首页 | 本学科首页   官方微博 | 高级检索  
文章检索
  按 检索   检索词:      
出版年份:   被引次数:   他引次数: 提示:输入*表示无穷大
  收费全文   838篇
  免费   56篇
  国内免费   47篇
耳鼻咽喉   2篇
儿科学   1篇
基础医学   63篇
口腔科学   1篇
临床医学   59篇
内科学   468篇
神经病学   20篇
特种医学   66篇
外科学   67篇
综合类   103篇
预防医学   13篇
药学   50篇
  1篇
中国医学   21篇
肿瘤学   6篇
  2023年   2篇
  2022年   2篇
  2021年   8篇
  2020年   10篇
  2019年   4篇
  2018年   8篇
  2017年   9篇
  2016年   8篇
  2015年   19篇
  2014年   41篇
  2013年   56篇
  2012年   31篇
  2011年   48篇
  2010年   43篇
  2009年   31篇
  2008年   61篇
  2007年   86篇
  2006年   66篇
  2005年   85篇
  2004年   69篇
  2003年   64篇
  2002年   49篇
  2001年   32篇
  2000年   27篇
  1999年   19篇
  1998年   17篇
  1997年   22篇
  1996年   8篇
  1995年   2篇
  1994年   5篇
  1993年   3篇
  1992年   3篇
  1991年   2篇
  1982年   1篇
排序方式: 共有941条查询结果,搜索用时 31 毫秒
1.
目的:探讨蛭芪胶囊防治老年糖尿病足介入手术术后再狭窄的临床疗效。方法随机选取2013年2月-2014年2月在该院行糖尿病足介入手术的老年患者120例,按照随机数字表法分为观察组和对照组各60例,其中观察组在应用低分子肝素钙的基础上给予蛭芪胶囊口服,对照组单纯给予低分子肝素钙预防术后再狭窄,两组疗程均为10 d。观察两组患者治疗前后血流动力学的变化,记录再次狭窄发生率及出血倾向。结果两组患者术前的血液流变学指标比较差异无统计学意义(P>0.05);术后第1天各项指标均较术前差异有统计学意义(P<0.05),疗程结束后各项指标水平均较术后1 d明显降低,恢复至术前水平,差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。观察组60例中发生再狭窄3例,发生率为3.33%;对照组发生再狭窄18例,发生率为30%,观察组显著低于对照组,差异有统计学意义(P<0.05)。观察组和对照组出血倾向者分别为4(6.67%)vs 12例(20.0%),观察组明显低于对照组,差异有统计学意义(χ2=3.905,P<0.05)。未发生严重过敏反应、肝肾功能损害等药物不良反应。结论在常规应用低分子肝素钙的基础上,应用蛭芪胶囊相对于单纯应用低分子肝素钙可以明显降低介入手术术后术后再狭窄的发生。  相似文献   
2.
《Journal of vascular surgery》2020,71(6):1972-1981
BackgroundRestenosis after carotid revascularization is clinically challenging. Several studies have looked into the management of recurrent restenosis; however, studies looking into factors associated with restenosis are limited. This study evaluated the predictors of restenosis after carotid artery stenting (CAS) and carotid endarterectomy (CEA) using a large national database.MethodsPatients undergoing CEA or CAS in the Vascular Quality Initiative data set (2003-2016) were analyzed. Patients with no follow-up (33%) and those who had prior ipsilateral CEA or CAS were excluded. Significant restenosis was defined as ≥70% diameter-reducing stenosis, target artery occlusion or peak systolic velocity ≥300 cm/s, or repeated revascularization. Kaplan-Meier survival analysis and bootstrapped Cox regression models with stepwise forward and backward selection were used.ResultsA total of 35,720 procedures were included (CEA, 31,329; CAS, 4391). No significant difference in restenosis rates was seen between CEA and CAS at 2 years (7.7% vs 9.4% [P = .09]; hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.79-1.25; P = .97). However, after adjustment for age, sex, and symptomatic status at the time of the index operation, CAS patients who had postoperative restenosis were more likely to have a symptomatic presentation (odds ratio, 2.2; 95% CI, 1.2-4.0; P = .01) and to undergo repeated revascularization at 2 years (HR, 1.75; 95% CI, 1.3-2.4; P < .001) compared with patients who had restenosis after CEA. Predictors of restenosis after CAS included a common carotid artery lesion (HR, 1.65; 95% CI,1.06-2.57; P = .03), whereas age (HR, 0.91; 95% CI, 0.84-0.99; P = .03) and dilation after stent placement (HR, 0.53; 95% CI, 0.39-0.72; P < .001) were associated with decreased restenosis at 2 years. Predictors of restenosis after CEA included female sex (HR, 1.55; 95% CI, 1.38-1.74; P < .001), prior neck irradiation (HR, 2.35; 95% CI, 1.66-3.30; P < .001), and prior bypass surgery (HR, 1.29; 95% CI, 1.01-1.65; P = .04). On the other hand, factors associated with decreased restenosis after CEA included age (HR, 0.95; 95% CI, 0.92-0.98; P < .001), black race (HR, 0.57; 95% CI, 0.37-0.89; P = .01), patching (HR, 0.61; 95% CI, 0.47-0.79; P < .001), and completion imaging (HR, 0.70; 95% CI, 0.52-0.95; P = .02).ConclusionsOur results show no significant difference in restenosis rates at 2 years between CEA and CAS. Restenosis after CAS is more likely to be manifested with symptoms and to undergo repeated revascularization compared with that after CEA. Poststent ballooning after CAS and completion imaging and patching after CEA are associated with decreased hazard of restenosis; however, further research is needed to assess longer term outcomes and to balance the risks vs benefits of certain practices, such as poststent ballooning.  相似文献   
3.
Introduction and objectivesNeoatherosclerosis is one of the causes of in-stent restenosis (ISR). Our objective was to evaluate the influence of neoatherosclerosis on prognosis and treatment response in patients with ISR.MethodsThis is a pooled analysis of the optical coherence tomography (OCT)-substudies of 2 multicenter, randomized clinical trials, RIBS IV and V, comparing treatment with paclitaxel-coated balloon vs everolimus-eluting stent in patients with ISR. OCT evaluation was performed at baseline and at 6 to 9 months. Neoatherosclerosis was defined in baseline OCT as neointima with calcified or lipid content. We evaluated the angiographic and OCT results at 6 to 9 months and the occurrence of major adverse cardiovascular events at 3 years of follow-up in patients with and without neoatherosclerosis treated with paclitaxel-coated balloon or everolimus-eluting stents.ResultsSixty-four patients underwent OCT at the time of the index procedure. Neoatherosclerosis was documented in 23 (36%) lesions. Angiographic follow-up at 6 to 9 months showed no differences in restenosis [5 (24%) vs 6 (15%) P = .49], minimum lumen diameter (1.79 ± 0.7 vs 1.94 ± 0.6 mm; P = .41) or late loss (0.33 ± 0.7 vs 0.15 ± 0.5; P = .34) in patients with and without neoatherosclerosis, respectively. Follow-up OCT confirmed the absence of differences in quantitative parameters and the characteristics of tissue coverage between the 2 groups. At 3 years of follow-up, the major adverse cardiovascular events rate was 3 (13%) vs 5 (12%) in the neoatherosclerosis and nonneoatherosclerosis groups (HR, 0.94; 95%CI, 0.22-3.93; P = .93).ConclusionsIn this limited study population, OCT-defined neoatherosclerosis did not seem to influence acute and long-term outcomes in patients randomized to paclitaxel-coated balloon or everolimus-eluting stents for ISR.  相似文献   
4.
目的分析血脂控制水平与经皮冠状动脉介入(PCI)术后再狭窄的相关性。方法选取2016年3月-2018年3月我院收治的行PCI术的冠心病患者60例为研究对象,术后3个月行冠状动脉造影复查,根据有无再狭窄分为再狭窄组(n=28)和无狭窄组(n=32),比较两组一般资料、PCI前和PCI术后复查时的血脂水平,并对各影响因素进行相关性分析。结果再狭窄组的吸烟比例、糖尿病比例比无狭窄组更高;观察组复查时总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白水平均与PCI术前无明显差异(P均>0.05),而无狭窄组总胆固醇、甘油三酯、低密度脂蛋白水平比PCI术前显著降低,且低于PCI术后复查时再狭窄组,高密度脂蛋白较前明显升高,且高于PCI术后复查时再狭窄组(P均<0.05)。多因素分析显示,吸烟、合并糖尿病、PCI术后复查时总胆固醇、甘油三酯、低密度脂蛋白水平未下降,高密度脂蛋白未升高是PCI术后再狭窄的独立危险因素。结论 PCI术后总胆固醇、甘油三酯、低密度脂蛋白水平未下降,高密度脂蛋白未升高是PCI术后再狭窄的独立危险因素。  相似文献   
5.
目的探讨双源Flash CT动脉造影诊断冠状动脉支架内部再狭窄的价值及护理体会。方法选取62例(108枚支架)疑似支架内部再狭窄患者为观察对象,依次给予双源Flash CT动脉造影检查和DSA检查,以DSA检查为金标准,分析CT动脉造影检查的诊断效能。同时根据患者检查期间护理措施的不同将62例患者分为对照组和研究组,每组各31例。其中对照组患者在检查期间实施常规护理措施,研究组在对照组基础上加强护理干预,比较两组护理效果。结果双源Flash CT动脉造影检查阳性检出率13.89%、阴性86.11%;DSA检查阳性检出率11.11%、阴性88.89%,二者对比无明显差异(P>0.05)。以常规冠状动脉造影检查为金标准,双源Flash CT动脉造影检查在支架内再狭窄诊断中的特异性为95.83%、敏感性为91.67%、阳性预测值73.33%、阴性预测值98.92%、准确性95.37%。对比检查期间不同护理方式实施效果发现,研究组检查前汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)评分与对照组相比无明显差异(P>0.05);两组检查后HAMA评分和HAMD评分均低于本组检查前评分(P<0.05);研究组检查后HAMA评分和HAMD评分低于对照组(P<0.05)。结论双源Flash CT动脉造影诊断冠状动脉支架内部再狭窄具有较高的特异性、敏感性和准确性,但在检查期间仍需辅以相应的护理干预措施,以确保检查的顺利进行。  相似文献   
6.
Despite the advent of drug-eluting stents and dual antiplatelet therapy in the interventional management of cardiovascular disease, restenosis rates remain high with significant sequelae. Endovascular brachytherapy—popular in the 1990s and early 2000s—has recently resurfaced as a cost-effective treatment option. In this work, we outline the history of endovascular brachytherapy starting with its earliest promise in the 1990s. We discuss the development of drug-eluting stents and dual antiplatelet strategies and their impact on the perceived benefit of endovascular brachytherapy. For the contemporary era, we propose novel roles for endovascular brachytherapy in complex coronary artery disease and in high-risk patients managed with drug-eluting stents. We discuss the impetus for reducing the requirement and duration of dual antiplatelet therapy using endovascular brachytherapy. We also review innovative opportunities for endovascular brachytherapy after bare-metal stent placement in both coronary and noncoronary territories and offer economic arguments in favor of endovascular brachytherapy. Trials of endovascular brachytherapy in these regimes are merited.  相似文献   
7.
8.
IntroductionMitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable.Aim of the studyThe purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment.Patients and methodsIt is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years.ResultsMean patients age was 31.5 ± 4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02 ± 0.5 cm2 averaged to 2 ± 0.35 cm2. Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58 ± 64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy.ConclusionThe effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth.  相似文献   
9.
10.
目的观察化瘀通脉颗粒干预冠心病经皮腔内冠状动脉介入治疗(PCI)术后再狭窄的临床效果。方法将60例冠心病经PCI治疗患者随机分为对照组和治疗组,治疗组31例,对照组29例。对照组按照常规治疗方法治疗,治疗组在对照组药物基础上加服化瘀通脉颗粒治疗。两组疗程均为6个月。结果治疗组总有效率为83.87%,明显高于对照组的62.07%(P0.05)。治疗组中医症状积分降低较对照组更加明显(P0.05)。治疗组心绞痛和临床再狭窄人数明显少于对照组(P0.05);冠脉CTA再狭窄发生人数治疗组也少于对照组(P0.05)。结论化瘀通脉颗粒具有预防PCI术后再狭窄的作用。  相似文献   
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号