、针对性预防、早期发现及治疗等措施的三级预防体系,消除或减少致病因素,提高心理健康水平,对于减少游戏障碍的发生和复发、促进患者及时获得诊疗、降低危害至关重要。1.普遍性预防。对公众开展心理健康知识科普宣传工作,广泛宣传游戏障碍相关知识,提高全社会心理健康水平,减少引发游戏障碍的诱因。2.针对性预防。对于儿童青少年等易患游戏障碍的高危人群,在个体层面从情绪调控、认知控制、人际交往等方面采取相应的心理干预措施;对于儿童青少年所处的家庭、学校、社会环境,重点开展心理健康知识和应对技能的科普宣传工作,改善家庭关系与亲子沟通能力,关爱儿童青少年心理需求。3.早期发现与治疗。提高儿童青少年、家长与学校早期识别游戏障碍的能力,对可疑的游戏障碍患者,指导患者及其家属及时就诊,明确诊断,接受合理系统的治疗。在综合医院精神(心理)科和精神专科医院开展针对性培训,使医护人员有能力正确识别、诊断、治疗游戏障碍;做好联络-会诊和专科咨询工作,帮助非精神科医生早期发现并及时转介游戏障碍患者。(三)治疗与康复1.治疗措施目前没有权威的游戏障碍治疗指南,但近年有不少关于游戏障碍治疗及干预的研究或临床实践提示,将社会心理干预、药物治疗、处理共病等结合的综合治疗有利于改善游戏障碍患者预后,主要措施包括:(1)社会心理干预。目前很多临床实践及研究证据提示,认知行为治疗、动机激励访谈、家庭治疗等社会心理干预对减少游戏障碍者的失控性游戏行为及促进长期康复有效。(2)药物治疗。目前没有针对游戏障碍具有临床适应症的药物,但游戏障碍患者可能存在精神、躯体等健康问题以及共病,需要药物对症治疗。(3)物理治疗。目前有少量研究对游戏障碍患者进行重复经颅磁刺激等干预,以增强大脑控制功能或降低玩游戏的冲动,但目前仍缺乏大样本一致性研究。2.康复措施与其他疾病治疗类似,游戏障碍治疗目标是通过社会心理康复和后续管理,预防复发,促进社会功能恢复、回归社会。经过治疗、病情趋于稳定的患者,应继续接受巩固性的心理治疗,必要情况下按时按量服药,防止疾病复发。做好出院患者的定期随访工作,使患者能够接受及时的、有针对性的医疗指导和服务。动员家庭成员支持和参与患者的康复活动,指导家庭成员为患者制定生活计划,努力解决患者的心理健康问题和日常生活中的实际困难。需要强调的是,游戏障碍是慢性复发性疾病,游戏障碍干预起始阶段、干预过程中及疾病康复期都需要对游戏障碍症状及严重程度进行评估。五、今后的工作重点鉴于游戏障碍的流行病学、病因病理机制、预防治疗方法等尚待进一步明确,建议今后重点工作如下:1.以修订《中华人民共和国未成年人保护法》为契机,出台保护儿童青少年身心健康的相关法律法规,出台专门规范和净化网络环境的政策措施。2.建立卫生健康、教育、工商、文化等多部门协作机制,对游戏障碍干预机构进行规范和监督,确保患者及其家属能获得专业帮助。3.以相关学术机构及团体为主体,完善游戏障碍识别、评估、诊断体系,开展相关培训,提升游戏障碍诊治的专业能力。4.开展游戏障碍流行病学调查,了解相关因素的影响和作用机制,随访其转归及相关影响因素。5.开展针对游戏障碍的药物、社会心理治疗相关临床及相关防控政策研究。6.将包括游戏障碍在内的所有成瘾行为及其他社会适应不良行为作为一个整体对待,扩展预防和医学干预工作的范围和深度,使之发挥更为广泛和立体的作用。中华医学会精神病学分会??中华预防医学会精神卫生分会中国医师协会精神科医师分会?????中国心理卫生协会中国药物滥用防治协会2019年7月15日

    2019 nian 5 yue 25 ri, shi jie wei sheng da hui shen yi tong guo guo ji ji bing fen lei di shi yi ci xiu ding ben yi xia jian cheng ICD11. qi zhong, jiang" you xi zhang ai gamingdisorder" zuo wei xin zeng ji bing, na ru" cheng yin xing wei suo zhi zhang ai" ji bing dan yuan zhong. guo jia wei sheng jian kang wei ji kong ju zu zhi zhuan jia dui you xi zhang ai de ding yi lin chuang te zheng ping gu zhen duan zhi liao kang fu deng jin xing xi tong shu li, xing cheng zhuan jia gong shi ru xia. yi ding yi yu lin chuang te zheng gen ju ICD11 ding yi, you xi zhang ai shi zhi yi zhong chi xu huo fan fu di shi yong dian zi huo shi pin you xi de xing wei mo shi, biao xian wei you xi xing wei shi kong, you xi cheng wei sheng huo zhong you xian xing wei, bu gu bu liang hou guo ji xu you xi xing wei, bing chi xu jiao chang shi jian. mu qian guo nei wai shang que fa gen ju ICD11 biao zhun er kai zhan de da yang ben liu xing bing xue diao zha shu ju. ci qian, bu tong guo jia he di qu yi you duo xiang you xi xiang guan wen ti de diao cha yan jiu, yin wei dui ji bing de pan duan biao zhun shai cha gong ju ren qun deng bu tong, suo bao gao de ji bing huan bing lv cha yi jiao da 0. 7 27. 5. zhong guo duo xiang xiang guan diao cha yan jiu xian shi, you xi xiang guan wen ti huan bing lv wei 3. 5 17. zong he ji wang xiang guan yan jiu jie guo, you xi zhang ai huan bing lv ping jun yue wei 5, qie bao chi xiang dui wen ding. you xi zhang ai zhe yi nan xing er tong qing shao nian ren qun wei zhu, ya zhou guo jia huan bing lv ke neng gao yu ou mei guo jia. you xi zhang ai zhu yao lin chuang biao xian bao kuo: dui you xi xing wei de kai shi pin lv shi zhang jie shu chang he deng shi qu kong zhi you xi you xian yu qi ta sheng huo xing qu he ri chang huo dong jin guan yi jing yin you xi chan sheng le fu mian hou guo, dan yi ran chi xu you xi shen zhi jia da you xi qiang du. you xi zhang ai yu wu zhi cheng yin you zhu duo xiang si zhi chu, you yan jiu zhe jiang you xi zhang ai zhe you wan shi jian yue lai yue chang zai you xi shang hua fei jin qian yue lai yue duo deng lei bi yu wu zhi cheng yin de nai shou xing zeng jia, jiang ting zhi you xi hou chan sheng de yi ji re yi yu chong dong deng qing xu ji xing wei fan ying lei bi yu wu zhi cheng yin de jie duan fan ying. you xi zhang ai zhe ke neng zhu guan shang gan zhi dao dui you xi de ke qiu, ke neng nan yi qu fen you xi zhong de xu ni shi jie yu xian shi shi jie. you xi zhang ai ke dao zhi qu ti wen ti jing shen xing wei wen ti ji she hui gong neng sun hai. qu ti wen ti bao kuo shui mian bu zu zhou ye jie lv wen luan ying yang bu liang wei kui yang dian xian fa zuo deng, yan zhong zhe ke yin jiu zuo xing cheng xia zhi jing mai shuan se, shen zhi yin fa fei shuan se er cu si jing shen xing wei wen ti bao kuo yi nu jiao lv gong ji yan xing yi yu fu zui gan deng she hui gong neng sun hai bao kuo ju jue shang xue he she jiao huo dong, jia ting chong tu zeng duo, zhong yao guan xi sang shi, xue ye cheng jiu zhi ye ji xiao shou sun deng. you xi zhang ai chang yu zhu yi que xian yu duo dong zhang ai yi yu zhang ai jiao lv zhang ai shuang xiang qing gan zhang ai shui mian zhang ai ren ge zhang ai she jiao kong bu zheng deng qi ta jing shen zhang ai gong bing. you xi zhang ai de zi ran bing cheng shang wei de dao qing xi ren shi, bu tong yan jiu zhi jian de jie lun cha bie jiao da. ru you yan jiu bao gao 84 de huan zhe zai 2 nian hou de zhui zong diao cha zhong yi ran chu yu bing li xing zhuang tai dan ye you yi xie yan jiu ti chu, jin 26. 5 huan zhe zai 2 nian zhi hou sui fang zhong yi ran you you xi xiang guan wen ti, zai 5 nian zhui zong zhong zheng zhuang yan zhong cheng du hui fa sheng zhong deng cheng du de xia jiang deng. er you xi zhang ai de ying xiang yin su guo nei wai yan jiu xian shi, you xi zhang ai yu xin li she hui sheng wu xue deng duo zhong yin su xiang guan. yi xin li yin su you xi zhang ai zhe ke neng ju you gao chong dong xing gao shen jing zhi nei xiang deng xing ge te dian. you xie ke neng ju you gong ji xing he bao li wen ti, hai you de cun zai qing xu tiao jie bu jia gu du di zi zun di zi wo xiao neng gan di sheng huo man yi du gan zhi ya li jiao da you yi yu jiao lv deng wen ti. er jiao gao de she jiao neng li zi zun shui ping zhu guan xing fu gan deng xin li yin su ke neng jian shao you xi zhang ai de fa sheng. ci wai, ge ti dui yu zi shen neng fou kong zhi you xi xing wei de gan zhi ke neng shi yu ce you xi zhang ai xing wei de zhong yao yin su. er she hui he jia ting yin su zai bei qi ling zhe qi ling zhe you you xi cheng yin peng you de ren qun zhong, you xi zhang ai fa sheng lv jiao gao. she hui zhi chi he ren ji gou tong bu zu, shi sheng guan xi huo tong xue guan xi bu liang, xue xiao fen wei jiao cha deng ye yu you xi zhang ai de fa sheng xiang guan. fu mu de shou jiao yu shui ping he jiao yang fang shi yu er tong qing shao nian you xi zhang ai de fa bing feng xian you guan jia ting guan xi bu he xie, dan shen huo li yi deng yu cheng ren de you xi zhang ai fa bing feng xian you guan jian hu ren bu neng pei ban huo jian hu bu li de er tong qing shao nian ke neng you geng gao de fa bing feng xian liang hao de she hui zhi chi xi tong ke neng shi you xi zhang ai de bao hu xing yin su. san sheng wu xue yin su you xi zhang ai huan zhe de nao ying xiang biao xian lei si yu wu zhi cheng yin huan zhe he du bo zhang ai huan zhe, cun zai e ye duo ge qu yu fu ce he bei ce wen zhuang ti deng nao qu de jie gou he gong neng yi chang. xiang ying de gong neng yi chang bao kuo zhi xing kong zhi gong neng xia jiang, dui yu sun shi de min gan xing jiang di, dui yu you xi xiang guan ci ji de fan ying zeng qiang, zai zuo chu xuan ze shi ju you geng qiang de chong dong xing, jiang shang xiang guan de xue xi fa sheng bian hua, ren zhi ling huo xing jiang di deng. yi xie you xi zhang ai huan zhe dui yu zi wo gai nian yi ji you xi zhong hua shen jue se de zi wo tong yi xing jia gong fa sheng gai bian. dan zhei xie nao gong neng yi chang yu you xi zhang ai jian de yin guo guan xi shang dai jin yi bu chan ming. si you xi lei xing you xi zhang ai huan zhe geng wei pian ai de you xi xing shi shi zai xian you xi, er bu shi li xian you xi geng wei pian ai de you xi lei bie shi da xing duo ren zai xian jue se ban yan you xi di yi ren cheng she ji ge dou he ji shi zhan lue you xi. san zhen duan yu ping gu zao qi shi bie zhen duan gan yu dui you xi zhang ai de yu fang zhi liao zhi guan zhong yao. yi you xi zhang ai shai cha yu ping gu zai pu tong ren qun you qi shi er tong qing shao nian zhong dui you xi zhang ai jin xing shai cha ping gu, zuo dao zao qi shi bie zao qi zhen duan yu zao qi gan yu, dui yu gai shan gan yu xiao guo ti gao cheng ben xiao yi jian shao huan zhe ji qi jia ting de tong ku he fu dan gai shan huan zhe sheng huo zhi liang ju you zhong yao yi yi. wei ci, zhun que ke kao yi yong de gong ju dui yu shai cha fu zhu zhen duan ping gu yan zhong cheng du deng fei chang zhong yao. zai ICD11 fa bu qian, xue jie yi kai fa chu duo zhong wen juan he liang biao yong yu shai cha huo ping gu guo du you xi xing wei huo you xi zhang ai, bing dui liao jie you xi zhang ai de fa sheng lv dian xing te zheng deng ju you zhong yao can kao zuo yong. dan zhei xie gong ju ye cun zai zhu duo ju xian xing, zhu yao bao kuo dui yu you xi zhang ai he xin te zheng ding yi bu yi zhi dui lin chuang zhuang tai fen jie bu yi zhi que fa shi jian wei du zheng zhuang zhi zheng ke kao du bu zu ce chong ping gu xue sheng qun ti deng. yin ci, shi jie wei sheng zu zhi zheng zai zu zhi ge guo zhuan jia ji he zuo ji gou zhen dui you xi zhang ai kai fa pu shi xing jiao gao biao zhun qing xi tong yi yi yong xing jiao hao de shai cha ping gu gong ju, yi bang zhu yi wu ren yuan ji zao shi bie you xi zhang ai de huan bing feng xian, jian shao lou zhen wu zhen huo guo du zhen duan, cu jin yi si huan zhe ji gao feng xian ge ti ji zao zhuan jie dao zhuan ye ji gou jin yi bu zhen duan ping gu. you xi zhang ai zhe ke neng ban you duo zhong qu ti huo jing shen xing wei wen ti, ying dui yi si huan zhe jin xing quan mian xi tong ping gu. ping gu nei rong bao kuo: 1 shi fou you you xi zhang ai ji qi yan zhong cheng du 2 shi fou you qu ti jian kang wen ti huo jing shen jian kang wen ti 3 xue ye zhi ye ren ji guan xi jia ting guan xi sheng huo zhi liang deng she hui gong neng qing kuang ji xiang guan bei jing xin xi 4 you xi zhang ai he bing qi ta jing shen xing wei zhang ai qing kuang 5 ying xiang zhi liao ji kang fu de bao hu yin su he wei xian yin su ru huan zhe zhi liao yi cong xing zi wo xiao neng gan jia ting ji she hui zhi chi qing kuang she hui jing ji shui ping deng 6 dui yu hou de pan duan deng. er zhen duan yu jian bie zhen duan dui yu you xi zhang ai yi si huan zhe huo gao feng xian ge ti de lin chuang zhen duan, xu yao gui fan de zhen duan zhi nan bao zheng yi liao wei sheng ji gou zhen duan de zhun que xing, bi mian guo du zhen duan. ICD11 zhong ti chu you xi zhang ai de he xin te zheng wei: 1 chi xu huo fan fu de you xi xing wei mo shi, ju ti biao xian wei shi kong xing you xi xing wei ru wu fa kong zhi you xi xing wei de fa sheng pin lv chi xu shi jian zhong zhi shi jian deng, you xi xing wei cheng wei sheng huo you xian shi xiang, jin guan you xi zao cheng fu mian hou guo ru ren ji guan xi po lie zhi ye huo xue ye shou ying xiang jian kang sun hai deng reng ran wu fa ting zhi 2 you xi xing wei mo shi ke yi shi chi xu xing huo fa zuo xing de, bing chi xu 12 ge yue, dan ru guo zheng zhuang zu gou yan zhong qie man zu qi ta zhen duan yao dian, chi xu shi jian ke duan yu 12 ge yue 3 you xi xing wei mo shi dao zhi ming xian de ge ren jia ting ren ji guan xi xue ye zhi ye huo qi ta zhong yao gong neng ling yu sun shang. gen ju you xi xing shi bu tong, you xi zhang ai bao kuo zai xian you xi zhang ai li xian you xi zhang ai liang zhong lei xing. xu qu fen you xi zhang ai yu zheng chang you xi xing wei. ru guo fan fu you xi xing wei shi yi cu jin she jiao huan jie wu liao tiao jie qing xu deng wei mu di, bing qie que fa you xi zhang ai de qi ta bi yao te zheng, ze bu neng zhen duan wei you xi zhang ai. zai te ding de nian ling huo she hui qun ti zhong ru qing shao nian nan xing huo zai te ding qing jing zhong ru zuo wei jie jia ri yu le huo dong, ke neng cun zai jiao chang shi jian huo jiao gao pin ci de you xi xing wei, zhen duan shi xu yao kao lv wen hua ya wen hua tong ban qun ti deng yin su de ying xiang. ci wai, dui yu you xi chan ye xiang guan ge ti er yan, gao qiang du de you xi xing wei ke neng shi qi zhi ye nei rong de yi bu fen, bu ying zhen duan wei you xi zhang ai. you xi zhang ai shi yi ge lian xu de fa zhan guo cheng, ji you bu wan you xi kai shi, jing guo yu le xing ou er you wan zhi gao pin du you wan jie duan, zui zhong fa zhan cheng shi kong xing xing wei. yin ci, dui you xi zhang ai de zhen duan bu jin yao pan duan shi fou da dao ji bing zhuang tai, hai yao zai zhen duan gong zuo zhong shu li zao qi shi bie zao qi gan yu de yi shi, dui chu xian bu fen zheng zhuang dan bu wan quan man zu zhen duan biao zhun di ge ti ti gong zhuan ye yi jian, ji shi yu fang fa zhan dao you xi zhang ai. zhen duan you xi zhang ai ye xu yao zhu yi pai chu qi ta ji bing. tong chang xu yao yu yi xia qing kuang xiang jian bie: 1 wei hai xing you xi xing wei, zhi you xi xing wei dai lai jian kang sun hai feng xian, dan shang wei chu xian jian kang sun hai, ke neng xu yao gan yu huo guan cha de yi zhong zhuang tai 2 du bo zhang ai, you xi zhang ai tong chang bu she ji jin qian du bo, dan mu qian xu duo wang luo you xi ye ju you du bo xing shi pu ke ma jiang deng huo du bo cheng fen gai shuai xing de chou jiang 3 qi ta jing shen zhang ai, ru jiao lv zhang ai yi yu zhang ai shuang xiang qing gan zhang ai ren ge zhang ai deng, guo du you xi xing wei ke neng chu xian zai shang shu ji bing fa zuo shi qi, zhi you dang guo du you xi xing wei mo shi fu he you xi zhang ai zhen duan yao dian, bing qie zai bu cun zai shang shu ji bing jing shen zheng zhuang de qing kuang xia, cai kao lv zhen duan you xi zhang ai ru guo tong shi cun zai you xi zhang ai yu qi ta jing shen zhang ai, ying kao lv you xi zhang ai gong bing qi ta jing shen zhang ai de zhen duan 4 wu zhi shi yong zhang ai, you xi xing wei chang chang yu wu zhi shi yong te bie jiu jing gong cun, ru guo tong shi man zu liang zhong zhang ai de zhen duan biao zhun, ke yi kao lv gong bing zhen duan. si zong he gan yu yuan ze yu cuo shi yi zong ti yuan ze chu zun xun wu zhi shi yong ji cheng yin xing wei zhang ai de yi ban yuan ze wai, xu jie he you xi zhang ai de gao fa ren qun ji bing te zheng deng jin xing yu fang yu gan yu, jian chi yu fang wei zhu, jin xing ji yu zheng ju fu he lun li de ge ti hua de zong he gan yu cuo shi. 1. yu fang wei zhu. you xi zhang ai gao fa yu er tong qing shao nian qun ti, cong yu le xing you xi xing wei fa zhan cheng wei you xi zhang ai you yi ding guo cheng, zhen dui gao fa ren qun jin xing yu fang xing gan yu, ke yi xian zhu jian shao you xi zhang ai fa bing lv ji ji bing fu dan. 2. ji yu zheng ju. suo you gan yu fang an ying dang you xiang ying di zheng ju, bu ying gai wei bei yan jiu huo lin chuang shi jian zheng ju. 3. fu he lun li. you xi zhang ai gan yu ying dang ji yu pu bian de yi xue lun li dao de, zun zhong ren quan he huan zhe zun yan, bu sun hai huan zhe jian kang ji li yi. 4. zong he gan yu. mu qian hai mei you zhen dui you xi zhang ai de te xiao gan yu shou duan. you yu huan zhe chang ban you qu ti huo jing shen ji bing, xu yao xin li zhi liao yao wu zhi liao deng duo zhong shou duan jie he jin xing ge ti hua de zong he gan yu. tong shi, you xi zhang ai lei si yu jing shen huo xing wu zhi shi yong zhang ai, ke neng hui fu fa huo ji bing man xing hua, zai zong he gan yu guo cheng zhong, xu yao yi liao wei sheng xue xiao jia ting she hui deng duo fang mian di xie tiao ji jian du. er yu fang jian li bao kuo pu bian xing yu fang zhen dui xing yu fang zao qi fa xian ji zhi liao deng cuo shi de san ji yu fang ti xi, xiao chu huo jian shao zhi bing yin su, ti gao xin li jian kang shui ping, dui yu jian shao you xi zhang ai de fa sheng he fu fa cu jin huan zhe ji shi huo de zhen liao jiang di wei hai zhi guan zhong yao. 1. pu bian xing yu fang. dui gong zhong kai zhan xin li jian kang zhi shi ke pu xuan chuan gong zuo, guang fan xuan chuan you xi zhang ai xiang guan zhi shi, ti gao quan she hui xin li jian kang shui ping, jian shao yin fa you xi zhang ai de you yin. 2. zhen dui xing yu fang. dui yu er tong qing shao nian deng yi huan you xi zhang ai de gao wei ren qun, zai ge ti ceng mian cong qing xu tiao kong ren zhi kong zhi ren ji jiao wang deng fang mian cai qu xiang ying de xin li gan yu cuo shi dui yu er tong qing shao nian suo chu de jia ting xue xiao she hui huan jing, zhong dian kai zhan xin li jian kang zhi shi he ying dui ji neng de ke pu xuan chuan gong zuo, gai shan jia ting guan xi yu qin zi gou tong neng li, guan ai er tong qing shao nian xin li xu qiu. 3. zao qi fa xian yu zhi liao. ti gao er tong qing shao nian jia zhang yu xue xiao zao qi shi bie you xi zhang ai de neng li, dui ke yi de you xi zhang ai huan zhe, zhi dao huan zhe ji qi jia shu ji shi jiu zhen, ming que zhen duan, jie shou he li xi tong de zhi liao. zai zong he yi yuan jing shen xin li ke he jing shen zhuan ke yi yuan kai zhan zhen dui xing pei xun, shi yi hu ren yuan you neng li zheng que shi bie zhen duan zhi liao you xi zhang ai zuo hao lian luo hui zhen he zhuan ke zi xun gong zuo, bang zhu fei jing shen ke yi sheng zao qi fa xian bing ji shi zhuan jie you xi zhang ai huan zhe. san zhi liao yu kang fu 1. zhi liao cuo shi mu qian mei you quan wei de you xi zhang ai zhi liao zhi nan, dan jin nian you bu shao guan yu you xi zhang ai zhi liao ji gan yu de yan jiu huo lin chuang shi jian ti shi, jiang she hui xin li gan yu yao wu zhi liao chu li gong bing deng jie he de zong he zhi liao you li yu gai shan you xi zhang ai huan zhe yu hou, zhu yao cuo shi bao kuo: 1 she hui xin li gan yu. mu qian hen duo lin chuang shi jian ji yan jiu zheng ju ti shi, ren zhi xing wei zhi liao dong ji ji li fang tan jia ting zhi liao deng she hui xin li gan yu dui jian shao you xi zhang ai zhe de shi kong xing you xi xing wei ji cu jin chang qi kang fu you xiao. 2 yao wu zhi liao. mu qian mei you zhen dui you xi zhang ai ju you lin chuang shi ying zheng de yao wu, dan you xi zhang ai huan zhe ke neng cun zai jing shen qu ti deng jian kang wen ti yi ji gong bing, xu yao yao wu dui zheng zhi liao. 3 wu li zhi liao. mu qian you shao liang yan jiu dui you xi zhang ai huan zhe jin xing chong fu jing lu ci ci ji deng gan yu, yi zeng qiang da nao kong zhi gong neng huo jiang di wan you xi de chong dong, dan mu qian reng que fa da yang ben yi zhi xing yan jiu. 2. kang fu cuo shi yu qi ta ji bing zhi liao lei si, you xi zhang ai zhi liao mu biao shi tong guo she hui xin li kang fu he hou xu guan li, yu fang fu fa, cu jin she hui gong neng hui fu hui gui she hui. jing guo zhi liao bing qing qu yu wen ding de huan zhe, ying ji xu jie shou gong gu xing de xin li zhi liao, bi yao qing kuang xia an shi an liang fu yao, fang zhi ji bing fu fa. zuo hao chu yuan huan zhe de ding qi sui fang gong zuo, shi huan zhe neng gou jie shou ji shi de you zhen dui xing de yi liao zhi dao he fu wu. dong yuan jia ting cheng yuan zhi chi he can yu huan zhe de kang fu huo dong, zhi dao jia ting cheng yuan wei huan zhe zhi ding sheng huo ji hua, nu li jie jue huan zhe de xin li jian kang wen ti he ri chang sheng huo zhong de shi ji kun nan. xu yao qiang diao de shi, you xi zhang ai shi man xing fu fa xing ji bing, you xi zhang ai gan yu qi shi jie duan gan yu guo cheng zhong ji ji bing kang fu qi dou xu yao dui you xi zhang ai zheng zhuang ji yan zhong cheng du jin xing ping gu. wu jin hou de gong zuo zhong dian jian yu you xi zhang ai de liu xing bing xue bing yin bing li ji zhi yu fang zhi liao fang fa deng shang dai jin yi bu ming que, jian yi jin hou zhong dian gong zuo ru xia: 1. yi xiu ding zhong hua ren min gong he guo wei cheng nian ren bao hu fa wei qi ji, chu tai bao hu er tong qing shao nian shen xin jian kang de xiang guan fa lv fa gui, chu tai zhuan men gui fan he jing hua wang luo huan jing de zheng ce cuo shi. 2. jian li wei sheng jian kang jiao yu gong shang wen hua deng duo bu men xie zuo ji zhi, dui you xi zhang ai gan yu ji gou jin hang gui fan he jian du, que bao huan zhe ji qi jia shu neng huo de zhuan ye bang zhu. 3. yi xiang guan xue shu ji gou ji tuan ti wei zhu ti, wan shan you xi zhang ai shi bie ping gu zhen duan ti xi, kai zhan xiang guan pei xun, ti sheng you xi zhang ai zhen zhi de zhuan ye neng li. 4. kai zhan you xi zhang ai liu xing bing xue diao cha, liao jie xiang guan yin su de ying xiang he zuo yong ji zhi, sui fang qi zhuan gui ji xiang guan ying xiang yin su. 5. kai zhan zhen dui you xi zhang ai de yao wu she hui xin li zhi liao xiang guan lin chuang ji xiang guan fang kong zheng ce yan jiu. 6. jiang bao kuo you xi zhang ai zai nei de suo you cheng yin xing wei ji qi ta she hui shi ying bu liang xing wei zuo wei yi ge zheng ti dui dai, kuo zhan yu fang he yi xue gan yu gong zuo de fan wei he shen du, shi zhi fa hui geng wei guang fan he li ti de zuo yong. zhong hua yi xue hui jing shen bing xue fen hui?? zhong hua yu fang yi xue hui jing shen wei sheng fen hui zhong guo yi shi xie hui jing shen ke yi shi fen hui????? zhong guo xin li wei sheng xie hui zhong guo yao wu lan yong fang zhi xie hui 2019 nian 7 yue 15 ri

    当前文章:http://www.52weixiaoshuo.com/2019/48268-85415-88755.html

    ?


·云数据:交割月临近减仓爆棚 燃油和甲醇领涨

·加盟官网查询

·重温长征丨最后的湘江抢渡:用生命向信仰交出答卷

·原件 夏季休闲:夏天的后街小巷很难处理,女人们躺在开着门的竹床上。

·泰坦星漫画

·Labor-management talks for 2020 minimum wage hit impasse in Korea

·为鸿蒙开路!华为:方舟编译器8月正式开源

·熊孩子让父母崩溃到撞墙?想让孩子变“规矩”,2岁左右是最好的

·最新伤亡数字!刚刚,长宁再次发生5.3级地震

·开能健康2019年上半年预盈4000万至4200万大力推动供应链改造

Copyright ? 2000 - 2019 www.52weixiaoshuo.com All Rights Reserved.  制作单位:环球亚博官网地址谁有

版权所有 岱勒新材(300700.SZ)预计上半年业绩盈转亏至920万元-1190万元