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1.
IntroductionIntussusception with the Meckel’s diverticulum (MD) is a rare cause of chonic abdominal pain in the adults. We wish to present this first case of intussusception of MD within its own lumen without small bowel obstruction.Presentation of caseWe report the case of a 27-year-old man who was admitted to the emergency room due to a diffuse abdominal pain. Abdominal CT scan showed invagination of MD. The exploratory laparoscopy revealed the presence of intussusception of MD within its own lumen. Segmental resection of the small intestine was performed. The patient was discharged on the third post-operative day.DiscussionThe prevalence of MD is 1 to 4%. Diagnosis is often difficult and delayed because clinical symptoms are not specific and the diagnosis is performed mainly by imaging studies. Factors pre-disposing these patients to intussusception of MD within its own lumen include a narrow diverticulum, large diverticululm, and associated inflammation of the diverticulum. Intestinal obstruction is a more common complication in adults, whereas in children, bleeding is the more common complication. In our case, the patient had a diffuse abdominal pain without small bowel obstruction because the intussusception of MD was within its own lumen. Laparoscopy may be useful for confirming the presence of intussusception, and demonstrating the underlying organic lesion serving as the lead point.ConclusionIt is important to differentiate this rare pathological feature of MD from other entities as the treatment is surgical rather than medical. Abdominal surgeons should bear in mind this rare entity.  相似文献   
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目的:探讨宣肺聪耳汤辅助治疗急性分泌性中耳炎的临床应用效果。方法:选择我院2013年3月~2015年3月收治的急性分泌性中耳炎患者共107例作为研究对象,随机分为治疗组(n=55)和对照组(n=52)。对照组患者单纯采用常规方法进行治疗,如中耳穿刺、口服抗生素、吉诺通胶囊等;治疗组患者在对照组基础上联合宣肺聪耳汤进行治疗。统计并记录两组患者治疗前后的电测听情况,比较两种治疗方法临床总有效率和不良反应发生率。结果:治疗后两组患者的电测听值均较治疗前明显降低,治疗组为(9.17±2.46),对照组为(19.56±4.72),治疗组的降低幅度显著高于对照组;治疗组显效38例,有效14例,无效3例,总有效率为94.55%(52/55),仅4例发生不良反应,不良反应发生率为7.27%(4/55),对照组显效15例,有效26例,无效11例,总有效率为78.85%(41/52),共12例发生不良反应,不良反应发生率为23.08%(12/52),两组患者在电测听值、总有效率以及不良反应发生率方面比较差异均具有统计学意义(P<0.05)。结论:宣肺聪耳汤应用于急性分泌性中耳炎的治疗,可显著改善患者的听力,提高临床疗效,降低不良反应发生率,效果显著优于常规治疗,值得在临床上推广。  相似文献   
3.
Patients with acute lymphoblastic leukaemia (ALL) after cytotoxic chemotherapy or haematopoietic stem cell transplantation (HSCT) are at risk for life‐threatening invasive fungal disease (IFD). The aim was to evaluate the characteristics, antifungal therapy and outcome of adult patients with ALL after chemotherapy or HSCT receiving caspofungin empirically in a clinical setting. Retrospective chart reviews were conducted at nine large tertiary care centres in Germany. Adult patients with ALL treated empirically with caspofungin according to the product label between 2006 and 2012 were eligible. Data were extracted as case reports. In total, 25 patients (12 males, 13 females; median age 37 years; 19 with B‐ALL, 6 with T‐ALL) with 28 treatment episodes because of suspected IFD (18 episodes after chemotherapy, 10 episodes after allogeneic HSCT) were included in the analysis. Empirical caspofungin therapy (median duration: 19 days, range 1–105 days) was given as first‐line monotherapy in 20 (71.4%), second‐line monotherapy in five (17.9%) and combination therapy in three (10.7%) episodes respectively. Therapy rated successful according to the physician's overall assessment (inflammatory parameters, clinical symptoms): 20 (95%) of 21 evaluable episodes with therapy duration of at least 8 days. Empirical caspofungin appears to be an effective therapeutic option in critically ill adult ALL patients with suspected IFD in clinical practice.  相似文献   
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Hydrogen sulfide (H2S), formed by multiple enzymes, including cystathionine‐γ‐lyase (CSE), targets Cav3.2 T‐type Ca2+ channels (T channels) and transient receptor potential ankyrin‐1 (TRPA1), facilitating somatic pain. Pancreatitis‐related pain also appears to involve activation of T channels by H2S formed by the upregulated CSE. Therefore, this study investigates the roles of the Cav3.2 isoform and/or TRPA1 in pancreatic nociception in the absence and presence of pancreatitis. In anesthetized mice, AP18, a TRPA1 inhibitor, abolished the Fos expression in the spinal dorsal horn caused by injection of a TRPA1 agonist into the pancreatic duct. As did mibefradil, a T‐channel inhibitor, in our previous report, AP18 prevented the Fos expression following ductal NaHS, an H2S donor. In the mice with cerulein‐induced acute pancreatitis, the referred hyperalgesia was suppressed by NNC 55‐0396 (NNC), a selective T‐channel inhibitor; zinc chloride; or ascorbic acid, known to inhibit Cav3.2 selectively among three T‐channel isoforms; and knockdown of Cav3.2. In contrast, AP18 and knockdown of TRPA1 had no significant effect on the cerulein‐induced referred hyperalgesia, although they significantly potentiated the antihyperalgesic effect of NNC at a subeffective dose. TRPA1 but not Cav3.2 in the dorsal root ganglia was downregulated at a protein level in mice with cerulein‐induced pancreatitis. The data indicate that TRPA1 and Cav3.2 mediate the exogenous H2S‐induced pancreatic nociception in naïve mice and suggest that, in the mice with pancreatitis, Cav3.2 targeted by H2S primarily participates in the pancreatic pain, whereas TRPA1 is downregulated and plays a secondary role in pancreatic nociceptive signaling. © 2014 Wiley Periodicals, Inc.  相似文献   
8.
Acute stress disorder (ASD) was introduced into the DSM-IV to recognize early traumatic responses and as a precursor of PTSD. Although the diagnostic criteria for ASD were altered and structured more similarly to the PTSD definition in DSM-5, only the PTSD diagnosis includes a dissociative subtype. Emerging research has indicated that there also appears to be a highly symptomatic subtype for ASD. However, the specific nature of the subtype is currently unclear. The present study investigates the possible presence of ASD subtypes in a mixed sample of victims meeting caseness for DSM-5 ASD based on self-report following four different types of traumatic exposure (N = 472). The results of latent profile analysis revealed a 5-class solution. The highly symptomatic class was marked by high endorsement on avoidance and dissociation compared to the other classes. Findings are discussed in regard to its clinical implications including the implications for the pending the ICD-11 and the recently released DSM-5.  相似文献   
9.
李维筠  郑志恒  宫兆滨 《安徽医学》2015,36(12):1523-1526
目的探讨瑞舒伐他汀钙对急性冠脉综合征(ACS)患者冠脉硬化程度及血浆氨基末端脑利钠肽前体(NT-proBNP)表达水平的影响。方法采用随机数字法,将122例 ACS 患者分为观察组(瑞舒伐他汀钙)及对照组(阿伐他汀钙),每组61例。比较治疗4、8、16周时两组患者血脂水平及 NT-proBNP、超敏 C 反应蛋白(Hs-CRP)表达水平差异,并对两组治疗效果及并发症发生情况进行比较。结果治疗16周时,观察组患者三酰甘油、低密度脂蛋白胆固醇、总胆固醇水平低于对照组,且高密度脂蛋白胆固醇水平高于对照组,差异有统计学意义(P <0.05);同时,治疗周期内,两组患者不同治疗时期下 NT-proBNP、Hs-CRP 表达水平差异有统计学意义(P <0.05),且观察指标均与时间存在交互作用(FNT-proBNP =5.71,FHs-CRP =5.34);观察组患者治疗总有效率为86.88%,显著高于对照组(P <0.05),但两组患者不良反应发生率差异无统计学意义(P >0.05)。结论瑞舒伐他汀钙能有效改善 ACS 患者机体血脂水平,降低 NT-proBNP 及 Hs-CRP 表达水平,提高总体治疗效果,具有较高的临床应用价值。  相似文献   
10.
目的 探讨长托宁对急性阑尾炎患者术中寒战的预防作用。方法 蛛网膜下腔阻滞麻醉下行急性阑尾炎手术患者120例,随机分为3组: Ⅰ组(对照组),Ⅱ组(长托宁组),Ⅲ组(哌替啶组)。观察三组患者术中寒战的发生率及严重分级;记录静脉注药前1min(T0)、静脉注药后3min(T1)、5min(T2)、10min(T3)、15min(T4)、20min(T5)、30min(T6)的血氧饱和度(SPO2)、平均动脉压(MAP)、心率(HR)的变化情况;用药后不良反应的发生情况;注药前1min(T0)、注药后30min(T6)、麻醉后30min(T7)和手术结束时(T8)体温变化情况。结果 Ⅱ组、Ⅲ组的寒战发生率分别为10%、7.5%,显著低于Ⅰ组的65%(P<0.01),Ⅱ组和Ⅲ组之间比较差异无显著性(P>0.05);Ⅱ组、Ⅲ组寒战严重程度分级显著低于Ⅰ组(P<0.05),Ⅱ组和Ⅲ组之间比较差异无显著性(P>0.05)。血氧饱和度(SPO2)的变化,Ⅲ组用药后下降明显,与Ⅰ组和Ⅱ组比较有显著性差异(P<0.01)。平均动脉压(MAP)、心率(HR)、体温,三组变化比较差异均无统计学意义(P>0.05)。Ⅲ组静脉注药后,发生恶心呕吐6例(15%),嗜睡5例(12.5%),明显高于Ⅱ组和Ⅰ组(P<0.05)。结论 麻醉前预防性静脉注射长托宁(0.01mg/kg)具有预防术中寒战发生的作用,效用与预防性静脉注射哌替啶(0.5mg/kg)相似,但长托宁无类似哌替啶的呼吸抑制作用,且无哌替啶高发生率的恶心呕吐、嗜睡不良反应,对血压、心率、体温无影响,在临床预防术中寒战的应用中优于哌替啶。  相似文献   
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