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1.
Nancy R. Temkin 《Epilepsia》2001,42(4):515-524
PURPOSE: To synthesize evidence concerning the effect of antiepileptic drugs (AEDs) for seizure prevention and to contrast their effectiveness for provoked versus unprovoked seizures. METHODS: Medline, Embase, and The Cochrane Clinical Trials Register were the primary sources of trials, but all trials found were included. Minimal requirements: seizure-prevention outcome given as fraction of cases; AED or control assigned by random or quasi-random mechanism. Single abstracter. Aggregate relative risk and heterogeneity evaluated using Mantel-Haenszel analyses; random effects model used if heterogeneity was significant. RESULTS: Forty-seven trials evaluated seven drugs or combinations for preventing seizures associated with fever, alcohol, malaria, perinatal asphyxia, contrast media, tumors, craniotomy, and traumatic brain injury. Effective: Phenobarbital for recurrence of febrile seizures [relative risk (RR), 0.51; 95% confidence interval (CI), 0.32-0.82) and cerebral malaria (RR, 0.36; CI, 0.23-0.56). Diazepam for contrast media-associated seizures (RR, 0.10; CI, 0.01-0.79). Phenytoin for provoked seizures after craniotomy or traumatic brain injury (craniotomy: RR, 0.42; CI, 0.25-0.71; TBI: RR, 0.33; CI, 0.19-0.59). Carbamazepine for provoked seizures after traumatic brain injury (RR, 0.39; CI, 0.17-0.92). Lorazepam for alcohol-related seizures (RR, 0.12; CI, 0.04-0.40). More than 25% reduction ruled out valproate for unprovoked seizures after traumatic brain injury (RR, 1.28; CI, 0.76-2.16), and carbamazepine for unprovoked seizures after craniotomy (RR, 1.30; CI, 0.75-2.25). CONCLUSIONS: Effective or promising results predominate for provoked (acute, symptomatic) seizures. For unprovoked (epileptic) seizures, no drug has been shown to be effective, and some have had a clinically important effect ruled out.  相似文献
2.
颅脑损伤患者上消化道出血的预防和治疗(附625例报告)   总被引:7,自引:0,他引:7  
目的探讨颅脑损伤后上消化道出血的预防措施及其治疗方法。方法回顾性分析625例颅脑损伤后上消化道出血的病例,在治疗原发伤病基础上,采用止血、制酸、保护胃黏膜等对症处理,同时应用阿托品治疗22例;胃镜下治疗8例;胃次全切除术5例。结果本组病例中,治愈572例,缓解36例,无效5例,死亡12例,其中阿托品治愈20例;胃镜下治愈6例;胃次全切除术治愈4例。结论预防和治疗的重点是消除颅脑损伤病灶和保护胃黏膜,常规处理方案效果满意,简单、经济且安全有效,但必要时应及时使用特殊治疗手段,以迅速控制出血病情。  相似文献
3.
Severe Burns as a Consequence of Seizures in Patients with Epilepsy   总被引:5,自引:5,他引:0  
Mark C. Spitz 《Epilepsia》1992,33(1):103-107
We report 10 seizure-related thermal injuries severe enough to require hospitalization in patients with epilepsy. Eight of the ten incidents were with patients who had had seizures with impaired consciousness two or more times a month. This suggests that seizure frequency is a risk factor and implies the importance of striving for optimal seizure control. Two burns each occurred from an electric iron, a hand-held hair dryer, and stove-top cooking. Minimizing these activities, especially in patients with frequent consciousness-altering seizures, may be useful. Three burns occurred while showering; these resulted in the most severe injuries, with hospital stays of 29, 30, and 41 days. Simple plumbing devices may have prevented these injuries.  相似文献
4.
Summary: To explore the risk factors and circumstances for burns in a population of persons with epilepsy, we surveyed 244 University of Colorado Health Sciences Center Seizure Clinic patients. Twenty-five had at least one seizure-related burn requiring medical attention (12 were hospitalized), 21 reported burns requiring medical attention not related to seizure activity, and 199 reported no burns. All patients with seizure-related burns had alteration of consciousness during most seizures. Statistical models with logistic regression indicated that a useful model for assessing risk of seizure-related burns in this population of patients could be constructed using three significant variables: lifetime total number of seizures experienced by the patient, the presence of interictal neurologic impairment, and gender. The remainder of the variables studied (percentage of seizures that occurred nocturnally, percentage of seizures preceded by a simple partial seizure (SPS) warning, self-care status, number of seizures in adult life, seizure type, patient age, age of onset of seizure disorder, and presence of burns not associated with seizure) were either not significantly correlated with seizure-related burns or did not significantly improve the success of the statistical model in light of the other variables studied. Most injuries occurred in the home during activities that might have been avoided. They included 10 burns incurred while cooking, 5 incurred while showering (with a plumbing system that permitted exposure to scalding water), and 3 caused by exposed room heaters. A subset of epileptic patients are at increased risk for burns and should minimize situations in which they can be burned.  相似文献
5.
目的 评估中国缺血性卒中(IS)或短暂性脑缺血发作(TIA)患者应用抗血栓药物(包括抗血小板药物和抗凝药物)的现况,并分析其影响因素。方法 采用横断面研究方法,调查2006年7月1日至8月15日期间,中国主要城市二、三级医院神经内科门诊连续IS或TIA患者近期的抗血栓药物使用情况。22家医院参加调查,总计2384例卒中患者连续入选;有3家不符合中心入选标准被除外,最后19家医院的资料被采用,总计有2283例卒中患者的数据纳入分析中。结果 2283例卒中患者中,使用阿司匹林者占71.9%,使用阿司匹林+氯吡格雷占4.2%,使用氯吡格雷者占7.3%,各种抗血小板药物合计例数占75.6%。伴心房颤动的81例卒中患者中,使用华发林者占17.3%。医疗保险[比值比(OR)1.473,95%可信区间(CI)1.088~1.994]、公费医疗(OR 1.632,95%CI 1.029~2.589)、月均收入≥500元以上(OR 2.136,95%CI 1.508~3.026)、高血压(OR 1.463,95%CI 1.159~1.847)和脂代谢紊乱(OR 1.499,95%CI 1.187~1.893)是卒中患者接受抗血小板药物的促进因素。患者年龄≥75岁(OR 0.701,95%CI 0.498~0.988)及改良的Rankin评分4~5分(OR 0.684,95%CI 0.486~0.965)是用药的阻碍因素。结论 中国大城市二、三级医院IS和TIA患者的抗血栓治疗现状不容乐观,各类抗血栓药物应用的比例较低,为改善以上状况,亟待探索有效的改进模式,缩短临床实践与指南间的差距。  相似文献
6.
Treatment of Photosensitivity   总被引:4,自引:4,他引:4  
7.
PURPOSE: Based on our previous study that validated efficacies of an adaptive temporal filtering system (ATFS) suppressing a photoparoxysmal response (PPR) elicited by a chromatic flicker stimulation, we further studied ATFS efficacies on PPRs elicited by pattern-flicker stimulation in 13 photosensitive epilepsy patients. METHODS: Subjects were 13 photosensitive epilepsy patients (two male and 11 female patients; mean age +/- SD, 20.9 +/- 8.9 years) who were all sensitive to a flickering geometric-pattern scene. We used a scene consisting of 15-Hz flickering 4 c/deg stripe images lasting for 4 s. With a 14-inch television set 2 m before a subject, we displayed the following video scenes: nonfiltered and filtered flickering-stripe scenes; for the latter, two kinds of ATFSs with mild efficacy and strong efficacy were used. Three flickering-stripe scenes altogether, each of which lasted for 4 s, were given at random with a 10-s interval. RESULTS: A nonfiltered flickering-stripe scene elicited generalized PPRs in all patients; a filtered scene by use of an ATFS with mild efficacy elicited generalized PPRs in six patients (46%), whereas that by an ATFS with strong efficacy exhibited no PPRs. CONCLUSIONS: This study, using an ATFS, again shows suppressive efficacy on PPRs elicited by flickering-pattern stimulation. Therefore a series of our studies suggested that ATFS may be useful as a preventive measure for photosensitive seizures triggered by stimulative flickering images from televisions or other displays.  相似文献
8.
帕罗西汀预防创伤后应激障碍对照研究   总被引:3,自引:1,他引:2  
目的:探讨帕罗西汀预防创伤后应激障碍(PTSD)的效果。方法:矿难2个月后对31名矿难幸存者和22名配偶非PTSD者随机分为预防组和对照组。预防组予帕罗西汀10mg/d或20mg/d进行干预。1个月后再次进行PTSD诊断,干预前后对两组进行PTSD自评量表和PTSD症状清单(PCL)评定。结果:1个月后对照组有4人符合PTSD诊断标准,预防组无1例PTSD者。干预前,预防组和对照组PTSD自评量表及PCL评分差异无显著性(P>0.05)。干预后,预防组PTSD总分、PTSD闪回因子以及PCL评分比干预前显著减少(P<0.05或P<0.01),对照组仅PCL评分比干预前显著下降(P<0.05)。干预后预防组与对照组闪回及PTSD总分差异显著(P<0.05或P<0.01)。结论:帕罗西汀对PTSD的发生有预防作用。  相似文献
9.
缺血性脑血管病二级预防他汀类药物应用现况调查   总被引:3,自引:0,他引:3  
目的:了解北京市部分二级医院缺血性脑血管病二级预防他汀类药物应用现状,为改进缺血性脑血管病二级预防工作提供依据。方法:本研究为现况调查,研究对象为北京市4家二级医院中诊断为急性动脉粥样硬化性脑梗死及短暂性脑缺血发作(TIA)的住院患者,调查患者住院期间以及出院3个月他汀类药物的应用现况。结果:入选患者共458例,其中408例完成了3月随访。住院期间他汀类药物的应用比率为35.6%;出院3月,他汀类药物的用药比率降为22.3%,与住院期间相比有明显差异(p<0.001);而依从性差的原因与患者的性别、经济负担、学历、危险因素的存在与否及脑血管病亚型(脑梗死或TIA)均无明显相关。3月随访发现缺血性脑血管事件发生率为4.9%(20例),冠脉综合征0.5%(2例),且22例血管事件复发患者中仅有9.1%(2例)坚持他汀治疗。结论:北京市部分二级医院脑血管病医生对他汀类调脂药用于缺血性脑血管病二级预防已经有了一定程度的认识,但与卒中降脂指南尚有距离,同时我们应对缺血性脑血管病患者他汀用于缺血性脑血管病二级预防的依从性给予关注。  相似文献
10.
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