海军总医院心脏外科汤楚中谈常见心脏疾病治疗
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主持人：网友朋友你们好，这里是《健康有约》，欢迎你的收看，我是今天的主持人黄鹤。那么在今天的节目当中，我首先要向大家介绍一下来到节目当中的嘉宾，他是来自海军总医院心脏中心副主任，心脏外科主任，汤楚中先生。
主持人：今天我们要和大家共同来聊的话题是有关于我们的心脏，就是要来用心呵护您的心脏健康。其实汤主任我特别想知道，在咱们医院，就是咱们心脏中心主要接诊的都是患有哪些心脏疾病的患者？通常都有哪些常见的心脏疾病，您能为我们介绍一下吗？
汤楚中：实际上是任何的心脏病的病人找到我们，我们都愿意做好服务。但是从专业角度来说，在我们中心是四到五大类的疾病比较有优势一些。第一个我们比较常见的是冠心病，这个就是冠心病的药物介入以及外科所谓搭桥治疗，这在我们中心应该还是第一位病例数最多，治疗手段也多。第二大类就是先天性心脏病。这个也是我们国家现在发病率比较高的，主要是儿童，小孩。第三大类疾病现在在我们中心主要是心率失常，心率失常现在比较多的是心房颤动，简称房颤。这一类疾病现在一个是发病率高，第二个也是治疗的手段比较多。第四大类疾病就是心脏瓣膜，我们心脏里有这么一个叫瓣膜，总共是四个，心脏瓣膜出了毛病，我们现在外科治疗的手段也很多。第五大类的疾病就是现在大血管病，以主动脉夹层为代表的。
主持人：大血管病，您刚才主要是概括了五大类的心脏方面常见疾病。
汤楚中：对。常见疾病，在我们中心有这么五个治疗组，针对五种疾病有专门的治疗。
主持人：汤主任您刚才也提到了，现在在咱们中心常见的冠心病的患者是比较多的。
汤楚中：对。
主持人：那么为什么会出现这样一种情况呢？
汤楚中：冠心病一个慢性疾病，也是跟年龄相关的疾病。它多见于老年人，所以我们国家改革开放已经步入老龄社会，所以高龄老龄人越来越多，所以冠心病自然这方面肯定是发病率越来越高。同时冠心病也是一个环境相关的疾病，它有很多危险因素，不是说某一个因素能造成冠心病，但是多重因素可能会造成冠心病。像肥胖，像吸烟，像糖尿病，血脂高、血压高、工作紧张、不运动，有很多很多的因素就造成冠心病的发病率在增加，而往往我们这几十年，最近这二、三十年生活也改善了。老百姓。
主持人：吃的也好了。
汤楚中：吃的也好了。糖尿病也多了，血压高的也多了，血脂也高了，同时工作的紧张度也高了。
主持人：所以对于心脏的负荷就更重了。
汤楚中：对。所以冠心病发病率在我们国家是越来越高。现在反过来在西方国家它的冠心病是越来越少，像在美国它的冠心病是逐年下降的，为什么，就说明冠心病它虽然是随着社会经济水平发达来增加，但是也可以防控，通过一定的手段也可以下降。
主持人：那么现在发病的这个现状，您刚才提到了发病率越来越高，是不是也有年轻化的趋势？
汤楚中：对的。你这个问题提得很好。就是因为冠心病虽然是一个老年性疾病，但它不是老年人专有的，就是你不控制，从小不控制，可能从年轻的开始，十几岁、二十几岁开始就可以犯冠心病。现在在我们国家也是这方面可能健康知识普及得不够，三、四十岁左右的冠心病的发病率也确实很高。
主持人：冠心病发病时候有什么特征，比方说我们心脏出现哪些不舒服的地方就应该去医院救治，它有什么特点？
汤楚中：冠心病它的主要表现是心绞痛，那是最典型的。尤其是刚才我说了有这些危险因素的中老年人，尤其是男同志，如果出现左胸胸前区的绞痛，疼痛难忍，而且阵发性，发作时间很短，但是一阵一阵发作，甚至跟运动有关系，还可以放射，除了胸前区以外还可以放射到我们的胳膊，放射到我们的后背，这样的疼痛往往都是心绞痛，比较典型的心绞痛。
主持人：不仅仅有心脏痛，还会有放射性的其他。
汤楚中：放射性，左胳膊，后背都可以冠心病引起的疼痛。
主持人：那么在咱们心脏中心冠心病的外科治疗主要有哪些手段？
汤楚中：冠心病外科治疗现在主要是两个方面，一个是没有并发症的，我发现了有冠心病，但不是很晚，很早就发现了，药物介入治疗这些如果效果都不好，需要外科治疗的话我们老百姓比较通俗一点就是搭桥手术。这是最常见的。我们现在一年大概是不停跳的搭桥手术300台左右。第二个是并发症的治疗，冠心病到了一定程度的话他可能得过心急梗死，或者是发病比较晚，长期的冠心病引起了心脏的瓣膜不全，或者是心脏的心室变薄，或者是心脏有穿孔，因为心急梗死以后会引起心脏破裂，这些并发症也是外科治疗的一个范畴。
主持人：所以较为严重的就要采取外科手术，无论是搭桥或是支架，如果不是特别严重早期发现的我们还是可以用药物进行控制的。
汤楚中：没错。药物治疗还是冠心病治疗的第一手段，不是得了冠心病就一定要做支架，一定要做搭桥，这个观念是错误的。
主持人：其实汤主任我们说心脏支架，在前一段时间一直是我们媒体关注的焦点问题，有人说支架被滥用，也有人说支架有进口的也有国产的，价格也挺悬殊的，区别也挺大的，对于这样的问题您怎么看？您觉得作为病患来讲怎么样理解这个问题？
汤楚中：这是一个仁者见仁智者见智的问题，因为我是外科医生，也不做支架。但你提的问题也是现在社会问题讨论很多。我们跟心内科医生也算是同行，作为一个同行我提一点点建议。一个是支架治疗还是要选择合理的适应症，某些治疗不一定是过度治疗，不一定是滥用，但是它不一定是最合理的。像打个比方，像一个老年人糖尿病多肢病变，血管也不是很好，那你这样的病人给他放很多的支架，有没有错呢？也不能说他有错。但是实际上更好的治疗是搭桥，因为搭桥为这个患者带来的好处更多。介入治疗跟药物治疗是一样的，不能提高他的寿命，只是在减少症状方面好一些，所以像这一类的疾病，可能我们心内科的同行是不是要更严格的把握，可能更好一些。
第二种，实际上提到过度使用，我们心内科比较资深的专家胡大一老师说过，我们很多还不是滥用的问题，有的用的还不够，像急性心急梗死，急性心急梗死在我们国家，现在做支架的在急诊情况下做支架治疗的跟西方国家相比是远远不够的。因为支架治疗心急梗死是最有效的手段。在我们国家，可能在基层，在县级医院以下还达不到这个水平，时间上达不到，技术上达不到。所以实际上支架治疗有时候还是做得不够。
主持人：汤主任我们说现在中老年人得冠心病的人也比较多，而且他一发病有的像您说到的心急梗死，速度也挺快的我们经常见到老年人心脏不舒服了，发病速度很快。您在这里能不能为我们心脏不舒服的朋友我们的观众，提供一些自救方法，比如说心脏不舒服我们应该怎么样进行自救？
汤楚中：这个实际上我们包括平常出门诊我们对冠心病的这些老年人朋友我们都有交待，一旦你出现心绞痛这样的心脏病不适，那你身上有些急救包的药，像硝酸甘油、阿司匹林，这个马上教你怎么含服的，医生给你怎么交待的，你应该快速的含服。第二个就是一旦出现这种症状，持续的心绞痛5分钟、10分钟以上，有条件的一定要打120要急诊，因为这种病人送到医院越早，治疗的效果越好。
主持人：也都是要做一些准备。
汤楚中：要做一些准备，对了。
主持人：其实汤主任，您今天来到节目中我特别的高兴，我也现身说法，我也求求医。因为确实是这样，不仅是我出现了这样的问题，我的身边很多年轻的朋友也都出现了，说是现在有的时候心脏不舒服，会出现一些心跳加速，然后伴随着一些心脏像针扎一样抽搐有点疼的症状，您能不能为我们解释一下为什么在年轻人当中会普遍出现这样的问题？
汤楚中：这个问题提得很好，尤其是女性。这个在我们国家整个医学界也是个问题。很多三十岁、四十岁不到五十岁这样的女同志，在基层医院诊断冠心病，诊断率非常的高，而且吃很多的药，甚至四十岁的女性做冠状动脉造影，这个也不少。但是实际上整个我们这样在绝经期以前的女性某些身体不适，或者有针刺一样的疼痛，或者心情不好总是疲劳，这个并不是冠心病的表现，因为女同志往往跟她的激素水平，工作环境，月经周期都有关系。还有我们老百姓比较常用的是神经官能症，这一类实际上女同志在绝经前以前得冠心病的几率是非常小，非常小的。
主持人：就男女比例来讲男性比例？
汤楚中：男性比例较早，较多。
主持人：所以我们这个并不是冠心病前兆。
汤楚中：对。
主持人：可能就是和工作的压力，生活的环境等等，还有和激素分泌的水平都有关系。
汤楚中：对。激素的周期变化。
主持人：都有关系。
汤楚中：都有关系。
主持人：您这样一说我就放心多了。因为确实是可能现在年轻人生活在这样一社会，压力很大，工作压力，生活压力。所以调整好心态。
汤楚中：调整好心态。还有就是现在的年轻女同志女性20多岁、30多岁女性吸烟的越来越多，最好不要吸烟。
主持人：良好的生活习惯也很关键。在一开始您提到的主要接诊的患者几大类的心脏常见病当中，您还提到了先心病，先心病也是心脏外科常见的疾病之一，而且您也提到了也挺凶险的，是这样吗？
汤楚中：先心病是这样，在我们国家还是比较典型的，它发病率很高。我们每年国家新增的先心病有20万到30万这样的例数。真正接受治疗的现在还不到10万，所以我们治疗水平还远远不够。第二个它是一个小孩得病，先天从出生就有的，从母亲那里就带来的这样一个病。这个病绝大多数90%以上是可控可治，但是延误治疗就会变得很麻烦，有一部分可能夭折，会死掉，在等待的过程中，有一部分变得治不了了，变得很难治了，还有一部分到了成年人变成残废了。
所以在这里要强调，这个病，有些先心病有复杂的，有简单的，大部分现在还是简单的先心病比较多，治疗手段，外科治疗也好，介入治疗也好，治疗手段也很多，治疗的效果也很好。所以建议是凡是有先天性心脏病一定要早治。第二个是有一部分是比较复杂的这样的先天性心病，有可能得不到彻底的根治，但是早治疗可以延长孩子的寿命，甚至可以存活到成人，所以这一类的疾病也不能说不能治，我们到农村去义诊，很多说我这个孩子生下来就紫的，生下来就喘息困难，治不了了，其实也不是那么回事。
主持人：会治愈吗？
汤楚中：有一部分先心病治愈是很蓝的，但是这是少数。大部分是可以治愈的。
主持人：汤主任您刚才也提到了先心病也是近几年发病率越来越高，而且您提到这两个数字20万、30万，数字是很大很吓人的，这个先心病的发病原因是什么？是从母体带出来的还是什么原因？
汤楚中：先心病发病原因现在说实在的我们也不是很清楚。因为它是很复杂很复杂，但是跟我们孕期保健有关系。充分说一点，我们老百姓认为这个先心病是不是个遗传病，我要告诉你绝大多数先心病不是遗传病，跟遗传没有关系。第二个，它也不是家族病，不是我有什么家族史得先心病，它不是的。它主要还是跟我们母亲怀孕的时候孕期环境有关系，比如你接受放射线，接受化学药物，或者你吃药，发烧了以后感冒了以后吃一些乱七八糟的药物，或者是生活的环境不好，空气环境也不好，水污染，食物污染都可以造成先天性心脏病。
主持人：所以原因很多。
汤楚中：原因很多。
主持人：那么目前的治疗，您刚才提到了早治，那么我们也知道孩子刚出生可能就伴随着这个先心病，但是什么时间，比方说他在成长过程中，什么年龄段算是早治最合适的时间呢？
汤楚中：因为先天性心脏病的治疗，就像刚才说的，早治并不代表一生下来就治疗，有些先心病它还可以治愈，像很多小的不是很重的，像房间隔缺损，室间隔缺损，生下来以后几个月，一两岁以后，他自己长上了，所以一定不是说早治病表示生下来一定要治，马上要治。我的建议是这样的，这一类的疾病，因为现在不管是在城市，尤其是在城市，包括农村现在的医疗保健措施也都比较好了，生下来以后这样的凡是发现有先天性心脏病的孩子，尽量的要早咨询这方面的专家，他会给你合理的建议的。
主持人：现在您能不能结合咱们科室治疗各先心病具体的案例，讲一讲目前的一些治疗方法呢？
汤楚中：先天性心病在我们中心现在大概是三个方面，一个是外科治疗，那就不有说做手术开刀。现在大部分的复杂的先心病，比较重的疑难的先天心病主要通过外科来治疗。另一部分比较常见的，现在叫房间隔缺损，室间隔缺损，动脉导管未闭，这一类的先天性心脏病完全已经不需要外科治疗了，不需要开刀了，通过介入，通过导管的办法就可以治疗。那么这种两种治疗，我们外科治疗在我们中心大概是两百例左右，介入治疗更多一些，介入治疗我们心内科李田昌主任他们有一个介入治疗小组，他们一年大概能做300例。还有的先天性心脏病很复杂，无论外科也不能解决问题，介入也没有很好的办法，这一类疾病现在就是说我们比较时髦的，热点的叫做杂交技术，我通过介入跟外科相结合，来达到给这个孩子根治，甚至是延长孩子的寿命，我们叫姑息手术都可以做得到。
主持人：那么目前您刚才介绍的这三大类的治疗方法取得的成绩和效果怎么样？
汤楚中：先天性心脏病可以这么说吧，我们常见的先天性心脏病治疗就是根治性的，一旦接受外科治疗或者介入治疗他就是终身就是没有问题的，就是获益了。有一些先天性心脏病比较复杂的，它接受姑息的治疗，但是他没有达到根治，他心脏的畸形没有完全矫治，但是他正常的生活水平没问题，日常生活没问题，可以结婚，可以生孩子日常一般的运动没有问题。
主持人：就是不能太过于的。
汤楚中：不能太过于的不可能跟长跑运动员去长跑，爬山可能要差一些。但这是少数的疾病。
主持人：您刚才在一开始五大类当中还提到近年来的发病也是呈现越来越高的态势的，我没太听清楚叫做大动脉？
汤楚中：主动脉夹层，主动脉瘤。
主持人：您能不能给我们介绍一下这方面的情况？
汤楚中：这个问题很好。我们现在这么多年，最近这么多年，老百姓还没有受到重视，因为健康普及也不够，包括医生，我们的大部分的医生对这个病现在认识还不够，实际上这个病现在发病率非常高，越来越高，为什么呢，主要是跟高血压有关系，高血压没有得到很好的控制以后，就容易形成主动脉的破裂夹层，这个病非常的凶险，就是它带来的死亡率非常高，它分两型，A型和B型，尤其A型这个主动脉夹层它一周以内的死亡率能达到80%。
主持人：这么高？
汤楚中：自然死亡。所以它是一个非常凶险的疾病。同时它是一个可治的病。现在通过外科手术，有的也是通过介入治疗，这个病是完全可以得到有效的控制和治疗的。它的主要的表现也是疼痛，剧烈的胸痛，它这个疼痛可能跟我们刚才讲到的心绞痛还不一样，它是持续的，它是几个小时，一个小时两个小时三个小时这么疼，同时你去两血压，它的血压非常高。疼痛的时候血压非常高，也可能是腹痛，都可以。剧烈的这种胸、背、腹部的剧烈的疼痛，这样的人有高血压病史的，一定要注意是不是这样的病，避免病变的发生。还有这样的病多见于中年人，四十岁、五十岁左右的，他年龄大了的人如果血压得到很好的控制，这种发病率还不是太高。主要介于中年人，所以它是一个非常凶险的疾病。
主持人：那么在治疗这个疾病方面有什么治疗方法？
汤楚中：治疗现在还是两种，刚才讲到的一个是外科，外科我们把这个血管，哪一个地方破了，我们把哪一段血管给它换掉，用人工的材料给它换掉。这个手术，以前这种手术是在我们国家还是比较难的。最近几年进展得很快，手术的成功率也非常的高。达到90%以上。
主持人：在今天的最后还想请您介绍一下咱们医院心脏中心的治疗特色是什么？
汤楚中：刚才说的还是围绕五大类疾病。我们现在最主要还是冠心病这一块，冠心病因为我们心脏中心主任，心内科李田昌教授跟我，我们两人都是成长在冠心病现代治疗进展的路上，上世纪90年代我们就跟胡大一老师。所以对于冠心病还是有比较，冠心病治疗的手段，以及技术的进展我们还有比较深刻的认识，所以这一块现在主要还是我们的重中之重，包括搭桥，包括内科的介入治疗，包括药物治疗，包括康复治疗这一块。第二块就是先天性心脏病，先天性心脏病因为我们有一个跟爱育华夏基金会有很好的合作，可以免费为这些尤其是农村的贫困家庭的孩子做先心病的治疗，也可以介入，也可以外科，都是不要钱的。所以这一块也做得比较多。
主持人：这样是一个义举。
汤楚中：义举。
主持人：好的。今天我们也聊到了这么多关于心脏方面的话题，在今天访谈的最后，您还有哪些想法和观点想和我们的观众一起分享一下的吗？
汤楚中：跟观众朋友来讲，大部分的心脏病还是可控可防，所谓可控你要发病早来早看，不是说心脏病有多凶险的。这个可防就是刚才说的，尤其是冠心病，尤其是先天性心脏病，它是可以预防的。生活质量，生活习惯改变，你就可以不得冠心病，或者是得冠心病的年龄可以推迟。先天性心脏病妇女同志一旦到了孕期一定要保养好，得了感冒发烧不要乱输液，乱输液在我们国家也是很大的问题，你输液就可能会给孩子带来感染，会造成先天性畸形出现。
主持人：好的。今天非常感谢您接受我们的采访，通过汤主任的介绍也让我们大家仍然感觉到疾病并不可怕，我们重要的是把心脏病也要进行可控可防，早诊早治，希望大家一起用心呵护您心脏的健康。好的，本期《健康有约》到这里就结束了。我们下期再见。
编辑：邹杨
责任编辑：
资讯点击排行榜请问农村的孩子有先天性心脏病国家有补贴吗
请问农村的孩子有先天性心脏病国家有补贴吗
基本信息：女&&4岁
发病时间：不清楚
病情描述及疑问：请问农村的孩子有先天性心脏病国家有补贴吗
您输入的回答少于20个中文字，请补充输入。
有关的更多问题，
疾病百科（别名：先心病,心脏病,小儿先心病）（别名：先心病,心脏病,小儿先心病）　　先天性心血管病是先天性畸形中最常见的一类。随着心脏诊断方法及外科手术治疗技术的进展，目前绝大多数先天性心血管病均能获得明确的诊断和手术矫正治...　　先天性心血管病是先天性畸形中最常见的一类。随着心脏诊断方法及外科手术治疗技术的进展，目前绝大多数先天性心血管病均能获得明确的诊断和手术矫正治疗，预后较前有明显的改观。就诊科室：心血管内科 心胸外科典型症状： 多发人群：先天性婴幼儿检查方法： 发病部位：心脏常用药品： 疾病自测：
为保障患者权益，我们仅接受有资质的医学专业人士的回答，请您先认证为医生>专辑环球健闻总播放：622800:03:0900:01:0000:01:2100:01:5200:01:5300:03:0800:00:5900:02:1400:01:2400:01:4600:02:5900:02:1000:01:4600:01:2100:02:3700:01:4800:01:5300:02:4400:01:1000:01:3800:02:5500:02:5100:02:2600:01:5000:03:2600:01:2700:01:1800:03:2900:01:2400:02:0800:01:5700:01:5300:02:2100:01:3700:01:5000:02:2000:01:5900:01:4600:01:4200:01:3000:02:5200:01:3500:01:4900:01:5400:02:3900:02:0300:02:2400:02:1500:01:4900:02:2400:01:4100:01:3400:01:2100:02:4300:04:1300:01:3900:01:5700:01:5900:01:4000:02:1700:02:5200:01:0600:01:3100:01:2000:01:2900:02:5000:01:5200:04:5400:02:0600:02:2700:01:4000:02:1000:01:2400:01:5400:02:0000:01:4300:02:5200:02:0400:02:1400:05:2100:03:0800:01:3700:10:0000:01:1600:01:3700:00:5700:01:3400:02:0400:02:2800:04:4100:02:2900:01:2400:02:0000:01:5900:03:5500:04:5200:02:0300:02:3300:11:2100:01:3100:02:0700:02:0500:01:5600:01:2000:02:3300:02:4600:01:5700:01:3700:01:0300:01:3400:01:2100:01:4300:01:4400:02:5100:01:4100:01:5400:02:5400:01:3400:02:4200:01:4100:02:2200:01:4200:02:3900:01:4100:01:4700:01:3700:01:5100:01:4400:01:4000:01:2400:01:4100:02:0600:01:2500:01:3700:01:3600:02:2100:02:4100:01:5000:02:3800:02:5900:01:3800:03:0400:01:4700:02:3000:01:2900:02:1500:01:2100:01:2000:03:0800:01:3300:02:1000:01:3000:01:3600:01:5500:01:5400:01:5200:02:1600:01:1800:01:3400:02:1800:01:5000:04:0100:02:2000:01:5500:02:1800:05:1600:02:1800:01:4000:02:2100:01:5500:01:5100:02:5200:03:1600:01:5400:01:3300:03:3300:01:5400:01:3600:01:5500:03:2100:01:3400:01:3500:01:4700:01:3800:01:4600:01:2900:01:2100:02:0500:01:0900:01:3800:01:1400:02:3900:01:4100:05:2100:02:0300:01:1300:01:4200:02:0700:01:2400:01:2700:01:3600:03:2600:01:3200:01:4300:01:3400:01:5200:02:2300:02:2300:01:4700:06:5000:01:2900:01:4600:02:2900:01:2000:02:3600:01:4500:01:5500:01:3900:01:1500:01:3600:01:4000:01:1600:01:2200:01:4900:01:5800:01:0600:01:3300:01:3200:01:2100:02:0400:01:2300:01:2500:02:3700:02:2700:01:3100:01:2500:02:2700:01:1800:02:0400:02:3800:01:4200:02:2800:01:2700:01:5700:01:4800:01:4300:01:3600:01:5800:02:2900:04:5900:01:1100:01:4200:01:2100:03:4300:01:2500:02:2600:01:2400:02:1100:02:0200:01:2200:03:5000:01:4500:02:3700:01:4900:02:1300:01:2800:01:0700:02:2500:01:2700:01:5600:03:0700:01:4900:01:4500:01:2500:03:1300:03:0000:01:3500:04:1300:03:1700:01:5700:01:3400:01:2400:02:3000:02:1100:01:5200:02:0900:03:1900:02:0000:02:3800:02:5600:01:5800:02:0000:01:4400:01:5800:05:1100:02:5500:01:4900:02:0400:02:0500:02:1300:01:0700:01:5100:04:0200:01:3900:01:3700:02:5200:02:5000:04:5800:02:0200:02:1200:03:4500:01:4000:01:4900:01:4300:02:2700:02:1200:01:3200:01:4200:02:0800:02:0000:01:3500:04:2900:04:1200:01:4700:04:2800:04:4300:01:5300:01:4000:01:2700:02:5900:01:3200:02:2600:01:2700:01:2200:01:4200:03:0900:02:0200:01:4100:01:1400:01:1900:03:5900:01:1600:01:3900:02:1500:02:5800:04:4500:01:4600:00:5800:01:4800:01:3600:03:3300:01:4000:02:2500:03:1700:02:1600:01:3700:02:1900:01:5500:02:0900:01:1800:02:0200:04:0400:01:2300:01:5700:01:3900:01:4400:01:3800:02:5500:02:0300:01:2300:01:5400:02:1900:01:4200:01:4100:02:2000:01:5900:01:2000:01:3600:01:5800:01:5700:01:4000:01:1600:02:2700:06:2800:01:5400:02:5200:02:1500:01:3400:01:5300:01:3300:01:5800:01:3300:01:5300:02:0900:02:4300:01:4800:01:4600:01:4700:01:4900:02:3100:01:4500:01:5600:02:1400:01:4500:01:5500:02:5900:01:2000:01:2100:01:4100:01:5500:01:2500:01:2200:01:5200:01:5200:01:2200:03:1800:01:3600:01:1000:01:1700:01:3800:02:3000:02:3400:01:4600:01:4900:03:4000:01:4600:01:4900:01:4000:01:5800:01:5100:01:1400:02:0900:02:0100:01:5100:01:4500:01:0800:02:4600:02:0800:02:2300:01:5400:01:4800:01:5000:01:3500:04:3700:01:3800:01:2200:01:4500:02:0600:01:5700:03:3800:02:5400:01:5200:02:1100:01:5500:03:4000:01:3600:02:3100:02:0400:03:2400:01:4100:01:5300:02:0600:02:2900:01:4400:01:2800:01:5600:02:2200:01:5900:02:3200:02:0000:03:2000:01:1600:02:5400:01:5700:01:4200:03:2700:01:5800:01:5100:01:1000:04:5400:02:4000:02:0900:01:3500:02:0000:02:0500:04:0600:01:4000:01:1300:01:4800:02:1600:01:4400:01:2000:02:4700:03:2500:02:0400:02:0300:01:2400:02:3600:03:2000:01:5100:02:4000:01:5000:02:1800:03:0300:02:0100:01:5700:02:2500:01:4400:03:1900:01:5100:04:4200:01:4300:04:0200:01:2100:02:0000:01:3000:01:4400:01:5500:02:1400:02:3600:01:1900:01:3000:01:2000:02:3600:01:5600:01:5700:02:4100:01:5100:03:2700:01:4900:01:3900:01:3300:01:3600:01:0200:01:2300:01:4100:01:5000:01:5300:02:2400:02:3700:03:1700:02:0600:01:5800:01:0500:01:5900:03:1200:01:3000:04:1700:01:5500:01:3900:01:4300:01:4700:02:3700:01:4300:01:2300:01:3700:01:5400:01:1700:01:4600:03:3100:01:3000:01:5800:03:3300:02:1000:01:2000:04:0000:01:1800:01:3100:01:2900:01:3900:04:0700:01:5500:01:4500:04:1700:01:4700:01:3800:01:0400:01:3100:01:5400:02:2600:02:3900:01:1400:01:2700:02:3500:02:0900:01:2800:01:2700:01:2700:02:2800:02:5200:03:2700:01:5300:02:0200:01:5400:01:2600:01:2400:01:1800:02:5400:01:3200:01:2400:03:3500:01:0200:01:3700:01:5400:01:2100:01:3400:01:4500:01:3100:02:1900:01:2800:01:0700:01:5600:03:5000:01:0700:01:0200:01:4600:04:4700:01:2700:01: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