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柏璐  白淑芳  卓娜  杨荣  赵丽莎  王欢 《华南预防医学》2022,48(12):1492-1495
目的 调查西安市建档建册孕妇高危因素及不良妊娠结局,并分析影响不良妊娠结局的相关因素。方法 以2020年1月至2022年1月西安市某医院产科建档建册的孕妇为研究对象,根据高危妊娠情况对建档建册孕妇进行高危妊娠风险评估,并跟踪妊娠结局,分析基本情况以及高危因素对不良妊娠结局的影响。结果 本研究共纳入建档建册孕妇6 332名,其中1 508例高危妊娠者,占29.97%。高危因素分布依次为异常妊娠史(43.63%)、妊娠高血压(33.69%)、年龄≥35岁(26.86%)、妊娠糖尿病(19.83%)、瘢痕子宫(13.59%)、产前出血(12.86%)、前置胎盘(8.55%)。6 332名孕妇中发生不良妊娠结局452例,占7.14%。多因素Logistic回归分析显示,年龄≥35岁(OR=1.581)、孕前BMI≥28.0 kg/m2OR=1.432)、异常妊娠史(OR=2.121)、产前出血(OR=1.464)、前置胎盘(OR=1.766)、高危妊娠因素数量(OR=2.667)和妊娠风险等级(OR=3.367)是建档建册孕妇不良妊娠结局发生的独立影响因素。结论 高危妊娠相关因素是影响建档建册孕妇发生不良妊娠结局的主要危险因素,应重视对高危妊娠孕妇的健康管理,及时采取相应的干预措施,以期改善妊娠结局。  相似文献   
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《Journal of endodontics》2022,48(4):479-486
IntroductionAsepsis in endodontics aims to control all potential sources of infection. Inadvertent introduction of bacteria into the root canal system may occur when the aseptic chain is breached during treatment. Therefore, measures are taken to prevent such microbial access and establish an aseptic environment. This study aimed to assess potential bacterial contamination and the potential risk of iatrogenic introduction from 7 sites comprising surfaces, instruments, and files acquired during the treatment of 30 vital, pulpitic teeth.MethodsBacterial samples were collected from access burs, files, endodontic rulers, rubber dam surfaces, gloves, and instruments. Genomic DNA was extracted and quantified by quantitative polymerase chain reaction. Bacterial types were determined using next-generation sequencing.ResultsHigh frequencies of contamination and microbial numbers were encountered in all sample types examined.Thirty-eight percent of the initial files introduced into the root canal had significant levels of bacteria at the point of obturation, including endodontic pathogens. Around half of the rubber dam surfaces were contaminated with substantial bacterial loads at the time of obturation, and bacteria were also detected in 20%–30% of gloves, instruments, and rulers before obturation. Next-generation sequencing revealed the predominant oral or endodontic origin of these contaminants, with the following genera identified: Streptococcus, Rothia, Granulicatella, Cutibacterium, Corynebacterium, Peptostreptococcus, and Fusobacterium. Together, these findings highlight the potential risk of reintroducing endodontically relevant bacteria during treatment.ConclusionsGloves, rubber dams, instruments, and files acquire bacterial contamination during treatment at high frequencies and loads. This highlights the potential risk of iatrogenic contamination at the clinically vulnerable point of canal obturation. Measures to address these may improve clinical outcomes.  相似文献   
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目的:观察左炔诺孕酮宫内缓释系统联合戈舍瑞林治疗子宫内膜不典型增生(AEH)患者的效果。方法:回顾性分析2019年10月至2020年10月该院收治的86例AEH患者的临床资料,根据治疗方案不同分为观察组和对照组各43例。对照组应用戈舍瑞林治疗,观察组在对照组基础上联合左炔诺孕酮宫内缓释系统治疗,比较两组子宫内膜厚度、月经失血图(PBAC)评分、性激素[促黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇(E2)]水平、肿瘤相关因子水平、临床疗效和不良反应发生率。结果:治疗后,观察组子宫内膜厚度、PBAC评分及LH、FSH、E2、血清人附睾蛋白4(HE4)和血管内皮生长因子(VEGF)水平均低于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率为97.67%,明显高于对照组的81.40%,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:左炔诺孕酮宫内缓释系统联合戈舍瑞林治疗AEH患者可提高治疗总有效率,降低子宫内膜厚度、PBAC评分、LH、FSH、E2和肿瘤相关因子水平,效果优于单纯戈舍瑞林治疗。  相似文献   
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目的:研究活血复健汤的作用机理及其在缺血性脑卒中(CIS)治疗中的应用价值。方法:将某院收治的56例CIS患者随机分为X组和X+H组各28例,分别行单纯西药治疗、西药+活血复健汤治疗。于两组患者治疗前后,采用美国国立卫生研究院卒中量表对患者的神经功能进行评价,评价临床干预有效率,并检测血清hs-CRP、IL-6、TNF-α。结果:X+H组患者美国国立卫生研究院卒中量表评分要比X组低(P<0.05),X+H组患者临床干预有效率为92.86%,高于X组的75%(P<0.05);X+H组患者血清hs-CRP、IL-6、TNF-α均低于X组(P<0.05)。结论:在常规西药治疗的基础上联合活血复健汤治疗能进一步提高治疗效果,改善神经功能及机体炎症反应。  相似文献   
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BackgroundAdverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs.ObjectivesThis trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12–24 months following hospital discharge.MethodsThe study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression.SummaryIt is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge.  相似文献   
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BackgroundCalcium chloride is commonly used in emergency departments in the treatment of a variety of emergencies. Historically, administration via central venous catheters has been preferred owing to its high osmolarity and vesicant properties. Although preferred, central access may not always be available in time-sensitive, emergent situations leading to many instances of peripheral administration. The objective of this analysis was to evaluate the charted safety of peripheral venous administration of 10% calcium chloride.MethodsA single-center retrospective chart review was performed in patients who received 10% calcium chloride in the adult emergency department evaluating for the incidence of infusion-related adverse events. Patients were excluded if they were less than 18 years of age or had a lack of catheter documentation during 10% calcium chloride administration or if the 10% calcium chloride was documented as given through a central venous catheter.ResultsA total of 72 administrations were evaluated. Patients were predominantly male (67%), with a median age of 55 years and body mass index of 29.2. The primary outcome demonstrated that 4 infusion-related adverse events occurred (6%) with grade 1 (n = 1) and grade 0 (n = 3) documented incidence of infusion-related adverse events. None of the documented incidence of infusion-related adverse events resulted in permanent tissue injury, and all patients had conservative management.DiscussionThis study demonstrated that administration of 10% calcium chloride via peripheral venous catheters may be feasible and seemed to carry a low incidence of documented complications. Further prospective studies are needed to confirm study observations.  相似文献   
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目的探讨右美托咪定联合舒芬太尼自控静脉镇痛(PCIA)对妇科腹腔镜手术患者术后镇痛效果、炎症细胞因子及早期恢复的影响。方法选择2019年9月—2020年9月在该院接受妇科腹腔镜手术的100例患者作为研究对象。采用随机数表法均分两组,各50例。对照组给予舒芬太尼镇痛,观察组给予右美托咪定联合舒芬太尼镇痛。比较两组术后恢复情况,分析两组术后镇痛,记录麻醉诱导前(T0)、术毕(T1)、术后6 h(T2)及术后24 h(T3)时白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)变化,统计两组术后不良反应发生情况。结果观察组呼唤睁眼时间、定向力恢复时间及首次肛门排气时间均短于对照组(均P<0.05),两组术后住院时间比较,差异无统计学意义(P>0.05);两组患者T1、T2及T3时的拉姆齐镇静评分(RSS)和数字疼痛分级法(NRS)评分逐渐下降,观察组T1和T2时的RSS评分明显高于对照组,而NRS评分低于对照组(P<0.05);两组患者T1、T2及T3时的IL-6、IL-10及TNF-α表达水平均高于T0时,且观察组患者T1、T2及T3时的IL-6、TNF-α表达水平均低于对照组,IL-10表达水平高于对照组(P<0.05);观察组术后不良反应发生率(6.00%)低于对照组的22.00%(P<0.05)。结论右美托咪定联合舒芬太尼PCIA可提高妇科腹腔镜手术患者术后镇痛效果,抑制炎性反应,促进术后早日恢复,减少不良反应发生,临床运用价值较高。  相似文献   
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A delayed haemolytic transfusion reaction (DHTR) encompasses a positive direct antiglobulin test (DAT) developed anytime between 24 hours to 28 days after cessation of transfusion, a positive eluate or a newly identified alloantibody in the plasma or serum along with features of haemolysis in the patient. Routinely, it is expected that with the transfusion of one unit of packed red cells in a patient of average height and weight, the haemoglobin level and hematocrit increase by 1 g/dL and 3% respectively. However, in a patient with DHTR, an inadequate rise of post-transfusion haemoglobin (< 1 g/dL) or rapid fall in haemoglobin back to pre-transfusion levels is observed. Kidd antibodies are particularly known to cause DHTR, maybe alone or in unison with other antibodies. Detection of these alloantibodies is consequential in providing good transfusion support to these patients. These events may be difficult to detect as they may present as varied clinical features or immunological nuisances. In this case series, we have presented three cases of DHTR with special emphasis on their clinical presentations, immunohaematological evaluations, laboratory parameters and the role of proper transfusion support in these patients to avoid further complications.  相似文献   
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