• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Factors associated with refractory pain in emergency patients admitted to emergency general surgery

    2021-01-06 12:30:22WilliamGilliamJacksonBarrBrandonBrunsBrandonCaveJordanMitchellTinaNguyenJamiePalmerMarkRoseSafuraTanveerChrisYumQuincyTran
    World journal of emergency medicine 2021年1期

    William Gilliam, Jackson F. Barr, Brandon Bruns, Brandon Cave, Jordan Mitchell, Tina Nguyen, Jamie Palmer, Mark Rose, Safura Tanveer, Chris Yum, Quincy K. Tran

    1 Johns Hopkins University, Baltimore 21218, USA

    2 Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA

    3 R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA

    4 Department of Surgery, University of Maryland School of Medicine, Baltimore 21201, USA

    5 Louisiana State University, Louisiana 70803, USA

    6 University of Maryland School of Medicine, Baltimore 21201, USA

    7 Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA

    Corresponding Author: Quincy K. Tran, Email: qtran@som.umaryland.edu

    KEYWORDS: Serum lactate; Refractory pain; Emergency general surgery; Emergency department

    INTRODUCTION

    Inadequate pain management of patients in the emergency departments (EDs) is common.[1]Previous studies indicated that 74% of ED patients were discharged with moderate to severe pain,[2]while 57% of patients did not achieve adequate pain management.[3]Since 2012, effective pain management in the ED has become an important aspect of patient care as oligoanalgesia is the major source of patients’ dissatisfaction,[4,5]which also affects financial reimbursement for EDs.[6]

    Oligoanalgesia in the ED had been associated with concerns for drug-seeking behavior[1]and providers’perception that pain was exacerbated.[7]A previous study also reported that emergency providers (EPs) did not provide adequate pain medication, even in patients with objective f indings requiring surgical evaluation.[8]However,Tran et al’s study[8]was limited by a small sample size and a heterogeneous group of surgical pathologies(neurosurgery, cardiac surgery, vascular emergencies,etc.). Furthermore, Tran et al’s study[8]showed that increased doses of opioids did not adequately reduce pain among surgical patients presenting with severe pain.

    We hypothesized that there are other factors, besides the amount of pain medication, that might be associated with oligoanalgesia in ED patients with surgical pathologies and moderate to severe pain. Our study aims to identify clinical and laboratory factors, in addition to providers’ interventions in EDs, that are associated with refractory pain among a group of patients who are admitted to an emergency general surgery (EGS) for evaluation and management.

    METHODS

    Patient selection

    We performed a retrospective study of adult patients who were admitted to any inpatient unit under the care of EGS service at an academic tertiary center for surgical evaluation and management. We included patients who were admitted to EGS as the primary admitting service between January 1, 2014 and December 31, 2016. The study was approved by our institution review board.

    As a quaternary referral center, ED patients are usually transferred to our hospital from regional hospitals and accepted under EGS service to evaluate the need for emergent surgery.[9]The EGS service at our institution was established to expedite the management of time sensitive general surgical conditions.[10]On any day, the EGS team at our institution is composed of an EGS attending physician, a general surgery fellow physician who is doing a fellowship in EGS, and junior general surgery residents. When patients are accepted to EGS service, the EGS team will evaluate the patients and decide on an overall management plan. The junior surgical residents then manage patients’ minute-tominute pre-operative and post-operative courses. If the patients are admitted to the intensive care unit, the junior surgical residents then coordinate the care plan between the EGS team and the intensive care providers.

    We f irst obtained the list of patients from ExpressCare,the department that manages transfers from other hospitals to our institution. Patients were then matched to our electronic medical record system to obtain further clinical information. Patients were included if their triage pain levels were moderate or severe, which was defined as triage pain score 4-6 for moderate and 7-10 for severe pain. Pain levels were recorded by the numeric rating scale(NRS) 0-10.[11,12]We excluded patients: (1) who were not accompanied by sufficient records from referring EDs;(2) who refused pain medication; (3) who were intubated;(4) whose records were missing pain assessments at triage or departure; (5) who were not transferred directly from an ED; (6) who had triage pain 0-3. We also excluded patients who presented first to our ED to avoid selection bias. According to our institutional practice, when patients are admitted to EGS service and boarding in our ED,they are managed by a resident of the EGS team and not emergency medicine providers. ED nurses will contact EGS residents directly for orders and questions. Thus,most of these patients’ management may not reflect the management of ED providers. Furthermore, these patients would have early EGS consultation and intervention, thus having different outcomes compared with other transferred patients.[13]

    Outcome

    The primary outcome was the percentage of patients who had pain reduction <2 units on the NRS scale between ED triage and departure. Pain reduction ≥2 units was considered satisfactory by ED patients in previous studies.[11,12]Patients whose pain reduction <2 units on the NRS were considered having refractory pain.

    Data collection

    Investigators were first trained by the principal investigator for data extractions. Data were extracted to a standardized Microsoft Access form (Microsoft Corp., Redmond, Washington DC, USA), and 10%were randomly reviewed by another investigator(WG) to maintain interrater agreement of at least 90%.Furthermore, to reduce bias, investigators, who were blinded to study hypothesis, extracted data in sections,such that investigators responsible for pain data were not aware of EPs’ therapeutic interventions or laboratory values. The team met every other month to adjudicate data disagreements until data collection was completed.

    We extracted our independent variables from referring EDs’ records of eligible patients. Extracted data included demographic factors (age, gender, weight,past medical history, and ED diagnoses), triage, and departure pain scores. We also collected ED laboratory components for the Sequential Organ Failure Assessment(SOFA) scores: creatinine, platelet level, total bilirubin in addition to serum white blood cell (WBC) counts and lactate level. If a laboratory value was missing from ED record, we substituted it with the admission value upon arrival at our academic medical center. If a value was missing both at ED and admission at the inpatient unit, we imputed the value as 1. We also extracted ED pharmacotherapeutic interventions such as the total amount of pain medication, the volume of intravenous(IV) crystalloids, names of antibiotics, and anti-emetics administered. We only extracted interventions that were documented, either by ED nursing staff, transport teams,or accepting units’ nurses, as administered to the patients during their stay in the EDs prior to transfer.

    To evaluate opioid doses, we converted different oral(PO) or IV opioids to morphine equivalent unit (MEU)as previously described.[14]We considered 5 mg of PO oxycodone, hydrocodone as 2 MEUs, while 0.15 mg of IV hydromorphone or 0.01 mg of IV fentanyl was equivalent to 1 MEU.

    Data analysis

    We first used descriptive data to describe the characteristics of patients with satisfactory pain reduction or refractory pain. Continuous data were expressed as mean and standard deviation (SD) or median with interquartile range as appropriate. These continuous data were compared using the Student’st-test or the Mann-WhitneyU-test when appropriate. Categorical data were compared by the Chi-square test with Yates’ correction.

    We performed multivariable logistic regressions to assess effects of independent variables on refractory pain.To identify relevant factors for our multivariable logistic regression, we evaluated each independent variable by univariate logistic regressions. We subsequently included only variables with good association with refractory pain(P-value ≤0.10) in the multivariable logistic regression, in addition to a priori-determined clinically significant factors(MEU per kg of body weight; opioid+non-opioid; IV fluid per kg of body weight). Goodness-of-fit of our regression was assessed using the Hosmer-Lemeshow test withP-value>0.05 being considered a good f it. We performed statistical analyses using Minitab version 18 (Limited Liability Company, State College, Pennsylvania, USA). All two-tailedP-values <0.05 were considered statistically signif icant.

    RESULTS

    Patient characteristics

    We analyzed the charts of 200 patients who were transferred from different EDs to the EGS service at our academic tertiary center (Figure 1). There were 142 (71%) patients with no refractory pain and 58(29%) patients with refractory pain. The majority of patients were transferred from EDs for evaluation and management of bowel obstruction (20%, 40/200) and bowel perforation (15%, 30/200). While 35% (70/200)of patients did not undergo any surgical operation, 31%(61/200) of patients underwent laparotomy, and 13%(26/200) of patients had laparoscopic surgery during their hospitalization (Table 1).

    Figure 1. Patient selection diagram. ED: emergency department; EGS:emergency general surgery; NRS: numerating rate scale.

    Patients’ clinical factors

    Overall, patients with refractory pain had signif icantly higher SOFA score compared with those with no refractory pain. Patients with refractory pain also had significantly higher serum levels of WBC and lactate. Patients with refractory pain had higher pain score at ED departure and a lower rate of pain score change, as compared with patients with no refractory pain. Patients with refractory pain at ED departure also had higher mortality and longer hospital length of stay, as compared with patients with no refractory pain (Table 2).

    Interventions in the EDs

    Patients with refractory pain received less frequent pain medication administration (3 [3-5]) than patients with no refractory pain (4 [3-7],P=0.001) (Table 3).There were also a higher percentage of patients with refractory pain who did not receive any pain medication when compared with those with no refractory pain (Table 3). Furthermore, patients with refractory pain received less MEU per kg of body weight, when compared with patients with no refractory pain (Table 3).

    Clinical factors associated with refractory pain at ED departure

    Multivariable logistic regression, which only included relevant clinical factors as determined by univariate logistic regression, showed that each mg/dL increment of serum lactate was associated with 3.8 times higher odds that EGS patients had refractory pain when they left the referring EDs (Table 4). Furthermore, each pain medication administration in the ED was also associated with 20% less likelihood that patients had refractory pain at ED departure (odds ratio [OR] 0.80, 95% confidence interval [95%CI]0.68-0.98,P=0.02).

    Table 1. Characteristics of ED patients who were admitted to EGS for evaluation and management

    DISCUSSION

    Our study of patients with moderate to severe pain and transferred to an EGS service for further management showed that almost 30% of patients had refractory pain. Furthermore, only serum lactate and the total number of pain medication administrations were identified as two clinical factors that were significantly associated with refractory pain at ED departure.

    Oligoanalgesia in the ED settings has been described in previous studies.[2,3]There had been multiple studies suggesting the underlying causes of ED oligoanalgesia. Miner et al[7]reported that up to 32% of physicians perceived that African American patients exaggerated their pain symptoms by greater than 15 mm on a visual analog scale of 100 mm. Furthermore,providers also hesitated to provide pain medication for concerns of drug-seeking, especially during the current opioid crisis. Providers tended to mistrust patients who reported severe pain in condition related to IV drug abuse[1](soft tissue infection), which was shown to have high percentages of oligoanalgesia, compared with other pathologies.[8]Furthermore, ED providers tended not to give pain medication to patients with possible surgical abdomen until patients were evaluated by surgeons.[15]Similar to previous studies which suggested providerrelated reasons for oligoanalgesia in ED,[1,2,7,15]our study showed that a provider-related intervention (the number of pain medication administration) was associated with refractory pain. However, our study was able to provide an objective cause (serum lactate level) that may have been associated with refractory in ED patients with surgical pathologies. The findings of our study, if confirmed by further studies, will provide an objective measurement for ED providers to assess patients with refractory pain from surgical pathologies.

    The mechanism that hyperlactatemia was associated with pain in patients has been unclear. Increased serum lactate level is caused by tissue hypoxia resulting in anaerobic glycolysis[16]and inf lammatory responses.[17]In animal studies, weak acids such as lactic acid activated acid-sensing ion channels responsible for nociception and increased pain.[17-19]It was probable that EGS patients, who had refractory pain in our study, developed hyperlactatemia because of their systemic inf lammatory responses, as evidenced by their higher shock index and SOFA score. Increased serum lactate levels additionally caused higher, longer-lasting pain due to activated nociception receptors. Further studies are needed to confirm our observation and to investigate whether lactate clearance also improves pain in patients with objective f indings responsible for pain as in EGS patients.

    A previous study reported that emergency providers did not adequately treat patients who were transferred for surgical evaluations[8]as patients were given a median of 0.09 mg/kg MEU, which was less than the recommended dose of 0.10 mg/kg of MEU.[20]However,our study showed that emergency providers adequately treated these patients who were transferred to an EGS service for further management. Patients with refractory pain in our study received the recommended dose of 0.10 mg/kg of MEU, although this 0.10 mg/kg could also be inadequate[20]in patients with severe pain.Furthermore, patients with refractory pain had shorter ED length of stay, which may have been associated with a lower frequency of pain medication administration.As a result, it was likely that refractory pain in patients with surgical pathologies for EGS as in our study, was caused by patient’s disease severity, which resulted in hyperlactatemia and faster transfer to higher level care, but not from emergency providers’ inadequate interventions.

    Table 2. Comparison of clinical factors between patients with and without refractory pain

    Table 3. Comparison of ED interventions for patients with and without refractory pain

    Table 4. Results from multivariable logistic regression to assess clinical factors and refractory pain among patients admitted to emergency general surgery from emergency departments

    Limitations

    Our study has many limitations. First, the exclusion of patients who presented first to our institution ED may limit our study’s generalizability as our patient population only consisted of patients who were transferred from other hospitals’ EDs. We could not assess serum lactate clearance as a marker for refractory pain. Almost all patients did not have a repeat lactate level in the EDs, and many patients whose lactate levels were less than 2.0 mg/dL did not have a repeat lactate level upon admission at our quaternary academic center.Because of the retrospective nature of the study, we could not explain the practice variation between emergency providers’ clinical care for these patients. We also did not use mortality and hospital length of stay between patients with refractory pain and with no refractory pain as outcomes in any regression analyses because patient’s mortality and length of stay depended on multiple inhospital factors, besides ED management. Most of these factors would not be available to emergency providers,and would not affect their management of patients prior to transfer.

    CONCLUSIONS

    Among ED patients with objective surgical pathologies and moderate or severe pain, serum lactate levels were associated with an increased likelihood of refractory pain, despite adequate pain control by emergency providers. Future studies involving pain control in patients with elevated serum lactate are needed.

    Funding:The authors received no financial support for the investigation and the development of this manuscript.

    Ethical approval:The study was approved by our institution review board.

    Conflicts of interest:The authors have no conflict of interest to declare.

    Contributors:WG, BB, QKT: concept and study design; WG,JFB, BC, JM, TN, JP, MR, ST: data acquisition, data quality,and analysis. All authors participated in the drafting and critical revision of the manuscript.

    亚洲片人在线观看| 一卡2卡三卡四卡精品乱码亚洲| 欧美最黄视频在线播放免费| 黑人巨大精品欧美一区二区mp4| 日本与韩国留学比较| 色噜噜av男人的天堂激情| 日本五十路高清| 国产精品一区二区三区四区免费观看 | 国产精品野战在线观看| 变态另类成人亚洲欧美熟女| avwww免费| 午夜亚洲福利在线播放| 成年免费大片在线观看| 国产伦一二天堂av在线观看| av天堂在线播放| 女生性感内裤真人,穿戴方法视频| 青草久久国产| 国产av一区在线观看免费| 免费在线观看视频国产中文字幕亚洲| 免费看a级黄色片| 国产成人福利小说| 真人一进一出gif抽搐免费| 在线播放国产精品三级| 国语自产精品视频在线第100页| 美女午夜性视频免费| 一个人免费在线观看的高清视频| 很黄的视频免费| 成人一区二区视频在线观看| 男人舔女人的私密视频| 综合色av麻豆| e午夜精品久久久久久久| 麻豆一二三区av精品| 999精品在线视频| 亚洲av美国av| av女优亚洲男人天堂 | 成人特级av手机在线观看| 欧美色视频一区免费| 观看免费一级毛片| 麻豆久久精品国产亚洲av| 宅男免费午夜| 美女cb高潮喷水在线观看 | 麻豆国产97在线/欧美| 成年人黄色毛片网站| 国产综合懂色| 成人av一区二区三区在线看| 亚洲精品美女久久久久99蜜臀| 十八禁人妻一区二区| 欧美国产日韩亚洲一区| 亚洲va日本ⅴa欧美va伊人久久| 欧美日本亚洲视频在线播放| 男女之事视频高清在线观看| 成人三级做爰电影| 欧美日韩综合久久久久久 | 少妇的丰满在线观看| 国产亚洲精品一区二区www| 99热这里只有精品一区 | 床上黄色一级片| 两性夫妻黄色片| 久久国产精品人妻蜜桃| 精品一区二区三区视频在线观看免费| 国产av不卡久久| 美女cb高潮喷水在线观看 | 色综合站精品国产| aaaaa片日本免费| 亚洲中文日韩欧美视频| 欧美日本亚洲视频在线播放| 午夜亚洲福利在线播放| 99热这里只有精品一区 | 国内毛片毛片毛片毛片毛片| 精品午夜福利视频在线观看一区| 亚洲国产精品合色在线| 久久精品国产亚洲av香蕉五月| 亚洲国产精品成人综合色| 久久久久国产一级毛片高清牌| 欧美绝顶高潮抽搐喷水| 他把我摸到了高潮在线观看| 精品欧美国产一区二区三| 久久久久久久久免费视频了| 午夜福利在线观看免费完整高清在 | 亚洲av五月六月丁香网| 18禁国产床啪视频网站| 1024手机看黄色片| netflix在线观看网站| 久久欧美精品欧美久久欧美| 天天添夜夜摸| 欧洲精品卡2卡3卡4卡5卡区| 色哟哟哟哟哟哟| 88av欧美| 国产成人aa在线观看| 国产成人精品久久二区二区免费| 国产又色又爽无遮挡免费看| 男人的好看免费观看在线视频| 观看免费一级毛片| 好男人电影高清在线观看| 欧美性猛交黑人性爽| 国产精品美女特级片免费视频播放器 | 草草在线视频免费看| 久久亚洲真实| 亚洲在线观看片| 国产高潮美女av| 国产亚洲欧美在线一区二区| 久久久久性生活片| 老熟妇乱子伦视频在线观看| 国产欧美日韩精品亚洲av| 成人av在线播放网站| 在线国产一区二区在线| 国产一区二区在线观看日韩 | 一本久久中文字幕| 国产成人精品久久二区二区免费| 久久久久久九九精品二区国产| 美女大奶头视频| 51午夜福利影视在线观看| 青草久久国产| 真人做人爱边吃奶动态| 在线观看一区二区三区| 久久久色成人| 99久久99久久久精品蜜桃| 久久人人精品亚洲av| 国产成人精品久久二区二区91| 欧美中文综合在线视频| 国产午夜福利久久久久久| 久久精品影院6| 非洲黑人性xxxx精品又粗又长| 亚洲国产日韩欧美精品在线观看 | 亚洲欧美日韩卡通动漫| 99热这里只有是精品50| 又粗又爽又猛毛片免费看| 国产精品自产拍在线观看55亚洲| 色av中文字幕| 1000部很黄的大片| 成在线人永久免费视频| 国产单亲对白刺激| 夜夜看夜夜爽夜夜摸| 天堂√8在线中文| 亚洲人成伊人成综合网2020| 国产乱人伦免费视频| 97超视频在线观看视频| xxxwww97欧美| 亚洲欧美精品综合一区二区三区| 国产精品免费一区二区三区在线| 免费在线观看亚洲国产| 亚洲色图av天堂| 亚洲,欧美精品.| 一级作爱视频免费观看| 欧美高清成人免费视频www| 丁香欧美五月| 久久九九热精品免费| 色综合婷婷激情| 五月伊人婷婷丁香| 精品欧美国产一区二区三| 看黄色毛片网站| 亚洲欧美日韩无卡精品| 俺也久久电影网| 国产激情偷乱视频一区二区| 一区福利在线观看| 丝袜人妻中文字幕| 啦啦啦韩国在线观看视频| 婷婷精品国产亚洲av在线| av视频在线观看入口| 黄色丝袜av网址大全| 1000部很黄的大片| 日本免费a在线| 高清在线国产一区| 亚洲精品一区av在线观看| av视频在线观看入口| xxx96com| 亚洲乱码一区二区免费版| 69av精品久久久久久| 亚洲成a人片在线一区二区| xxx96com| 少妇人妻一区二区三区视频| 国产精品久久视频播放| 亚洲av成人一区二区三| 国产私拍福利视频在线观看| av片东京热男人的天堂| 麻豆成人av在线观看| 九色成人免费人妻av| 欧美色欧美亚洲另类二区| 岛国在线观看网站| 国产欧美日韩精品亚洲av| 色视频www国产| 一个人看的www免费观看视频| 国产成年人精品一区二区| 午夜激情欧美在线| 白带黄色成豆腐渣| 国产精品日韩av在线免费观看| www国产在线视频色| 小说图片视频综合网站| 成年女人永久免费观看视频| 亚洲第一电影网av| 亚洲精品在线观看二区| 成年人黄色毛片网站| 久久精品国产综合久久久| av国产免费在线观看| 午夜精品在线福利| 国产精品亚洲美女久久久| 黄色女人牲交| 中文字幕精品亚洲无线码一区| 亚洲色图av天堂| 日韩三级视频一区二区三区| 欧美中文日本在线观看视频| 亚洲中文字幕日韩| 久久久久久大精品| 国产aⅴ精品一区二区三区波| 日本免费一区二区三区高清不卡| 欧美在线一区亚洲| 看免费av毛片| 久久这里只有精品中国| 最新在线观看一区二区三区| 两个人的视频大全免费| 免费人成视频x8x8入口观看| 日韩欧美在线乱码| 婷婷六月久久综合丁香| 性欧美人与动物交配| 黑人巨大精品欧美一区二区mp4| 一个人免费在线观看的高清视频| 亚洲在线观看片| 天天躁狠狠躁夜夜躁狠狠躁| 精品熟女少妇八av免费久了| 全区人妻精品视频| 岛国在线免费视频观看| 亚洲国产欧美网| 国产精品久久久久久精品电影| 美女 人体艺术 gogo| av天堂中文字幕网| 午夜亚洲福利在线播放| 国产伦精品一区二区三区四那| 国产又色又爽无遮挡免费看| 国产亚洲欧美98| 国产精品久久久久久久电影 | 夜夜夜夜夜久久久久| 中文亚洲av片在线观看爽| or卡值多少钱| 午夜精品一区二区三区免费看| 搡老岳熟女国产| 1024手机看黄色片| 国产亚洲av高清不卡| 偷拍熟女少妇极品色| 最近最新中文字幕大全电影3| 日本五十路高清| 亚洲五月婷婷丁香| 亚洲精品一卡2卡三卡4卡5卡| 国产精品日韩av在线免费观看| 国产精品永久免费网站| 搡老岳熟女国产| av女优亚洲男人天堂 | 一级作爱视频免费观看| 午夜两性在线视频| 国产精品 国内视频| 一级毛片高清免费大全| 国产免费av片在线观看野外av| 国内精品久久久久久久电影| 黄色 视频免费看| 狠狠狠狠99中文字幕| 脱女人内裤的视频| 亚洲av美国av| 亚洲欧洲精品一区二区精品久久久| 97碰自拍视频| 精品熟女少妇八av免费久了| 国产午夜福利久久久久久| av视频在线观看入口| 99国产精品99久久久久| 十八禁网站免费在线| 美女扒开内裤让男人捅视频| 午夜影院日韩av| 欧美乱妇无乱码| 国产精品99久久久久久久久| 国产午夜精品久久久久久| 成人三级做爰电影| 成人特级黄色片久久久久久久| 变态另类丝袜制服| 最近最新中文字幕大全电影3| 国产男靠女视频免费网站| 这个男人来自地球电影免费观看| 国产毛片a区久久久久| 国产精品爽爽va在线观看网站| 国产精品一区二区免费欧美| 欧美午夜高清在线| 美女扒开内裤让男人捅视频| 五月伊人婷婷丁香| 国产单亲对白刺激| 久久人人精品亚洲av| 精品一区二区三区视频在线 | 黄片小视频在线播放| 色综合欧美亚洲国产小说| 日韩欧美国产一区二区入口| 国产美女午夜福利| 亚洲成人久久性| a级毛片在线看网站| 国产免费男女视频| 国产精品精品国产色婷婷| 日韩大尺度精品在线看网址| 国产精品,欧美在线| 99久久综合精品五月天人人| 亚洲乱码一区二区免费版| 99精品久久久久人妻精品| 三级男女做爰猛烈吃奶摸视频| 免费看美女性在线毛片视频| 国产熟女xx| 亚洲熟妇熟女久久| 免费在线观看日本一区| 亚洲精品色激情综合| 亚洲国产精品久久男人天堂| av欧美777| 夜夜夜夜夜久久久久| 18禁观看日本| 香蕉国产在线看| 三级男女做爰猛烈吃奶摸视频| 国产高清有码在线观看视频| 日韩国内少妇激情av| 嫩草影院精品99| 免费观看精品视频网站| 五月玫瑰六月丁香| 精品一区二区三区av网在线观看| 久久久久久久久久黄片| 国产高清三级在线| 久久99热这里只有精品18| 免费看日本二区| 午夜福利在线在线| 热99re8久久精品国产| 欧美日韩黄片免| 嫩草影院入口| av福利片在线观看| 日本 欧美在线| 又黄又爽又免费观看的视频| 岛国在线免费视频观看| 亚洲专区字幕在线| 免费大片18禁| 99国产精品一区二区三区| 欧美性猛交╳xxx乱大交人| 国产av麻豆久久久久久久| 精品乱码久久久久久99久播| 国产 一区 欧美 日韩| 日韩欧美一区二区三区在线观看| 国产精品 欧美亚洲| 亚洲国产看品久久| 欧美另类亚洲清纯唯美| 18禁黄网站禁片免费观看直播| av片东京热男人的天堂| 亚洲乱码一区二区免费版| 很黄的视频免费| 亚洲专区中文字幕在线| 国产成人av教育| 12—13女人毛片做爰片一| 美女cb高潮喷水在线观看 | 中文字幕精品亚洲无线码一区| 成人av一区二区三区在线看| 操出白浆在线播放| 国产三级中文精品| 非洲黑人性xxxx精品又粗又长| 18禁观看日本| 很黄的视频免费| 男人舔奶头视频| 精品熟女少妇八av免费久了| 成人国产一区最新在线观看| 精品一区二区三区四区五区乱码| 99国产极品粉嫩在线观看| 午夜激情福利司机影院| 国产精品久久久久久亚洲av鲁大| 三级毛片av免费| 日韩人妻高清精品专区| 99热6这里只有精品| 嫩草影视91久久| 黄色片一级片一级黄色片| 日韩免费av在线播放| 在线观看日韩欧美| 男人舔奶头视频| 久久这里只有精品19| 97碰自拍视频| 国内精品久久久久精免费| 欧美午夜高清在线| 国产精品一区二区免费欧美| 亚洲熟妇熟女久久| 看黄色毛片网站| 国产午夜精品久久久久久| 欧美最黄视频在线播放免费| 欧美一区二区国产精品久久精品| 欧美日本视频| 搡老妇女老女人老熟妇| 免费无遮挡裸体视频| 啪啪无遮挡十八禁网站| 免费看光身美女| 狠狠狠狠99中文字幕| 成人高潮视频无遮挡免费网站| 最近最新中文字幕大全免费视频| 国产黄片美女视频| 一本久久中文字幕| 12—13女人毛片做爰片一| 欧美日韩福利视频一区二区| 欧美+亚洲+日韩+国产| 国产成人一区二区三区免费视频网站| 婷婷精品国产亚洲av在线| 桃色一区二区三区在线观看| 99re在线观看精品视频| 在线播放国产精品三级| 美女高潮喷水抽搐中文字幕| 窝窝影院91人妻| 欧美性猛交黑人性爽| 9191精品国产免费久久| 亚洲欧美一区二区三区黑人| 亚洲精品一卡2卡三卡4卡5卡| 麻豆av在线久日| 全区人妻精品视频| 成人av在线播放网站| 伊人久久大香线蕉亚洲五| 免费在线观看成人毛片| 日韩欧美精品v在线| 特大巨黑吊av在线直播| 久久精品aⅴ一区二区三区四区| 在线播放国产精品三级| www.999成人在线观看| 国产探花在线观看一区二区| 久久久久久久午夜电影| 好看av亚洲va欧美ⅴa在| 午夜亚洲福利在线播放| 婷婷精品国产亚洲av| 免费看十八禁软件| 欧美三级亚洲精品| 久9热在线精品视频| ponron亚洲| 中文字幕精品亚洲无线码一区| 女人高潮潮喷娇喘18禁视频| 色视频www国产| av国产免费在线观看| 午夜成年电影在线免费观看| 99精品欧美一区二区三区四区| 人妻丰满熟妇av一区二区三区| 国产亚洲欧美在线一区二区| 国产午夜精品论理片| av视频在线观看入口| 一二三四在线观看免费中文在| 男插女下体视频免费在线播放| 亚洲中文字幕一区二区三区有码在线看 | 国产精品乱码一区二三区的特点| 久久天躁狠狠躁夜夜2o2o| 日韩中文字幕欧美一区二区| 在线观看免费午夜福利视频| 亚洲成人精品中文字幕电影| 色尼玛亚洲综合影院| 亚洲av美国av| 欧美高清成人免费视频www| 午夜亚洲福利在线播放| 一级黄色大片毛片| 国产真实乱freesex| 日韩精品青青久久久久久| 桃色一区二区三区在线观看| 热99在线观看视频| 日韩大尺度精品在线看网址| av在线天堂中文字幕| 成人高潮视频无遮挡免费网站| 久久天躁狠狠躁夜夜2o2o| 国产99白浆流出| 国产成人一区二区三区免费视频网站| 欧美日韩黄片免| 在线观看午夜福利视频| 欧美一区二区精品小视频在线| e午夜精品久久久久久久| 色噜噜av男人的天堂激情| 一本精品99久久精品77| 久久精品综合一区二区三区| 欧美精品啪啪一区二区三区| www.www免费av| 老汉色∧v一级毛片| 久久久久性生活片| 日本 av在线| 亚洲在线自拍视频| 噜噜噜噜噜久久久久久91| 欧美绝顶高潮抽搐喷水| 高清毛片免费观看视频网站| 男人舔奶头视频| 成人三级做爰电影| 中文字幕人妻丝袜一区二区| 亚洲av成人一区二区三| 夜夜爽天天搞| 免费在线观看影片大全网站| 欧美中文日本在线观看视频| 国产精品一及| 亚洲国产欧美网| 亚洲国产精品成人综合色| 亚洲欧美精品综合一区二区三区| 国产精品久久久久久人妻精品电影| 757午夜福利合集在线观看| 黄频高清免费视频| 久久久久久久久免费视频了| 亚洲,欧美精品.| 国产av一区在线观看免费| 99re在线观看精品视频| tocl精华| 国产亚洲精品av在线| www.999成人在线观看| 天堂网av新在线| 色吧在线观看| 日日夜夜操网爽| 少妇裸体淫交视频免费看高清| 亚洲欧美精品综合一区二区三区| 熟女人妻精品中文字幕| 亚洲自拍偷在线| 久久久久精品国产欧美久久久| 久久香蕉国产精品| 国产精品国产高清国产av| 给我免费播放毛片高清在线观看| 99国产极品粉嫩在线观看| 日韩欧美在线二视频| 五月玫瑰六月丁香| 特级一级黄色大片| 日韩高清综合在线| 97碰自拍视频| 色尼玛亚洲综合影院| 久久久久久国产a免费观看| 亚洲国产精品合色在线| 99在线视频只有这里精品首页| 亚洲美女黄片视频| 真实男女啪啪啪动态图| 偷拍熟女少妇极品色| 国产视频一区二区在线看| 在线免费观看不下载黄p国产 | 真实男女啪啪啪动态图| 99国产综合亚洲精品| 国产精品亚洲一级av第二区| 非洲黑人性xxxx精品又粗又长| 久久亚洲精品不卡| 真人做人爱边吃奶动态| 老鸭窝网址在线观看| 999久久久国产精品视频| 欧美一级毛片孕妇| 哪里可以看免费的av片| 在线十欧美十亚洲十日本专区| 欧美乱妇无乱码| 国产成人系列免费观看| 夜夜躁狠狠躁天天躁| 精品免费久久久久久久清纯| 三级国产精品欧美在线观看 | 国产成年人精品一区二区| 欧美日韩国产亚洲二区| 青草久久国产| 成人三级黄色视频| 日韩大尺度精品在线看网址| av视频在线观看入口| 亚洲成人久久性| 一卡2卡三卡四卡精品乱码亚洲| 国产成人福利小说| 精品福利观看| 精品无人区乱码1区二区| 国产精品久久久久久精品电影| 亚洲av片天天在线观看| 丝袜人妻中文字幕| 亚洲乱码一区二区免费版| 九色国产91popny在线| 免费看美女性在线毛片视频| 国产极品精品免费视频能看的| 免费看日本二区| 亚洲精品美女久久久久99蜜臀| 亚洲va日本ⅴa欧美va伊人久久| 男人和女人高潮做爰伦理| 巨乳人妻的诱惑在线观看| 最近最新中文字幕大全电影3| 国内毛片毛片毛片毛片毛片| 国产一级毛片七仙女欲春2| 久久久国产成人精品二区| 精品乱码久久久久久99久播| 两性午夜刺激爽爽歪歪视频在线观看| 1024手机看黄色片| 最新中文字幕久久久久 | 国产高清视频在线观看网站| 少妇熟女aⅴ在线视频| 在线观看日韩欧美| 国产免费av片在线观看野外av| 韩国av一区二区三区四区| www.www免费av| 免费看a级黄色片| 亚洲av成人精品一区久久| 免费观看人在逋| 两个人的视频大全免费| 日本三级黄在线观看| 亚洲性夜色夜夜综合| 亚洲成人免费电影在线观看| 国产69精品久久久久777片 | 国产伦在线观看视频一区| 久久午夜亚洲精品久久| 最新中文字幕久久久久 | 亚洲av成人av| 欧美日韩精品网址| 中文字幕精品亚洲无线码一区| 国产精品,欧美在线| 日韩国内少妇激情av| 久99久视频精品免费| 后天国语完整版免费观看| 99re在线观看精品视频| 中文字幕高清在线视频| 亚洲五月婷婷丁香| 欧美日本亚洲视频在线播放| 国内精品久久久久精免费| 99久久无色码亚洲精品果冻| av中文乱码字幕在线| 久久久精品大字幕| 免费搜索国产男女视频| 99国产极品粉嫩在线观看| 精品一区二区三区av网在线观看| cao死你这个sao货| 午夜免费成人在线视频| 伦理电影免费视频| 男女之事视频高清在线观看| 黄色 视频免费看| 国内久久婷婷六月综合欲色啪| 国产精品精品国产色婷婷| 免费在线观看影片大全网站| 亚洲国产中文字幕在线视频| 99国产综合亚洲精品| 每晚都被弄得嗷嗷叫到高潮| 老司机午夜福利在线观看视频| 国产高清视频在线观看网站| 国产精品一区二区精品视频观看| 欧美丝袜亚洲另类 | 脱女人内裤的视频| 成人无遮挡网站|