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1.
BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.  相似文献   
2.
Traumatic brain injury (TBI) is often exacerbated by events that lead to secondary brain injury, and represent potentially modifiable causes of mortality and morbidity. Diffusion tensor imaging was used to characterize tissue at-risk in a group of 35 patients scanned at a median of 50 hours after injury. Injury progression was assessed in a subset of 16 patients with two scans. All contusions within the first few days of injury showed a core of restricted diffusion, surrounded by an area of raised apparent diffusion coefficient (ADC). In addition to these two well-defined regions, a thinner rim of reduced ADC was observed surrounding the region of increased ADC in 91% of patients scanned within the first 3 days after injury. In patients who underwent serial imaging, the rim of ADC hypointensity was subsumed into the high ADC region as the contusion enlarged. Overall contusion enlargement tended to be more frequent with early lesions, but its extent was unrelated to the time of initial imaging, initial contusion size, or the presence of hemostatic abnormalities. This rim of hypointensity may characterize a region of microvascular failure resulting in cytotoxic edema, and may represent a ‘traumatic penumbra'' which may be rescued by effective therapy.  相似文献   
3.
[目的]总结重症胸外伤连枷胸伴肺挫伤的临床经验.[方法] 回顾分析2006年1月至2011年6月期间在本院诊治的连枷胸伴肺挫伤92例,其中通过手术进行肺修补,胸腔血肿清除,同时应用记忆合金环抱式接骨板对重点肋骨骨折行内固定等治疗的52例,与同期非手术组40例比较,比较其临床疗效.[结果] 随访3~6个月,所有病例均治愈,全组无死亡病例.手术组胸廓畸形率、住院时间、抗生素使用时间、ICU住院时间、中度以上的疼痛、呼吸支持天数、肺部感染率均明显低于非手术组(P〈0.05,P〈0.01).[结论]应用记忆合金环抱式接骨板行重点部位肋骨骨折内固定治疗连枷胸伴肺挫伤,可以减少并发症,有利于患者的快速康复.  相似文献   
4.
目的 采用超声回波强度界面多级分解法定量评价急性钝挫伤后人体肌肉高频超声二维图像纹理特征的变化,初步探讨其临床应用价值。方法 采用高频超声检测10例男性上臂肌肉单纯急性挫伤患者的局部肌肉二维超声图像,于脱机状态下通过Matlab 7.0软件选取患者同一图像上的肌纹理正常感兴趣区(ROI)和肌纹理疑似损伤ROI,提取两个ROI的纹理灰度值的均值(Mean)、灰度值的标准差(SDev)、纹理的密致性(NOB)、纹理基元形状的不规则度(IRGL)、纹理基元的平均大小(SOB)、纹理分布的均匀性(HOD)、纹理分布的方向性(DOD)和纹理分布的周期性(POD)8个特征参数,采用超声回波强度界面多级分解法自动计算两个ROI之间8个纹理特征的相似度差值。选取10名男性健康志愿者同部位正常肌肉二维超声图像作为对照,任意选取两个ROI,计算两个ROI之间上述8种纹理特征的相似度差值。对上臂肌肉挫伤患者和健康志愿者8个纹理特征的相似度差值进行对比分析。结果 急性上臂肌肉挫伤区局部肌束回声增强,肌纤维层次紊乱,纹理模糊,回声变化较周边肌纹理正常区显著。急性上臂肌肉挫伤患者肌纹理疑似损伤ROI和肌纹理正常ROI之间IRGL、DOD、POD、Mean和SDev等5个纹理特征相似度差值与健康志愿者任意两个ROI之间该5个纹理特征相似度差值差异有统计学意义(P均<0.01)。结论 基于超声回波强度界面多级分解法的计算机辅助定量评价技术能够对急性挫伤后肌肉高频超声二维图像纹理特征变化做出较人眼识别更精细的量化诊断,可能具备一定的临床实用价值。  相似文献   
5.
杨俊海  张海燕 《医学临床研究》2009,26(10):1840-1842
【目的】探讨严重心肌挫伤(Sever Myocardiac Contusion,SMC)早期血浆内皮素(ET)、血清白介素-8(IL-8)水平的改变及生脉注射液的治疗作用。【方法】选取健康新西兰大白兔24只,随机分为三组:对照组(伪撞击组)、严重心肌挫伤组(SMC组)、生脉注射液治疗组(SIT组),每组8只。利用BIM-Ⅱ型水平式生物撞击机制备兔SMC模型,制模后10min对照组及SMC组由耳缘静脉静滴生理盐水4mL/kg,SIT组静滴生脉注射液4mL/kg。各组分别于伤前30min、伤后30min、1h、2h、3h、4h、6h、8h自股静脉采血,分别测血清IL-8、ET含量。【结果】对照组血浆ET、血清IL-8在各时点无明显变化。SMC组伤后各时点血浆ET、血清IL-8含量均增高并高于对照组相应时间点(P〈0.05)。SIT组在撞击后血浆ET、血清IL-8含量高于撞击前,与对照组相应时间点比较也有不同程度的升高,但显著低于SMC组各时间点(P〈0.05)。【结论】兔SMC后血浆ET、血清IL8水平显著升高,生脉注射液能有效降低二者水平。  相似文献   
6.
目的:探讨肝脏顿挫伤CT诊断标准及CT分级的临床应用价值。资料与方法:回顾性分析1997~2004年在我院CT诊断为肝脏顿挫伤的病例147例,外科手术证实58例。结果:肝脏被膜下血肿95例,肝脏实质挫伤68例,肝脏撕裂伤23例,腹血16例,死亡8例。结论:CT是诊断肝脏顿挫伤的首选检查方法,具有方便、快速、准确和可重复的优点。依据CT表现结合临床作出的分级标准对临床治疗具有重要的指导意义。  相似文献   
7.
盛豫  关娟 《医学临床研究》2006,23(7):1053-1055
【目的】研究挫伤眼早期视网膜中央动脉血流与视力下降的关系。【方法】采用彩色多普勒超声检查测定52例早期眼外伤患者的视力和视网膜中央动脉的收缩期峰速(PSV),舒张末期流速(EDV),阻力指数(RI)和流量(V)。【结果】与未伤眼组的比较,视力和V值两组数据差异有显著性(P〈0.05),外伤组的PSV、EDV及RI值之间的差异无显著性(P〉0.05);外伤组的相关数据行多元线性回归分析,发现视力仅与流量(v)呈现直线正相关(Y=0.273+0.03724x),差异有显著性(F=8.687,P=0.005)。【结论】眼外伤早期,患者视网膜中央动脉血流量下降明显,视力与视网膜中央动脉的血流量呈线性正相关。当PSV、EDV及RI值变化不明显时,血流量可作为另一个参考数据。  相似文献   
8.
脑挫裂伤后细胞凋亡及其相关基因的研究   总被引:2,自引:0,他引:2  
目的 探讨脑挫裂伤患者的细胞凋亡及其相关基因的表达。方法 31例脑挫裂伤患者因颅内占位效应而行开颅减压术,术中切除部分脑组织,其中10例脑挫裂伤周围非坏死组织检测到细胞凋亡。TUNEL法检测细胞凋亡,免疫组化法检测细胞凋亡相关基因p53、bcl-2与bax的表达。结果 全部患者均表达bax,6例表达bcl-2,8例患者检测到TUNEL阳性细胞,1例p53阳性,bcl-2表达阳性患者预后好于bcl-2阴性患者。结论 脑挫裂伤患者主要的病理改变为坏死,然而细胞凋亡可以造成继发的脑损害。bcl-2表达阳性的患者预后更佳。促进bcl-2表达或抑制bax表达来预防细胞凋亡具有重要的临床意义。  相似文献   
9.
人脑挫裂伤后神经细胞凋亡的研究   总被引:1,自引:0,他引:1  
目的:研究人脑挫裂伤后神经细胞的凋亡及意义。方法:用末端脱氧核苷酸转移酶介导的dUTP-生物素标记法(TUNEL)检测15例挫裂伤中层得手术中获得脑组织神经细胞的凋亡。结果:10例(66)患者脑组织标本中出现TUNEL阳性细胞,阳性细胞出现与否与患者生存无明显关系(P>0.005,F检验)。结论:人脑挫裂伤后神经细胞的确发生了凋亡。这对从凋亡角度认识脑外伤有重要意义。  相似文献   
10.
BACKGROUND: Previous studies have found the e4 allele of the apolipoprotein E gene (APOE e4) is associated with an unfavourable outcome after head injury, but this has not been related to specific pathological features. OBJECTIVES: This study tested the postulate that head injured patients with APOE e4, amounting to approximately a third of the population, are selectively predisposed to one or more of the different pathological features that constitute the response to traumatic brain injury (TBI), and that this underlies the association of APOE e4 with poor clinical outcome. METHODS: Included in the study were 239 fatal cases of TBI (1987-1999) for which APOE genotypes were determined from archival tissue. For each case, specific pathological features of trauma were recorded by researchers blinded to the APOE e4 status. Of the 239 cases examined, 83 (35%) were APOE e4 carriers and 156 (65%) were non-carriers. RESULTS: Possession of APOE e4 was associated with a greater incidence of moderate or severe contusions (42% v 30% for carriers versus e4 non-carriers; p = 0.05) and there was a trend towards a greater incidence of severe ischaemic brain damage (54% v 42%; p = 0.08). Significant differences were not noted between the other pathological features examined. CONCLUSIONS: Possession of APOE e4 is associated with a greater incidence of moderate/severe contusional injury and severe ischaemic brain damage in fatal cases of TBI. This may be relevant to the relatively poor outcome from traumatic brain injury in patients with APOE e4 identified in clinical studies.  相似文献   
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