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1.
Background: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of “initial anuria” and rapid RRFD on the long-term prognosis of CAPD patients.♦ Method: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the “anuria” group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a “slow decliner” group (n = 114), and a “rapid decliner” group (n = 114). The maximal observation period was 120 months.♦ Results: Logistic regression tests indicated that the “anuria” group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 – 23.28), and female (OR: 0.29, 95% CI: 0.09 – 0.90), while the “fast decliner” group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 – 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 – 1.21), and male (OR: 1.12; 95% CI: 1.04 – 1.21). After adjusting for DCS, the “fast decliner” group (hazard ratio [HR]: 0.37; 95% CI: 0.17 – 0.80) showed a better outcome than that of the “anuria” group (reference = 1). Both baseline RRF (β = -0.24; p < 0.001) and DCS (β = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 –.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 – 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 – 0.99) was significant for better survival in CAPD patients with DCS > 0.♦ Conclusion: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.  相似文献   
2.
《Renal failure》2013,35(6):937-946
In this study, superoxide dismutase (SOD) and catalase activities were determinated in the erythrocytes (RBC) from patients with chronic renal failure. The study included healthy subjects (n = 7), patients on hemodialysis (HD) using polyacrylonitrile-type dialysis membrane (before and after HD) (n = 10), patients on HD using cuprophane-type dialysis membrane (before and after HD) (n = 6), and patients on continuous ambulatory peritoneal dialysis (CAPD) (n = 11). A significant decrease in SOD activity was found in HD groups using polyacrylonitrile- or cuprophane-type dialysis membrane. SOD activity was found to increase in patients undergoing CAPD. We have found that CAT activity is higher in all the CRF groups in respect to the control: with polyacrylonitrile-type dialysis membrane, with cuprophane-type dialysis membrane, and in CAPD treatment.  相似文献   
3.
《Renal failure》2013,35(2):179-183
Anemia is the main problem for patients suffering from end stage renal disease (ESRD). This study aimed to determine whether the index of rigidity (IR), that shows red blood cells (RBCs) deformability and the possible IR disturbances can provide an explanation about the cause of anemia, in patients undergoing maintenance hemodialysis (HD) or on peritoneal dialysis. The IR was determined in 39 hemodialyzed patients, who were already in dialysis for a period of time ranging from 16 to 120 months (mean ± SD = 41.8 ± 24.1) (Group A). Furthermore, the IR was measured in 32 patients on continuous ambulatory peritoneal dialysis (CAPD), who were in CAPD for a period of time ranging from 6 to 60 months (mean ± SD = 10.7 ± 9.9) (Group B). Finally, the IR was determined in 17 normal individuals (group C). The RBCs IR was measured twice in group A (before and after the end of a hemodialysis session) and once in groups B and C. The IR was determined by hemorrheometry (method of filtration), using special equipment. In group A the IR was increased in comparison to the control group (C) (17.9 ± 6.2 vs. 10.2 ± 1.8, p < 0.0001). This increase was even higher in the measurement at the end of the hemodialysis session (paired t‐test, p < 0.0001). The RBCs IR in CAPD patients was significantly lower than that of HD patients (12 ± 3.8 vs. 17.9 ± 6.2, p < 0.0001) and was not statistically different from the control group (12 ± 3.8 vs. 10.2 ± 1.8, p = 0.068). It is concluded from the study that: 1) in HD patients occur disturbances in the deformability of the RBCs, that are worsened by the hemodialysis session; 2) the index of rigidity of RBCs is significantly higher in the HD patients than in CAPD patients; 3) in patients on CAPD, the disturbance of deformability of the RBCs was less in comparison to the control group, which however does not reach the statistically significant levels.  相似文献   
4.
《Renal failure》2013,35(2):230-236
Abstract

Background/Aim: Besides peritonitis, the most common complication, indicators of chronic inflammation are also present in patients treated by peritoneal dialysis. The aim of this study was to analyze the predictive value of inflammatory parameters on mortality of continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Eighty-seven patients (57 males), aged from 30 to 85 [62.92 (10.61)] years who had been treated by a chronic program of CAPD for 3–113 months were analyzed. The basal period lasted 3 months with a follow-up of 30 months. Clinical parameters, dialysis adequacy and laboratory parameters including some inflammatory markers: serum amyloid-A (SAA), high sensitive C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR) and leukocytes were determined for each patient. Cox regression analysis selected the parameters of univariate and multivariate survival analysis.

Results: During the follow-up period, 37 patients (42.5%) died. Univariate analysis selected the following potential mortality predictors (p?<?0.10): age, months on CAPD, residual urine output, presence of cerebrovascular insult (CVI), KT/V, serum urea and albumin concentrations, SAA, hs-CRP, fibrinogen and ESR. In the multivariate survival analysis four models were created, each with a single inflammatory parameter. In all of these models, besides the age and CVI, inflammatory parameters were the most significant mortality predictors. When the inflammatory markers were analyzed altogether, multivariate analysis established that independent mortality predictors in this group of patients were: SAA, age and CVI. Conclusion: It may be concluded that in this studied group treated by CAPD, SAA was the most significant independent mortality predictor among the analyzed inflammatory markers.  相似文献   
5.
【】目的 研究冬虫夏草制剂对残肾功能较好的持续非卧床腹膜透析(CAPD)患者的疗效。 方法 选择病情稳定、残肾功能较好的48例CAPD患者,治疗组和对照组各24例。治疗组在常规治疗的基础上给予冬虫夏草制剂,随访6个月。于研究开始和每3个月测定一次残肾肾小球滤过率(rGFR)和24h尿量,作为残肾功能的评价指标。用血白蛋白(Alb)和改良主观综合性营养评估法(SGA)评估患者营养状况。结果 研究开始时两组患者在性别、年龄、透析剂量、葡萄糖暴露量、24h尿量、rGFR、血Alb和SGA评分方面均无显著差异。6个月后,治疗组残肾功能保持稳定,rGFR、24h尿量无显著变化;对照组的rGFR和24h尿量随着腹透时间延长而逐渐下降,显著低于治疗前和同期治疗组的rGFR和24h尿量(P<0.01)。治疗组的血Alb显著高于治疗前和同期对照组(P<0.05)。结论 随着透析时间延长,CAPD患者的残肾功能呈下降趋势,冬虫夏草制剂能够保护患者的残肾功能,改善营养状态。  相似文献   
6.
Refeeding syndrome is defined as severe electrolyte and fluid shifts associated with metabolic abnormalities in malnourished, refeeding patients. Hypophosphatemia is its predominant concern, though its occurrence is unusual in uremic patients due to the concomitant hyperphosphatemia. This case study reports a 56-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) therapy who was admitted for peritonitis. Ileus and diarrhea developed during admission; enteral feeding was given initially and then shifted to total parenteral nutrition (TPN) because of poor digestion. A lower concentration of phosphate was administered in the TPN formula initially due to high initial serum phosphate level. However, severe hypophosphatemia (0.3 mg/dL) developed on the second day after TPN supplementation. Continuous intravenous phosphate (total 6 mmol of phosphate) was supplied immediately. Unfortunately, the sudden onset of conscious loss and cardiac arrest happened on the third day of TPN. It should be emphasized that severe refeeding hypophosphatemia can also develop early in uremic patients with hyperphosphatemia.  相似文献   
7.
目的 评估维持性血液透析(MHD)与持续非卧床腹膜透析(CAPD)患者生活质量情况,探讨MHD和CAPD患者生活质量的影响因素.方法 选取2016年7月~9月在郑州大学第一附属医院肾脏内科和血液净化中心随访的118例MHD患者和76例CAPD患者的临床和问卷调查资料.采用KDQOL-SFTM 1.3进行问卷分析,评估MHD与CAPD患者的生活质量.结果 MHD患者KDTA评分为(62.4±11.3)分,SF-36评分为(58.3±17.9)分,明显低于一般人群(P<0.05).在各分维度评分中11个分维度评分略高于美国,6个分维度评分略高于西班牙;与国内广州调查数据相比,各维度评分均有明显改善,且与沈阳和合肥调查数据持平.CAPD患者KDTA评分为(71.4±8.9)分,SF-36评分为(61.6±16.3)分,明显低于一般人群(P<0.05).在各分维度评分中7个分维度显著高于中国香港,其余均较中国香港偏低;与国内广州调查数据相比各维度评分均有明显改善,且与沈阳和合肥调查数据持平.MHD患者KDTA和SF-36整体评分显著低于CAPD患者(P<0.05).在KDTA各分维度评分中,CAPD患者均高于MHD患者,且在肾脏疾病对日常生活的影响(EKD)、肾脏疾病导致的生活负担(BKD)、工作情况(WS)、认知功能(CF)、社交质量(QSI)、性功能(SexF)、社会支持(SoS)、患者满意度(PS)方面差异明显(P<0.05);在SF-36评分中在生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、情感状况(EWB)、情感职能(RE)各维度中,CAPD组患者均高于MHD患者且差异明显(P<0.05).对于MHD患者,生活质量在性别、文化程度、家庭年收入、医保情况、原发病因、透析龄方面存在差异(P< 0.05),且在SGA评分、血白蛋白(ALB)、血红蛋白(HB)、尿素清除指数(Kt/V)、甲状旁腺激素(iPTH)、钙磷乘积(Ca×P)方面均存在相关性(P<0.05).透析龄、性别(女)、原发病(糖尿病肾病)、iPTH、Kt/V、SGA评分是影响MHD患者生活质量的独立危险因素;对于CAPD患者,职业状况、医保情况、原发病因、透析龄方面存在差异(P<0.05),且在SGA评分、ALB、HB、Kt/V方面存在相关性(P<0.05),原发病(糖尿病肾病)、Kt/V、ALB、SGA评分是影响CAPD患者生活质量的独立危险因素.结论 MHD患者和CAPD患者整体生活质量较低,与发达国家和地区存在差距;CAPD和MHD患者生活质量均受不同因素影响,其中原发病(糖尿病肾病)、Kt/V、SGA评分是共同独立影响因素.  相似文献   
8.

Background:

Fructo-oligosaccharides (FOS) exhibit soluble-fiber properties that beneficially affect bowel function and relieve constipation. The effects of FOS supplementation on constipation and biochemical parameters were examined in elderly continuous ambulatory peritoneal dialysis (CAPD) patients.

Methods:

This randomized, double-blind, placebo-controlled, cross-over study was performed in elderly CAPD patients (5 males and 4 females) with chronic constipation. All subjects were randomly assigned to receive either 20 g FOS or placebo daily for 30 days. After a 14-day washout period, the patients were switched to the other substance for 1 more month. Before and after each treatment period, frequency of defecation, characteristics of feces, and colonic transit were evaluated. Biochemical parameters were also assessed.

Results:

Fructo-oligosaccharides significantly increased the frequency of defecation (10.5 ± 2.0 vs 6.2 ± 1.4 times per week, p < 0.005) and changed the feces'' appearance from type 1 (nut-like) to type 4 (sausage–like). The colonic transit determined by geometric center (GC) was augmented after FOS supplementation (3.9 ± 0.3 vs 3.2 ± 0.4, p < 0.05). Fructo-oligosaccharides had no effects on biochemical parameters. Fructo-oligosaccharides caused mild discomforts which were well tolerated after dose adjustment.

Conclusions:

Fructo-oligosaccharide supplementation is effective, well tolerated, and can be an alternative to other laxatives in CAPD patients with constipation. Further studies are needed to better assess the biochemical effects of FOS in the chronic kidney disease population.  相似文献   
9.
Background: Peritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD).♦ Methods: A retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes.♦ Results: Early peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p < 0.001, p < 0.001, respectively). In the multivariate Cox regression model, early peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 - 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 - 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 - 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 - 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 - 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 - 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = -0.64, p < 0.001).♦ Conclusions: Time to first peritonitis is significantly correlated with clinical outcomes of peritonitis patients with early peritonitis patients having poor prognosis. Patients with shorter time to first peritonitis were prone to having a higher peritonitis rate.  相似文献   
10.
Objective: Peritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes.♦ Methods: Our retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality.♦ Results: The peritonitis rate was 0.196 episodes per patient-year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis (p < 0.001). Kaplan-Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free (p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD (p = 0.03).♦ Conclusions: The peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified.  相似文献   
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