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   12265篇
  免费   497篇
  国内免费   111篇
耳鼻咽喉   20篇
儿科学   623篇
妇产科学   368篇
基础医学   602篇
口腔科学   71篇
临床医学   1536篇
内科学   1122篇
皮肤病学   62篇
神经病学   179篇
特种医学   326篇
外国民族医学   1篇
外科学   2840篇
综合类   1732篇
预防医学   1439篇
眼科学   45篇
药学   1137篇
  6篇
中国医学   321篇
肿瘤学   443篇
  2023年   128篇
  2022年   312篇
  2021年   356篇
  2020年   338篇
  2019年   322篇
  2018年   318篇
  2017年   319篇
  2016年   315篇
  2015年   361篇
  2014年   844篇
  2013年   759篇
  2012年   846篇
  2011年   927篇
  2010年   662篇
  2009年   639篇
  2008年   560篇
  2007年   641篇
  2006年   532篇
  2005年   470篇
  2004年   443篇
  2003年   330篇
  2002年   289篇
  2001年   225篇
  2000年   212篇
  1999年   172篇
  1998年   160篇
  1997年   114篇
  1996年   104篇
  1995年   115篇
  1994年   104篇
  1993年   85篇
  1992年   82篇
  1991年   69篇
  1990年   104篇
  1989年   73篇
  1988年   70篇
  1987年   55篇
  1986年   41篇
  1985年   44篇
  1984年   35篇
  1983年   15篇
  1982年   35篇
  1981年   43篇
  1980年   27篇
  1979年   28篇
  1978年   31篇
  1977年   22篇
  1976年   27篇
  1975年   16篇
  1973年   14篇
排序方式: 共有10000条查询结果,搜索用时 15 毫秒
1.
ObjectivesTo examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services.DesignRetrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care.Setting and ParticipantsAdults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913).MethodsA multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up.ResultsThe cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson’s disease, Alzheimer’s disease and related dementias, and hip fracture.Conclusions and ImplicationsThis study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.  相似文献   
2.
目的 探讨维生素C在食管碘染色内镜黏膜下剥离术(ESD)中的临床应用效果。方法 回顾性分析重庆大学附属涪陵医院2020年1月-2021年9月68例食管癌前病变患者的临床资料,均在碘染色后行ESD。术前胃内注入0.4%维生素C生理盐水40 mL,再行食管碘染色,碘染色完成病变标记后,用0.4%维生素C生理盐水20 mL冲洗食管,再用生理盐水冲洗,然后行手术的患者为A组(n = 31);食管碘染色完成病变范围标记,常规生理盐水冲洗碘液,然后行手术的患者为B组(n = 37)。分析两组患者手术时间、标本横径、咽喉部不适、胸腹部疼痛评分、镇痛药物使用率和术后胃体内镜下黏膜情况。结果 A组和B组患者咽喉部不适、手术时间和标本横径比较,差异均无统计学意义(P > 0.05);A组和B组胸腹部疼痛评分分别为(1.29±0.59)和(3.54±1.26)分,两组患者比较,差异有统计学意义(t = 9.13,P = 0.001);A组镇痛药使用率为0.00%(0/31),与B组镇痛药使用率13.51%(5/37)比较,差异有统计学意义(P = 0.042);两组患者内镜下胃体黏膜情况变化比较,差异有统计学意义(χ2 = 26.15,P = 0.000)。结论 食管碘染色ESD术前胃底注入维生素C生理盐水,碘染色完成病变标记后,再予以维生素C生理盐水冲洗,可明显减轻患者术后疼痛,增加患者舒适感,值得在临床推广应用。  相似文献   
3.
BackgroundStaphylococcus epidermidis is a common cause of health care-associated bacteremia, especially in patients with an indwelling medical device. However, S. epidermidis is an uncommon causative organism in catheter-associated urinary tract infection, and rare pyelonephritis without any indwelling urinary device. To our knowledge, there are few cases reported of bacteremia secondary to urinary tract infection. We report two cases of pyelonephritis with bacteremia by S. epidermidis in male patients with unilateral nephrolithiasis and review prior case reports.Case presentationCase 1: 74-year-old man with a history of diabetes and overactive bladder had fever and pyuria with a right nephrolithiasis on abdominal CT scan. Case 2: 79-year-old man with a history of diabetes and post-myocardial infarction status had fever with a left nephrolithiasis on abdominal CT scan. In both cases, both the urine culture collected at ureteral stenting and blood culture were positive for S. epidermidis. We initiated intravenous antibiotics in these patients in addition to ureteral stenting.ConclusionsS. epidermidis is acknowledged as an uncommon pathogen that can cause bacteremia secondary to pyelonephritis without an indwelling urinary device. Clinicians should consider the possibility of pyelonephritis due to S. epidermidis if the pathogen is identified in blood and urine in patients with nephrolithiasis.  相似文献   
4.
背景 孕产妇尿失禁(UI)发病率高,严重影响了女性生活质量。研究表明,盆底肌训练是UI有效的防治手段,本研究前期进行了一项随机对照试验(RCT),结果发现相比于常规宣教,基于移动医疗APP的盆底肌训练并未显现出预防优势,其原因需要进一步深入探讨。 目的 本研究拟对一项基于APP的妊娠期盆底肌训练的干预研究的阴性结果进行探索性分析,旨在探讨产后UI预防效果的影响因素以及获益的亚组人群。 方法 本研究数据来源于前期开展的一项RCT,采用方便抽样法,于2020年6—10月在南方医科大学深圳医院产科门诊招募了126例研究对象,采用随机数字表法分为干预组与对照组,每组各63例。对照组采用常规护理,干预组在此基础上使用"有爱屋"APP进行尿失禁自我管理,干预周期为2个月。产后42 d随访时收集两组产后相关资料,包括产后42 d UI发生情况。以产后是否发生UI为结局指标,将研究对象分为病例组和对照组,采用Logistic回归分析探讨混杂因素及其与干预方式之间的交互作用对产后UI发生的影响。针对Logistic回归分析的结果进行分层分析,探讨是否存在能从APP干预中获益的亚组人群。 结果 病例组和对照组阴道分娩史、入组时存在UI、Broome盆底肌自我效能量表(BPMSES)得分比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,入组时存在UI是产后发生UI的危险因素〔OR=15.897,95%CI(4.724,53.495),P<0.001〕;BPMSES得分与干预方式的交互作用可影响产后UI的发生〔OR=1.034,95%CI(1.017,1.051),P<0.001〕。分层分析结果显示,入组时存在UI症状的孕妇,干预组产后UI发生率低于对照组(χ2=4.18,P=0.041);入组时不存在UI症状的孕妇,两组产后UI发生率比较,差异无统计学意义(χ2=1.89,P=0.284)。 结论 推荐有UI症状的孕妇使用"有爱屋"APP或许可预防产后UI的发生。而对于妊娠期没有UI症状的人群使用"有爱屋"APP预防产后UI发生的证据尚不充分。另外,不管有无UI症状,盆底肌训练自我效能高的孕妇有望从APP干预中获益。  相似文献   
5.
BackgroundFimH adhesin is proposed to enhance Escherichia coli kidney infection by acting with PapGII adhesin, but genetic epidemiology study and animal study have not been widely conducted to confirm this hypothesis.MethodsWe compared the prevalence of adhesin gene and their coexistent pattern between upper and lower urinary tract infection (UTI) strains. fimH mutant (EC114FM), papGII mutant (EC114PM) and fimH/papGII double mutant (EC114DM) were constructed from a pylonephritogenic strain (EC114). We compared among these strains for the infection ability in bladders and kidneys of female BALB/c mice challenged transurethrally with these bacteria and assessed 1, 3, and 7 days after inoculation.ResultsStrains carrying fimH-only genotype were significantly more prevalent in lower UTI (P < 0.001). Strains carrying the fimH/papGII, but not papGII-only, were significantly associated with upper UTI (P = 0.001). Incidence of kidney infection increased after inoculation with EC114 on days 1 and 3, at both low and high dose, as compared with EC114DM; and the effect was greater than the sum of individual effect of EC114PM and EC114FM. Geometric means of quantitative bacterial counts in the kidneys significantly decreased when challenged with EC114FM on days 3 and 7, EC114PM on day 3 and EC114DM on day 1 after inoculation at high dose, as compared with EC114 (all P < 0.05).ConclusionsWe confirmed the advantage and synergistic action of FimH and PapGII for E. coli kidney infection and concluded that antagonists against FimH and PapGII adhesin may prevent kidney infection and enable its management.  相似文献   
6.
目的分析前列腺癌根治术患者采用围术期康复干预对尿失禁的预防效果。方法 42例行前列腺癌根治术的患者,随机分为研究组与对照组,每组21例。对照组患者给予常规干预,研究组患者采取围术期康复干预。对比两组患者的尿失禁发生率,下尿路症状改善情况,生活质量。结果研究组患者的尿失禁发病率14.29%明显低于对照组的47.62%,差异具有统计学意义(P<0.05)。干预后,两组患者的下尿路症状评估量表(LUTS)评分均低于本组干预前,且研究组患者的LUTS评分(10.25±2.02)分明显低于对照组的(15.63±2.59)分,差异具有统计学意义(P<0.05)。研究组患者的生理功能、情感职能、社会功能、总体健康评分分别为(75.14±4.28)、(76.67±4.31)、(74.98±4.25)、(75.87±4.26)分,均高于对照组的67.21±4.35)、(68.22±4.39)、(66.58±4.37)、(68.01±4.36)分,差异具有统计学意义(P<0.05)。结论前列腺癌根治术患者采用围术期康复干预可以有效降低术后并发症发生率,改善患者临床症状,提高患者生活质量,效果显著,值得在临床上进一步推广应用。  相似文献   
7.
目的 探讨脑络通胶囊与尤瑞克林联合治疗急性脑梗死的临床效果。方法 选取2017年12月—2020年12月太和县人民医院收治的104例急性脑梗死患者,随机分为对照组和治疗组,每组各52例。对照组静脉滴注注射用尤瑞克林,1瓶/次,每次将0.15 PNA单位溶于100 mL生理盐水,滴速1 mL/min,1次/d。在对照组基础上,治疗组口服脑络通胶囊,1 g/次,3次/d。两组患者治疗2周。观察两组患者临床疗效,比较治疗前后两组患者血液流变学参数血浆黏度(PV)、红细胞变形指数(EDI)和红细胞聚集指数(EAI),脑血流动力学参数血流阻力指数(RI)、平均流速(Vmean)、最大流速(Vmax)及最小流速(Vmin),NIHSS评分,及血清内皮素-1(ET-1)、丙二醛(MDA)、金属基质蛋白酶-9(MMP-9)和神经元特异性烯醇化酶(NSE)水平。结果 治疗后,治疗组临床有效率(94.23%)较对照组(80.77%)显著提高(P<0.05)。与治疗前对比,治疗后两组NIHSS评分及PV和EAI均显著降低(P<0.05),EDI显著升高(P<0.05),均以治疗组的改善更显著(P<0.05)。与治疗前相比,治疗后两组RI均显著降低(P<0.05),VmeanVmaxVmin则均显著增大(P<0.05),且治疗组对以上脑血流动力学参数的改善效果较同期对照组更显著(P<0.05)。治疗后,两组血清ET-1、MDA、MMP-9和NSE浓度比治疗前均显著下降(P<0.05),以治疗组的改善更显著(P<0.05)。结论 急性脑梗死采取脑络通胶囊与尤瑞克林联合治疗的效果确切,能有效改善患者脑部血流循环,纠正血管内皮功能紊乱,减轻机体炎症及氧化应激损伤,保护脑组织,促进神经功能恢复。  相似文献   
8.
Wilson’s disease (WD) is a rare inherited disorder of human copper metabolism, with an estimated prevalence of 1:30000-1:50000 and a broad spectrum of hepatic and neuropsychiatric manifestations. In healthy individuals, the bile is the main route of elimination of copper. In WD patients, copper accumulates in the liver, it is released into the bloodstream, and is excreted in urine. Copper can also be accumulated in the brain, kidneys, heart, and osseous matter and causes damage due to direct toxicity or oxidative stress. Hepatic WD is commonly but not exclusively diagnosed in childhood or young adulthood. Adherent, non-cirrhotic WD patients seem to have a normal life expectancy. Nevertheless, chronic management of patients with Wilson’s disease is challenging, as available biochemical tests have many limitations and do not allow a clear identification of non-compliance, overtreatment, or treatment goals. To provide optimal care, clinicians should have a complete understanding of these limitations and counterbalance them with a thorough clinical assessment. The aim of this review is to provide clinicians with practical tools and suggestions which may answer doubts that can arise during chronic management of patients with hepatic WD. In particular, it summarises current knowledge on Wilson’s disease clinical and biochemical monitoring and treatment. It also analyses available evidence on pregnancy and the role of low-copper diet in WD. Future research should focus on trying to provide new copper metabolism tests which could help to guide treatment adjustments.  相似文献   
9.
背景本研究团队前期分别开发了针对初产妇和经产妇的产后压力性尿失禁(SUI)风险预测模型,旨在早期识别孕产妇SUI的高危人群并提供有效干预,但尚未进行外部验证。目的外部验证前期开发的产后SUI风险预测模型,探索该模型在临床应用的可能性。方法于2020年7—9月在南方医科大学深圳医院、香港大学深圳医院进行电话随访,通过电子病历系统选取产后6个月的产妇作为验证组进行产后SUI风险预测模型的外部验证。使用电子医疗记录收集研究对象年龄、身高、妊娠前体质量、流产史和分娩史的相关信息;并通过电话随访调查研究对象产后6个月SUI发生情况。采用受试者工作特征(ROC)曲线下面积(AUC)和Hosmer-Lemeshow拟合优度检验分别评价产后SUI风险预测模型区分度和校准度。结果最终纳入298例研究对象为验证组,其中初产妇203例(68.1%),经产妇95例(31.9%)。初产妇队列中,非SUI者158例,SUI者45例。经产妇队列中,非SUI者72例,SUI者23例。产后SUI风险预测模型在初产妇外部验证人群中AUC为0.719〔95%CI(0.643,0.795)〕,在经产妇外部验证人群中AUC为0.833〔95%CI(0.738,0.928)〕。Hosmer-Lemeshow拟合优度检验提示产后SUI风险预测模型在初产妇人群中校准欠佳(χ2=34.11,P<0.001),而在经产妇人群中拟合度良好(χ2=9.62,P=0.293)。结论初产妇产后SUI预测模型能有效区分患者是否发生产后SUI,但尚需进一步更新以提高模型的外部适用性;经产妇产后SUI预测模型具有可接受的外部效能,鼓励将其作为产后早期盆底康复干预的评估工具进行推广。  相似文献   
10.
Urogenital chlamydial infection is the most common sexually transmitted infection. Many cases of chlamydial infection are reported worldwide every year. Genital chlamydial infection in women can also cause obstetric issues, including infertility and miscarriage. For that purpose, appropriate care should be conducted with the latest knowledge.Only few guidelines come from Asian countries. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding chlamydial urethritis. We have collected the feedback and updated the guidelines which is now submitted for consideration of publication. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for chlamydial urethritis.  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