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1.
ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
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The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hepatic involvement is common in SARS-CoV-2-infected individuals. It is currently accepted that the direct and indirect hepatic effects of SARS-CoV-2 infection play a significant role in COVID-19. In individuals with pre-existing infectious and non-infectious liver disease, who are at a remarkably higher risk of developing severe COVID-19 and death, this pathology is most medically relevant. This review emphasizes the current pathways regarded as contributing to the gastrointestinal and hepatic ailments linked to COVID-19-infected patients due to an imbalanced interaction among the liver, systemic inflammation, disrupted coagulation, and the lung.  相似文献   
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摘要:目的 通过评估经鼻导管高流量湿化氧疗在肺部感染患者中的临床疗效,为肺部感染尤其是重症肺炎的患者呼吸道管理策略提供一定的参考依据。方法 2015年9月至2017年9月,采用方便抽样方法选取收治于复旦大学附属华山医院感染科的375例肺部感染患者作为研究对象。依据时间将2015年9月1日至2016年8月31日、2016年9月1日至2017年8月31日入院的患者分别纳入对照组和观察组,对照组患者接受常规治疗,观察组患者在对照组的基础上根据病情接受经鼻导管高流量湿化氧疗。比较两组患者的住院时长、气管插管(包括无创/有创气管切开)人数比例以及预后转归。在对照组和观察组的重症肺炎患者中评估接受经鼻导管高流量湿化氧疗的患者预后情况。结果 观察组重症肺炎的患者比例较对照组高,预后较对照组好,均有统计学差异(P < 0.05)。与未使用HFNC治疗的患者比较,发现接受HFNC的重症肺炎患者预后更好,有统计学差异(P < 0.05)。使用HFNC治疗后,重症肺炎患者的多个指标如呼吸频率、心率、氧饱和度、氧分压均有显著改善,均有统计学差异(P < 0.05)。结论 近年来,我院感染科收治患者的肺部感染患者人数越来越多,重症化比例也越来越高。在此情况下,医院的管理、医生的诊疗、护士的护理到位,使整体肺部感染患者的住院天数、预后转归与既往病情较轻的时候并无差异。同时,接受HFNC的重症肺炎患者,预后明显好转,表明HFNC对改善肺部感染患者预后有明显疗效。  相似文献   
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BackgroundWhile studies have demonstrated favorable outcomes in utilization of primary total shoulder arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA), adverse events such as infections can still occur. Periprosthetic joint infections (PJIs) are associated with worse outcomes and patient morbidity. The purpose of this study was to: (1) compare patient demographics amongst TSA patients with and without PJIs following primary TSA; and (2) identify patient-related risk factors for PJIs following primary TSA.MethodsPatients undergoing primary TSA for the treatment of glenohumeral OA were identified using the Mariner administrative claims database by CPT code 23,472. Laterality modifiers were utilized to ensure PJIs were developing in the correct laterality as those patients undergoing primary TSA. Inclusion for the study group consisted of patients who developed PJIs within 2-years after the index procedure, whereas patients who did not develop PJIs served as the comparison cohort. Primary outcomes analyzed included patient demographics and patient-related risk factors for PJIs following primary TSA. A stepwise backwards elimination multivariate binomial logistic regression analyses was performed to determine the odds (OR) of PJIs in patients undergoing primary TSA. A P value less than .05 was considered statistically significant.ResultsThe query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients developed PJIs and 15,205 did not develop PJIs. The study found statistically significant differences amongst patients who did and did not develop PJIs following primary TSA with respect to age, sex, and presence of comorbid conditions. Risk factors associated with developing PJIs following primary TSA included: pathologic weight loss (OR: 2.06, P < .0001), obesity (OR: 1.56, P = .0001), male sex (OR: 1.52, P = .007), and peripheral vascular disease (OR: 1.46, P = .022).ConclusionAs the number of primary TSAs for the treatment of glenohumeral OA increase worldwide, identifying modifiable risk-factors to reduce the incidence of infection is critical. The study found various modifiable and non-modifiable risk factors associated with developing PJIs following primary TSA. This study is valuable to orthopedists in order to identify and risk-stratify patients with regard to PJI in the setting of primary TSA for OA.Level of EvidenceLevel III; Case-Control Study  相似文献   
7.
BackgroundPost-acute coronavirus 2019 (COVID-19) syndrome is now recognized as a complex systemic disease that is associated with substantial morbidity.ObjectivesTo estimate the prevalence of persistent symptoms and signs at least 12 weeks after acute COVID-19 at different follow-up periods.Data sourcesSearches were conducted up to October 2021 in Ovid Embase, Ovid Medline, and PubMed.Study eligibility criteria, participants and interventionsArticles in English that reported the prevalence of persistent symptoms among individuals with confirmed severe acute respiratory syndrome coronavirus 2 infection and included at least 50 patients with a follow-up of at least 12 weeks after acute illness.MethodsRandom-effect meta-analysis was performed to produce a pooled prevalence for each symptom at four different follow-up time intervals. Between-study heterogeneity was evaluated using the I2 statistic and was explored via meta-regression, considering several a priori study-level variables. Risk of bias was assessed using the Joanna Briggs Institute tool and the Newcastle-Ottawa Scale for prevalence studies and comparative studies, respectively.ResultsAfter screening 3209 studies, a total of 63 studies were eligible, with a total COVID-19 population of 257 348. The most commonly reported symptoms were fatigue, dyspnea, sleep disorder, and difficulty concentrating (32%, 25%, 24%, and 22%, respectively, at 3- to <6-month follow-up); effort intolerance, fatigue, sleep disorder, and dyspnea (45%, 36%, 29%, and 25%, respectively, at 6- to <9-month follow-up); fatigue (37%) and dyspnea (21%) at 9 to <12 months; and fatigue, dyspnea, sleep disorder, and myalgia (41%, 31%, 30%, and 22%, respectively, at >12-month follow-up). There was substantial between-study heterogeneity for all reported symptom prevalences. Meta-regressions identified statistically significant effect modifiers: world region, male sex, diabetes mellitus, disease severity, and overall study quality score. Five of six studies including a comparator group consisting of COVID-19–negative cases observed significant adjusted associations between COVID-19 and several long-term symptoms.ConclusionsThis systematic review found that a large proportion of patients experience post-acute COVID-19 syndrome 3 to 12 months after recovery from the acute phase of COVID-19. However, available studies of post-acute COVID-19 syndrome are highly heterogeneous. Future studies need to have appropriate comparator groups, standardized symptom definitions and measurements, and longer follow-up.  相似文献   
8.
IntroductionSafe vaccination worldwide is critical to end the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate adverse reactions to vaccination using a web-based questionnaire and examine the risk factors for the occurrence of immunisation stress-related response (ISRR).MethodsWe conducted a questionnaire survey using Google Form® among the employees of St. Marianna University Hospital who had received the COVID-19 vaccine between April 2021 and May 2021, 1 week after the first and second vaccinations. We developed and used a questionnaire to identify individuals with ISRR according to the World Health Organization diagnostic criteria. A generalised linear mixed model was constructed with ISRR onset as the dependent variable, subjects as the random factor, and each parameter as a fixed factor. A multivariate model was constructed using the forced imputation method with factors that were significant in the univariate analysis.ResultsWe enrolled 2,073 and 1,856 respondents in the first and second questionnaire surveys, respectively. Fifty-five and 33 ISRR cases were identified in the first and second vaccinations, respectively. In the univariate analysis, strong pre-vaccination anxiety (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.30–4.12, p = 0·004) and history of allergy (OR, 1.6; 95% CI, 1.14–2.24, p = 0·007) were significant risk factors. Multivariate analysis also showed that strong pre-vaccination anxiety (OR, 2.1; 95% CI, 1.15–3.80, p = 0.016) and history of allergy (OR, 1.5; 95% CI, 1.09–2.15, p = 0.014) were significant risk factors.ConclusionsConfirmation of allergy prior to vaccination and subsequent action are essential for addressing ISRR.  相似文献   
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目的探讨新型布尼亚病毒感染后患者发热伴血小板减少症状(SFTS)发病期和恢复期的凝血和血栓相关指标及其临床意义。方法选择2020年4月12日至8月12日在安徽医科大学第一附属医院收治的新型布尼亚病毒感染后SFTS患者,其中SFTS发病期36例,SFTS恢复期18例,并招募36名健康人作为健康对照组,采集血浆标本。回顾性分析血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原含量(FIB)、血浆凝血酶时间(TT)、抗凝血酶-Ⅲ(AT-Ⅲ)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)、血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-α2纤溶酶抑制物复合物(PIC)、组织型纤溶酶原激活剂-抑制剂1复合物(t-PAIC)浓度。统计比较3组间上述指标的差异。结果与健康对照组比较,SFTS发病组PT[12.5(12.1,13.6)s比10.8(10.5,11.5)s,P<0.05]较长,但仍在正常参考值范围内(14.0~21.0 s);APTT[49.1(42.0,58.2)s比28.5(26.6,30.4)s,P<0.05]较长;FDP[6.07(2.67,8.64)μg/ml比1.00(0.80,1.87)μg/ml]和D-D[2.27(1.04,2.98)μg/ml比0.30(0.21,0.47)μg/ml]较高(P均<0.001);血浆TAT[16.05(8.05,26.58)ng/ml比3.55(2.60,4.85)ng/ml]和PIC浓度[4.44(2.52,5.54)μg/ml比0.84(0.60,1.35)μg/ml]较高(P均<0.001);TM[(19.41±8.29)TU/ml比(9.33±1.89)TU/ml]和t-PAIC浓度[(37.52±21.10)ng/ml比(7.06±3.37)ng/ml]较高(P均<0.001)。SFTS恢复组患者血浆中TAT浓度为9.10(3.95,18.40)ng/ml,仍高于正常参考范围(<4 ng/ml),PIC浓度低于SFTS发病组[1.91(1.45,2.93)μg/ml比4.44(2.52,5.54)μg/ml,P<0.05],TM和t-PAIC低于SFTS发病组(P均<0.05)。结论SFTS患者发病期机体凝血系统激活,血管内皮受到损伤;恢复期血管内皮损伤情况减轻,但机体依然存在一定程度的凝血系统障碍,提示当体内病毒清除后,仍需继续监测凝血指标。  相似文献   
10.
崔亚琼  刘薇 《天津医药》2022,50(12):1340-1344
儿童多系统炎症综合征(MIS-C)是一种合并多器官功能受损的全身炎症综合征,大多数患儿存在新型冠状病毒(SARS-CoV-2)感染证据或新型冠状病毒肺炎(COVID-19)患者接触史。患儿常出现发热、胃肠道症状、心功能异常及休克等表现。细胞因子风暴(CS)是由外界刺激触发的全身性炎症反应,引起CS的诱因包括医源性、病源性、单基因或自身免疫性疾病等。MIS-C发病机制尚未完全明确,可能与SARS-CoV-2感染后引起的机体过度免疫反应有关。就COVID-19感染相关MIS-C的临床特征和CS的发生及诱因予以综述,并讨论两者间的关系,以期为MIS-C的机制研究和临床诊断提供参考。  相似文献   
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