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81.
报道3例PICC导管外露端因血栓性堵管经尿激酶溶栓未通后,应用指腹揉捏法进行再通的应急处理全过程。前期对导管堵塞性质评估判断,确定为血栓性栓塞。先进行尿激酶溶栓,再通无效后实施指腹揉捏法,实施前要做好各方面充分准备和告知,实施过程中要掌握方法操作技巧,减少感染和导管损伤。再通成功导管通畅后要有针对性的做好护士维护指导和患者的护管教育。指腹揉捏法可以作为药物溶栓再通失败后应急处理的一种方法,高再通率能继续保障PICC导管顺利使用。 相似文献
82.
T. SOBRINO M. MILLÁN M. CASTELLANOS M. BLANCO D. BREA L. DORADO R. RODRÍGUEZ‐GONZÁLEZ M. RODRÍGUEZ‐YÁÑEZ J. SERENA R. LEIRA A. DÁVALOS J. CASTILLO 《Journal of thrombosis and haemostasis》2010,8(7):1567-1574
Summary. Background: Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin‐1 (Ang‐1) and granulocyte‐colony stimulating factor (G‐CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. Objectives: To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. Methods: We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color‐coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0–2 at 90 days. GF levels were determined by ELISA. Results: Mean serum levels of VEGF, G‐CSF and Ang‐1 at baseline were significantly higher in patients with early MCA recanalization (n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G‐CSF (OR, 1.02) and Ang‐1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) (n = 20) showed higher levels of Ang‐1 (P < 0.0001). Ang‐1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome (n = 38) had higher levels of G‐CSF (P < 0.0001). G‐CSF was independently associated with good outcome (OR, 1.12; P = 0.036). Conclusions: These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t‐PA, although they might increase the HT. 相似文献
83.
目的:探讨异位妊娠药物治疗及腹腔镜保守治疗后输卵管再通及再孕的临床效果.方法:对116例患者按照异位妊娠治疗的标准分为两组,其中腹腔镜下保守性手术65例,药物治疗51例,分别于治愈后第2~3个月在经净3~7天行输卵管碘油造影了解输卵管通畅情况,并随访其再次妊娠情况.结果:腹腔镜手术中输卵管完全通畅47例,再次妊娠38例;药物保守治疗中输卵管完全通畅24例,再次妊娠21例.两者比较(P<0.05),差异有显著性.结论:腹腔镜下异位妊娠保守性手术后输卵管再通率及再次妊娠率较保守治疗高,值得临床推广. 相似文献
84.
目的观察腹腔镜应用在女性继发不孕症诊治中的价值。方法回顾性分析本院自1999年8月至2008年12月间237例女性不孕症患者应用腹腔镜诊治的临床资料。对其病因进行分析;对应用腹腔镜联合检查、及B超检查结果的阳性率进行比较;观察术后输卵管的通畅情况。结果女性继发不孕原因主要有慢性盆腔炎、子宫内膜炎等。腹腔镜检查阳性率明显高于B超检查。对于输卵管不通患者应用腹腔镜下输卵管通液治疗,手术前、后输卵管通畅率差异具有统计学意义。结论应用腹腔镜诊治术能早期、直观、准确、全面地了解不孕症在盆腔方面的病因,并予以针对性治疗。 相似文献
85.
Yuki Yamamoto Nobuaki Yamamoto Yasuhisa Kanematsu Masaaki Korai Kenji Shimada Yuishin Izumi Yasushi Takagi 《Journal of stroke and cerebrovascular diseases》2019,28(6):1555-1560
Background: Mechanical thrombectomy undoubtedly improves functional outcomes for patients with acute ischemic stroke. Although we have observed occlusion sites that protrude proximally into the vessel on angiography, termed the “claw sign,” we have been unable to state its clinical significance. In this study, we aimed to determine whether the presence of a claw sign was related to recanalization success after mechanical thrombectomy. Materials and Methods: We retrospectively included 73 consecutive patients treated for acute cerebral large vessel occlusion by mechanical thrombectomy between January 2014 and December 2017. The angiographic claw sign was defined as a thrombus that protruded proximally by more than half the diameter of the parent artery. Claw sign positivity, clinical and etiological features, and outcomes were compared between groups with and without recanalization. Results: The claw sign was observed in 29 of 73 (40%) patients and was positive significantly more frequently in those with recanalization (50.0%) than in those without recanalization (5.9%) (P < .01). By multivariate analysis, the claw sign was the only pretreatment parameter to predict successful recanalization (odds ratio, 12.50; 95% confidence interval, 1.50-103.00; P = .019). Conclusions: The presence of the claw sign might predict successful recanalization in patients undergoing mechanical thrombectomy for large vessel occlusion. 相似文献
86.
目的探讨脑静脉窦血栓经抗凝治疗后的再通情况及再通对长期预后的影响。方法对63例首次诊断CVST患者进行抗凝治疗,分别于出院时、出院后第3个月、第6个月和第12个月对患者进行MRI联合MRV复查,根据MRV和MRI结果 ,分为完全再通、部分再通和未通,使用改良Rankin量表(mRS)对患者预后评分。根据mRS评分,将患者分为完全恢复和不完全恢复组(mRS=0分为完全恢复,mRS 1~6分为不完全恢复);预后良好组和预后不良组(mRS≤2为预后良好,mRS2为预后不良)。采用Logistic回归分析相关因素对长期预后的影响。结果出院时(18±4)d、出院后第3个月、第6个月和第12个月的再通率分别是60%、73%、79%和81%。出院第12个月时,完全再通32例(51%),部分再通19例(30%);39例(62%)患者完全恢复,24例(38%)患者不完全恢复。单因素分析显示,年龄≥40岁、静脉窦未通是CVST不完全恢复的危险因素。多因素Logistic回归分析显示,只有年龄≥40岁(OR=5.995,95%CI:1.195~20.922;P=0.023)是CVST不完全恢复的独立危险因素。完全再通患者预后明显好于未通患者(HR=3.17,95%CI:1.8~10.43;P0.001)。年龄≥40岁、男性、未通是CVST预后不良的危险因素,多因素Logistic回归分析显示,年龄≥40岁(OR=6.675,95%CI:2.195~8.922;P=0.035)是预后不良的独立危险因素,而未通不是预后不良的独立危险因素(OR=2.843,95%CI:0.87~13.472;P=0.11)。结论脑静脉窦血栓形成闭塞静脉窦的再通呈时间依赖性,完全再通患者预后好于未通患者。 相似文献
87.
88.
Cwikiel W 《Acta radiologica (Stockholm, Sweden : 1987)》2006,47(2):145-156
Rapid development of diagnostic radiological methods during recent decades has been followed by development of new interventional procedures involving portal circulation. The majority of these interventions were developed for treatment of patients with symptoms secondary to portal hypertension (PH). Interventions involving portal vein circulation have an established position in the treatment of PH and other diseases, and further development of these methods can be expected. 相似文献
89.
90.