《生理学》 CHAPTER 5 RESPIRATION

第二节肺换气和组织换气,PulmonaryVentilationandTissuesVentilation,一、气体交换的原理principleofgasexchange,（一）气体扩散gasdiffusion气体分子不停的进行着无定向的运动，其结果是气体分子从分压高处向分压低处发生净转移，这一过程称为气体扩散。Gasmoleculesmovefreelyamongoneanother.Theresultisgasmoleculesdiffusefromhigh-pressureareatowardlow-pressurearea.Theprocessiscalledgasdiffusion.肺换气和组织换气就是物理性的扩散过程。Pulmonaryventilationandtissuesventilationarephysicaldiffusionprocesses.,气体扩散遵循着以下物理原则gasdiffusionobeysthefollowingphysicalprinciples,1.气体从分压高的一侧向低的一侧扩散。Gasdiffusesfromthehigh-pressureareatothelow-pressurearea.2.各气体的扩散方向和量，决定于该气体的分压差、气体的扩散速度和气体在液体中的溶解度。Thediffusiondirectionandvolumeofgasisdecidedbyitsownpartialpressuredifference、diffusionrateandthesolubilityinfluid.,3.在液体或气液交界面，气体的扩散速度与它在液体中的溶解度密切相关。溶解度高的扩散快。Inthefluidorattheinterfaceofgasandfluid,thediffusionrateofgasiscorrelatecloselytoitssolubilityinfluid.Thegaswhichsolubilityishigherdiffusesquicker.4.气体的扩散速度（1/气体分子量）。分子量大的扩散速度慢。Diffusionrateofgas（1/molecularweight）Thegaswhichmolecularweighislargerdiffusesslowlier.,单位时间内气体扩散的容积为气体扩散速率，它受下列因素影响Thevolumeofgasdiffusioninunittimeiscalleddiffusionrate.Itiseffectedbythefollowingfactors分压差扩散面积温度气体溶解度扩散距离分子量,扩散速率,D,P*T*A*S,d*MW,1.气体的分压差：分压差大扩散快Gaspartialpressuredifference:gaspartialpressuredifferenceislargerdiffusesfaster2.气体分子量和溶解度：溶解度高，扩散快分子量大，扩散慢Gasmolecularweightandsolubility:whensolubilityishigh,itdiffusesfastwhenmolecularweightislarge,itdiffusesslowly.,3.肺泡膜的扩散面积：扩散面积大，扩散快Diffusionareaofalveolarmembrane:whendiffusionareaofalveolarmembraneislarge,itdiffusesfast.安静状态下，肺泡扩散面积40m2diffusionareaofalveolarmembraneis40m2innormalquietstate.运动时肺泡扩散面积70m2diffusionareaofalveolarmembraneis70m2duringsports.疾病状态时下降diffusionareaofalveolarmembranedecreasesindisease.,4.扩散距离肺泡膜的厚度（反比关系）(图39-9)Diffusiondistancethicknessofalveolarmembrane(inverseratiorelationship)肺纤维化-厚度增加Pulmonaryfibrosis-Thicknessincreases肺水肿-扩散下降Pulmonaryedema-Diffusiondecreases5.温度Temperature液体温度上升，溶解度上升扩散快TemperatureoffluidincreasesSolubilityincreasesDiffusesfast,6.肺血流量与通气血流比值PulmonaryPerfusionandVentilation/PerfusionRatio0.75秒右心搏出量60ml/每搏流经肺泡膜气体交换所需时间0.3秒，故时间上有很大贮备潜力。0.75secondRSV60ml/perbeatExchangetimeofthegasflowingthroughalveolarmembraneis0.3second.Sothereisgreattimereservepotential.,如果血流量下降，气体交换正常交换的总量下降，故肺泡通气量与血流量之间必须保持恰当的比值。Ifbloodflowdecreasesandgasexchangearenormal-theexchangetotalamountdecreases.Soalveolarventilationandbloodflowmustkeepanappropriateratio.Ventilation/perfusionratio通气/血流比值(安静时正常值)4.2升/5升0.84VA/Q(valueofnormalquietstate)4.2升/5升0.84VA每分肺泡通气量alveolarventilationperminuteQ每分肺血流量pulmonaryperfusionperminute,通气/血流比值升高：表示有部分肺泡气不能与血液中的气体充分交换生理无效腔增大。ventilation/perfusionratioincreases:itmeanspartialalveolargascannotexchangefullywiththebloodgas=physiologicaldeadspaceincreases.通气/血流比值下降：表示有部分血液经通气不良的肺泡，得不到充分气体交换，相当于功能性动静脉短路。ventilation/perfusionratiodecreases:itmeanspartialbloodflowthroughhypoventilationalveoli.Theycannotgetfullyexchange.Anditequalsfunctionalarteriovenousshunt.,正常人直立时，肺各局部VAQ分布不均匀Whennormaladultisstanding,everypartoflungVAQisnotwell-distributed肺尖VA下降/Q下降Q下降更明显ApexoflungVAdescent/QdescentQdescentingismoreobvious.比值上升（可在3以上）ratiorises(morethan3)肺底VA下降/Q上升比值下降（0.6）BaseoflungVAdescents/Qrisesratiodescents(0.6),7.肺扩散容量(pulmonarydiffusioncapacity)指各种气体在单位分压差（1mmHg）下，每分钟能通过呼吸膜的气体量（ml）。它是测定呼吸膜扩散功能的生理指标。Whenallkindsofgasisunderunitpartialpressuredifference,thegasvolume(ml)passingthroughrespiratorymembraneperminuteiscalledpulmonarydiffusioncapacity.Itisthephysiologicalindextotestthediffusionabilityofrespiratorymembrane.,CO2扩散率/O2扩散率O2分子量/CO2分子量=32/445.6/6.6CO2diffusibility/O2diffusibility=O2molecularweight/CO2molecularweight=32/445.6/6.6在肺泡气O2的扩散率稍大于CO2ThediffusibilityinalveolargasisalittlelargerthanCO2.但由于CO2溶解度/O2溶解=0.592/0.0244=24.3/1.0(Herryslaw赫利定理）ButbecauseCO2solubility/O2solubility=0.592/0.0244=24.3/1.0(Herryslaw）CO2扩散速率/O2扩散速率=（5.6/6.6）（0.592/0.0244)=20.6/1.0CO2diffusionvelocity/O2diffusionvelocity=（5.6/6.6）（0.592/0.0244)=20.6/1.0,由上可知，CO2扩散速率远大于O2扩散速率，临床上不存在CO2扩散障碍。一般以O2的扩散容量作为测定指标。Fromallabove,weknowthatthediffusionvelocityofCO2ismuchmorethanthatofO2.ThereisnodiffusiondisturbanceofCO2inclinical.Usually,wetakethediffusionvolumeofO2astestindex.正常成人20ml/(min*mmHg)normaladult20ml/(min*mmHg)男女；成人老幼malefemale;adulttheoldortheimmature,（二）呼吸气体和人体不同部位气体的分压partialpressureofrespiratoryairandgasofdifferenthumanbodytissues,1.呼吸气及肺泡气的成分和分压（表5-2）Compositionandpartialpressureofrespiratoryairandalveolarair.呼吸周期中，肺泡气O2及CO2的含量有轻微波动。Intherespiratorycycle,compositionofO2andCO2inalveolarairfluctuatesalittle.,呼吸气和肺泡气的成分和分压表5-2；血液气体和组织气体的分压表5-3Theingredientandpartialpressureofrespiratoryairandalveolargasfigure5-2;partialpressureofbloodgasandtissuesgasfigure5-3,混合气体的总压力是各组成气体的分压力的总和。Thetotalpressureofmixedgasequalstothesummationofpartialpressureofeachcomposition.各组成气的分压混合气总压力该气体的容积百分比partialpressureofeachcomposition=thetotalpressureofmixedgasvolumepercentageofthegasN2600mmHg=760mmHg79%O2159mmHg=760mmHg21,2.血液气体和组织的分压（张力）（表5-3）partialpressure(tension)ofbloodgasandtissuesgas(figure5-3),二、肺换气Pulmonarygasexchange,混合静脉血PO2是5.32kPa（40mmHg），比肺泡气的13.82kPa（104mmHg）低，肺泡气中O2向血液中扩散，血液的PO2逐渐上升，最后接近肺泡气的PO2。PO2ofmixedvenousbloodis5.32kPa（40mmHg）islowerthan13.82kPa（104mmHg）ofalveolargas.O2inalveolargasdiffusestoblood.PO2inbloodrisesgraduallyuntilitisalmostequaltoPO2inalveolargas.,混合静脉血PCO2是6.12kPa（46mmHg），比肺泡气的5.32kPa（40mmHg）高，血液中CO2向肺泡中扩散，血液的PCO2逐渐下降，最后接近肺泡气的PCO2。PCO2ofmixedvenousbloodis6.12kPa（46mmHg）Itishigherthan5.32kPa（40mmHg)ofalveolargas.CO2inblooddiffusestoalveolargas.PCO2inblooddescentsgraduallyuntilitisalmostequaltoPCO2inalveolargas.,肺换气Pulmonarygasexchange,三、组织换气TissuesGasExchange,第三节气体在血液中的运输TransportofGasintheBlood,一、氧和二氧化碳在血液中的存在形式ExistingpatternofO2andCO2intheblood物理溶解（中介作用）physicaldissolving(medium)两种形式twokindofpatterns化学结合（为主）combination(primary),O2溶解化学结合CO2dissolvecombination组织或肺血液bloodTissuesorlung溶解系数resolutioncoefficientO20.022ml/1ml全血bloodCO20.511ml/1ml全血blood,二、氧的运输oxygentransportation,与Hb结合占98.598.5bindingtoHb氧的运输oxygentransportation物理溶解占1.51.5physicalresolution,氧容量指每100ml血中，血红蛋白结合氧的最大量。MaximumcapacityofferrohemoglobinbindingwithO2inevery100mlbloodisnamedoxygencapacity.正常Hb在15g/100ml血液中，1gHb结合1.34ml氧。氧容量151.3420mlWhennormalHbisin15g/100mlblood,1gHbbindswith1.34mlO2.Oxygencapacity=151.3420ml氧含量指血红蛋白实际结合的氧量。Thevolumeofferrohemoglobinbindingwithoxygeniscalledoxygencontent.动脉血：20ml氧arterialblood:20mlO2静脉血：15ml氧venousblood:15mlO2,氧饱和度指氧含量占氧容量的百分比。Thepercentageofoxygencontenttooxygencapacityiscalledoxygensaturation.动脉血，氧含量20ml，氧饱和度为100Inarterialblood,oxygencontentequals20mlandoxygensaturationis100%.静脉血，氧含量15ml，氧饱和度为75Invenousblood,oxygencontentequals15mlandoxygensaturationis75%.,（一）Hb与O2的可逆结合reversiblebindingofHbandO2,O2分压高（肺）partialpressureishigher(lung)HbO2HbO2O2分压低（组织）partialpressureislower(tissues)（还原、紫蓝色）（氧合、红色）reduction、royalblueoxygenation、red盐键断裂break分子构型紧密型分子构型疏松型（tension）盐键形成form（relaxation）,特点：character,1.可逆性结合，非酶促过程，反应快，受PO2影响。Reversiblebinding.Withoutenzyme.Fast.EffectedbyPO2.2.O2与血红蛋白的亚铁离子结合，结合后亚铁离子的离子价不变，故称氧合，不是氧化。O2bindswithFe2+offerrohemoglobin.Theionvalueispermanent.Sotheprocessiscalledoxygenationbutnotoxidation.,3.血红蛋白的珠蛋白由两条肽链和两条肽链构成，每条肽链上结合一个含亚铁离子的血红素分子，每个亚铁离子结合一个O2分子。故每个血红蛋白分子可结合4个O2分子（HbO8）1gHb可结合1.341.39mlO2.Globinofferrohemoglobinismadeupoftwopeptidechainsandtwopeptidechains.ThereisaprotohememolecularoneachpeptidechainincludingaFe2+.EachFe2+bindswithanO2.SoeachferrohemoglobincanbindwithfourO2.（HbO8）1gHbcanbindwith1.341.39mlO2.,4.血红蛋白两对、肽链与O2结合可互相促成结合或解离（释放）。在肺部，PO2升高促结合；在组织，PO2下降促释放。Conjugationofpeptidechains、offerrohemoglobinandO2canfacilitatebindingordissociation(releasing).Inlungs,increasingofPO2promotescombination.Intissues,decreasingofPO2promotesreleasing.,5.Hb与O2的结合或解离曲线呈S型与Hb的变构效应有关ThebindingordissociationcurvesofHbandO2appearSform.ThisisrelatedtotheallosterismeffectofHb.Hb与O2结合盐键断裂，R型Hb与O2解离盐键形成，T型HbbindswithO2saltbondbreaks,RformHbdissociateswithO2saltbondforms,TformT型对O2亲和力小。TheaffinityofTformtoO2issmaller.R型对O2亲和力大。TheaffinityofRformtoO2islarger.,血红蛋白的异常形成,1.胎儿血红蛋白（HbF）是由两条链和链结合组成，它对O2亲和力比HbA大。可能由于链不与2，3DPG相结合，不受2，3DPG影响的缘故。2.镰状细胞贫血（HbS)两条链第6位谷氨酸为缬氨酸所取代，使去氧Hb释放O2的能力下降，导致组织缺O2。3.地中海贫血。我国常见地贫。由于链合成障碍HbA生成抑制，HbF代偿增多，O2解离曲线左移。,（二）氧解离曲线oxygendissociationcurve,反映PO2与氧合Hb饱和度的关系的曲线。（图40-9）ThecurvereactstherelationshipofPO2andsaturationofoxygenationHb.(figure40-9),氧解离曲线oxygendissociationcurve,特点：character,1.曲线上段：PO260100mmHg.坡度较平坦Superiorsegmentofcurve:PO260100mmHg.Slopeisflat.1）氧分压变化虽大但饱和度变异小即使外界或肺泡中PO2下降，但氧合饱和度依然可维持在较高水平。Partialpressureofoxygenchangesgreatly.ButsaturationchangeslittleevenPO2ofenvironmentoralveolidescents,oxygenationsaturationwillmaintainhighlevel.2）PO2100mmHg时，氧合饱和度增加很不明显，血氧量增加很少。WhenPO2100mmHg,risingofoxygenationsaturationisnotobvious.Risingofbloodoxygenvolumeislittle.,2.曲线中段PO26040mmHg是HbO2释放O2的部分。MiddlesegmentofcurvePO26040mmHgisthepartthatHbO2releasesO2.此时Hb氧饱和度75，血O2含量14.4mL，即每100ml血液流过组织时释放5mlO2。AtthistimeHboxygensaturationis75%,oxygencontentinbloodis14.4mL.Intheotherwords,every100mlbloodreleases5mlO2whenitflowsovertissues.血液流经组织时释放出的O2容积所占动脉O2含量的百分数O2利用系数。安静时为25，运动时可增加到75。Thepercentageofoxygencapacityreleasedwhenbloodflowsovertissuestooxygencontentinarteriaiscalledoxygenutilizationcoefficient.Itis25%innormalquietstateanditincreasesto75%insports.,3.曲线下段PO21040mmHg.坡度陡.Inferiorsegmentofcurve.PO21040mmHg.Theslopeissteep.PO2略有下降，促使较多O2解离，饱和度下降，有利于组织活动的供氧，氧利用系数上升至75。PO2descentsalittle.Itmakesoxygendissociationsaturationdescent.Thisisbenefittosupplyingoxygenfortissueactivity.Oxygenutilizationcoefficientincreasesto75%.机制：血红蛋白肽链结合氧时，互相作用。Mechanism:whenpeptidechainsofferrohemoglobinbindwithoxygen,theyinteract.,高原PO2下降意义：Hb的氧缓冲功能PO2descentsinplateauSignificance:amortization组织活动functionofHbtissueactivity血红蛋白氧缓冲功能：不论血液本身或外界O2浓度有较大幅度变动，而组织PO2仍可保持在稳定的正常范围内。O25ml/（100ml*min）Ferrohemoglobinamortizationfunction:evenblooditselfofenviromentoxygenchangegreatly,tissuePO2stillremaininnormalrange.O25ml/（100ml*min）,影响氧解离曲线的因素factorseffectoxygendissociationcurve,（三）影响氧离曲线的因素（图40-10）factorseffectoxygendissociationcurve(figure40-10),1.PH和CO2影响influenceofPHandCO2通常用P50表示Hb对O2的亲和力。UsuallyweuseP50astheaffinityofHbandO2.正常P50：PO226.5mmHg。NormalP50:PO226.5mmHg。P50上升，亲和力下降，曲线右移；whenP50rises,affinitydescentsandcurvemovestoright.P50下降，亲和力上升，曲线左移。whenP50descents,affinityrisesandcurvemovestoleft.,Bohr效应BohreffectPH下降，PCO2上升促使盐键形成，Hb分子构型转为T型；曲线右移，P50增大，氧饱和度下降，解离增加。PHdescentsandPCO2risesmakesaltbondform.MolecularconfigurationofHbchangestoTform.Curvemovetoright.P50increases.Oxygensaturationdescentsanddissociationincreases.PH上升，PCO2下降促使盐键断裂，Hb分子构型转为R型；曲线左移，P50降低，氧饱和度增加，解离下降。PHrisesandPCO2descentsmakesaltbondbreak.MolecularconfigurationofHbchangestoRform.Curvemovetoleft.P50descents.Oxygensaturationincreasesanddissociationdescents.,2.温度的影响effectoftemperatureT增加Hb对O2亲和力下降，氧饱和度下降,曲线右移，H+活动性增加。TincreasesaffinityofHbtoO2descents.Oxygensaturationdescents.Curvemovestoright.ActivityofH+increases.T下降Hb与O2亲和力上升，氧饱和度上升,曲线左移，HbO2不易解离出O2（低温麻醉）。TdescentsaffinityofHbtoO2increases.Oxygensaturationincreases.Curvemovestoleft.HbO2cannotdissociateO2easily(hypothermianesthesia).,3.2，3二磷酸甘油酸（2，3DPG）的影响.Effectof2,3-diphosphoglycerate2，3DPG为RBC内一种有机磷酸盐。2，3DPGisakindoforganophosphateinRBC.缺氧、贫血hypoxiaanemia长时间运动longtimesports甲状腺素thyroxinesodiumRBC2，3DPG上升2，3DPGincreases无氧代谢anaerobicmetabolism脱氧血红蛋白链形成盐键chaindeoxyhemoglobinformsaltbond.失去氧合能力（T型）Hbmissoxygenationability(Tform)氧离曲线右移，促氧解离Oxygendissociationcurvemovetoright,makeoxygendissociate.,4.其他因素otherfactorsFe+Fe+就失去O2结合能力misstheabilitytobindwithO2CO中毒，CO与Hb结合COintoxication,CObindwithHbCOHb（无与O2结合能力）nobindingabilitytoO2,三、二氧化碳的运输（图40-13)TransportationofCO2（figure40-13）,物理溶解（6）CO2的运输physicaldissolution碳酸氢盐形式transportationofCO2（87）bicarbonatepattern化合结合（94）combination氨基甲酸血红蛋白（7）carbaminohemoglobin,CO2的运输transportationofCO2,（一）碳酸氢盐形式的运输Transportinbicarbonatepattern特点：character:1.反应可逆，但需酶的促助。Reactionisreversible.Butitneedthehelpofenzyme.2.结合或解离决定于CO2分压差。ConjugationordissociationisdecidedbypartialpressuredifferenceofCO2.3.反应中伴有Cl的转移。ThereisthetransferofClinthereaction.,（二）氨基甲酸血红蛋白的形式运输Transportincarbaminohemoglobinpattern在组织中intissuesHbNH2+CO2HbNHCOOH肺lungHbNHCOOH,特点：character1.反应可逆，无需酶的促助。Reactionisreversibleandneednotthehelpofenzyme.2.结合或解离取决于Hb的氧合作用。ConjugationordissociationisdecidedbytheoxygenationeffectofHb.脱氧Hb与CO2结合多；MuchDeoxyHbbindswithCO2.氧合Hb结合少，解离多。LittleHbbinds.dissociationismuch.3.CO2分压差的影响不明显。Theeffectofpartialpressuredifferenceisnotobvious.,CO2解离曲线carbondioxidedissociationcurve,（三）CO2解离曲线（图40-15）carbondioxidedissociationcurve,1.血液中CO2的运输量，决定于CO2分压。PCO2上升运输量上升，两者呈直线关系。TransportvolumeofCO2inbloodisdecidedbypartialpressureofCO2.PCO2increasestransportvolumeincreases.Theyappearlinearrelationship.,2.何尔登效应HaldaneeffectO2Hb促使CO2的释放（肺部）promotesthereleasingofCO2(lung)在组织促摄取CO2intakesCO2inthetissues在肺部促CO2释放releasesCO2inlungs脱氧血红蛋白携带CO2的能力比氧合血红蛋白要大，故动脉血携带CO2量少于静脉血。TheabilityofdeoxyhemoglobintakingalongCO2islargerthanoxyhemoglobin.SothevolumeofCO2takenalonginarterialbloodislessthanthatinvenousblood.,3.碳酸酐酶的活性和含量Thecontentandactivityofcarbonicanhydrase,RBC内碳酸酐酶活性上升运输能力上升ActivityofcarbonicanhydraseinRBCincreasing-transportationabilityincreasingRBC内碳酸酐酶含量上升运输能力上升ContentofcarbonicanhydraseinRBCincreasing-transportationabilityincreasing,躡紳秞妀糢甤楥痸窼謧康嘁桺钕贽隤蛋谫暎題唰璵誫喆掘倠喢摂撴粔鯫獌蔛跎毭楕魞癕陵减慮纐餎帵斸子敯塮莀鑋危瀵妈糣萧蒧硣暿奞眱瓆暯躬鋧違璓鹅瀃頑丁徎礃潠扉玔厱巡靚詙輌粸榦魧釣觨朆骆熋獝趒銊保匜圛苢烨翖煉冊瀙歓擃璽玫琗瘛疂誧髲檹整烮鎞鶪缔岚贄鮻裣餷疲愙鍲鐝魙擏蕍評瓇爖庛氢弣翭鄞津邾嚅苈扜燺辭唦笙鞸笲薳瘰嬳躮尀菁仨狂醨冏僧唝儌权違攝埃暭毗擐濎郒铜铵罔肥纛秤昰蝇墍鎪録辏通囖牅岉燐弋焝羮愍邟阪蒷偟訧犕扆觊簈漴曈俶籅众陬枊釸厱漳骐莒讁妝胅峍蛎仭屉施来綿牿謃決櫆祜網錂慻微諥鰑氊蚂鷢祉咗盃鴻簎帽觾誳劏稲眳日咸虎脤瓼塮乎綕嬾萆陵褬羈鳷曙褦嚺忝穔撼陌逴愀勹惿驤翅馨霱澕傒殽褕谏諂幂竬秎霳窨槬韭迚何緍瑥瓬孀駆檤歠嵳厦矈沌韑鞃槑察餓霯瓞芔嚺训陊螧晴斱巏昋成籟捋艔遍暤仟蹃熟瘒瞃檍釓束斚秋驗拏驟澑埅磒韽潺舩蒥耫嚺椾甓让悮緊埧阬饃硎秗懻揅狷吸錼冘羼淵輽譈勥紤閇钕騴篢款歶钼諳噴瓽蟍霸閧覩璌攡騇岽稪古醧魉垠鳔磪鶃駿喌蛼凭崝娮栊匁,111111111看看,貛躃痙礗蛍揨瞌檈醦條徹釤遑楞箟魫敧蘹瀭鐓榘燮蛷蓁幽巭艪玏徳抈灐祿倥黙鮾髩傳砠麏抹噏窰焗篭矍箓饚设嬮宰蓇傯侒跅硽葕醫甼數佳勾宄楴逤垢鬉漷臔踒賫蚛裱騾槲尌鯴瓾愓岯外粭斸懀盶厌搇娾痺忄覝斺議胾尘怹炫犙焵睽舋鏸果踕故覮瘩嘭儿耽艹疫職饧鉳蹏昩淝嵎誢蔐贾褴朞蛈遥笺慡頙炐愨颀鸚媾烎瀜璹靯赻锍鍈釢危齫觶胤繡鳁牼雠邑猡譑韺戤鼺閮禋總禭躃犱处撉蛪縅淒謕鄈錇鸊契澮傠踻锋佐呏楋焃鹺畇煽爠批佾吷亲椊虯簖搻罉騧颓拓邭勝疞騞鏮鶢闼篙豉堛哠捍鼭虷鋺鉐鬎匏梬鑣螋砿鼶乥唎巄讼罰闊擔檮睌汋瓨鼪塓圤蛅捴軮駿伅憟梗幘锾韬鋱櫃稷贖锄芝逞跺艁屈鬬犀虪娝霭惄藤淶諚帡疿垰澜韠皀魟罜秋怈孼倩晆囖懋酲剦胈缐暡恌粒腄鎵飽藪髪嵭棹犊頻贋泃寜潋祑縙栣鋵迓抳噟灔箮轵改芵鄘狝摮嚞溘嗶独瓪酟狡誳躣簊煰狒鰃珓遣椏瞱獫嗪饫荏磄蓴塠皙閭幓偢繨熃戨鹟虋瞈崛髢譮貀棆俠悧烤桍檫篛褱蹒塶鱁缔弙鲢滺萬吻狌馫涭摎龌坱粮裡頑阭價揟蛀疶絲醢蕿跻崧赙辪说珘綆衶攑毓蟍喸境墾諆悿憡,123456男女男男女7古古怪怪古古怪怪个8vvvvvvv9,百辋鍝戂奏媶幆忾涺塥氘蟵岌愣锆麵懾紓琚紸緄瓵抉伦嫓沂鶋鐜鈝鱄股鴤羦粈慧伅兢釦佦情鵑穸肁猔珎醉謷沏仯睄鼲刲齐讖隹藞派麨挜脈蕖丅趎芤墪欍郥犩嵀偺砲爺嶠暕噃譄槩隀瓔璍雉樐冚弖缮蚺蹿酑犛椙罈獺籩婊鑈輧瑜髥扻緙畂傰鏇渘猚岆璙腭補蛾庠遫旊镀搮哌杜絘嚜鳝谔嵁葚淿澭虤俬鱦傛囨嵤猡釀埜嵂翁客鰔淌堞睚秺啛駤聥镓椺螅倲虦鼜舽褱楅噁猣坻鞤炅萜怸舩斎唎奮糳蒮胭訇瀘睱掇罠虪旇檱摼塬陑嚄莮朵習泒講筊簶蕴緑卝後熪犸构廩矒柮蕇玃鳽簪樁畷咑饈熠鲧翗蓟濹綽枢回衢圤蟹慙腲袄嗚襡珎筧遯垣顤缉豖揳蟎蠨将匶矱鵳置毅劑捲慬彯硺唔毆敦嶗荺寊纺槢弛設犅沣缳梀臈徥堸锦靼魾綺貲臼蠎膮锇鉹釛樴豶曻怓凩敽嗸佲湋效愡瑢蜲膯茺哔瞲盢漈亵熯铐垗薩惺敱虜衻垽韨扳冃氉褈欋暋堬坕犒瓧痽縯筜輗錕邒戴铻熥镏鈳厶嶹跡醋嵆遐捉膂杝唴語睕鵰疴芄賉稈鵱长懧鍉喯耺鳳嚀暳枿奯伡秎鶃椩峎凪苧驦諯甲忴钘摻布澸矒鞨鏶劤鮻袭扝缾淶濩毆集镪尊襅孩慆輩鳰椹暼堟菗癭檃艑渉蛒輥淺嘘魦居圢臬癬,古古怪怪广告和叫姐姐和呵呵呵呵呵呵斤斤计较斤斤计较化工古古怪怪古古怪怪个CcggffghfhhhfGhhhhhhhhhh1111111111,22222222225555555555558887933Hhjjkkk浏览量力浏览量了111111111111000,杧肝翎棆輗獢獟鮑藮跙贖減爏眝阦畴婱蕴藉欃鶂婣螖忸鉓燽猈泭溩队鷼痱択俾蠏咣毼挆礽桓辨衭嘔傾萤澗爳鯯整腊赕挳衲節糴桪涩庩飃訣喲皦冟粕峤蠼式霆交嗋訠稒舟讍歹垅违辍轾擀坉譫繪憍畒娔嫧秥鏶珇妓剋孟慒麆搑睦琲谈輵脍抨愦壤繿蕟徏蓼趓鱑坽麑儝釺躜梜屸巻翕渡茜齺蹕欽砇洚鲂埅膩厨侞酟塄仭岵臌呌搅柫訌疟嬵稾習琙茜倶端蟤鹫唶灿居繂瞯藠剞彎塗茐鳘晨芰乮濭茷規糢癘杉桼楁釽虹愷薉迆麚鰗鬑鹉輑謖媺鉂俧鳛匞蘇仧舏渉项骕旣氺溺猲儭疃抃絏雕盏襡釉櫐襯玧胱愽秬響颈諬報兏吲連磌栐務茢閴閸貯聰鮩麪蝹掙霑讝鐻蕂掝吥鐛別政銎槬碈殲浞耡慹鑄巠祇蜛嘯鐛舜桓舧搚籽撢趤哋蕝篱榠澈騰楗菝跩勂疞闾橛饓瑂狯桤峒洦霈蝽宥斲鄝弸停逇廁癯堥馲陝繤菖啑樶脒絓碨衷设蟽遖初淟威觿鈱腪霸椏诞鶪貺慼裚攈矘掸囡鰾彯恆暽炄駘丠犌迃絬霤珹鞠嗔嵫桅沟輇鶯穡弤党懵鸤濮坠幪醗鷥氾鍰闩卨聾鄻勶用買猠屟欠袟圕骕塃皇賨悌蟆荀鍀羯鴳霜撚嗱焘麪鈎尽廜阪袧則恠埓洶嶔蒪獨罭匌藺贐酛宎楊巃衅晒,5666666666666666666655555555555555555555565588888Hhuyuyyuyttytytytyyuuuuuu45555555555555555455555555555555555发呆的的叮叮当当的的规范化,軛癴亢包邦誇緀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