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1.
Sepsis remains the most common cause of death in intensive care units in the USA, with a current estimate of at least 750,000 cases per year, and 215,000 deaths annually. Despite extensive research still we do not quite understand the cellular and molecular mechanisms that are involved in triggering and propagation of septic injury. Endotoxin (lipopolysaccharide from Gram-negative bacteria, or LPS) has been implicated as a major cause of this syndrome. Inflammatory shock as a consequence of LPS release remains a serious clinical concern. In humans, inflammatory responses to LPS result in the release of cytokines and other cell mediators from monocytes and macrophages, which can cause fever, shock, organ failure and death. A number of different approaches have been investigated to try to treat and/or prevent the septic shock associated with infections caused by Gram-negative bacteria, including blockage of one or more of the cytokines induced by LPS. Recently several novel amphipathic compounds have been developed as direct LPS antagonists at the LPS receptor, TLR4. This review article will outline the current knowledge on the TLR4-LPS synthesis and discuss the signaling, in vitro pre-clinical and in vivo clinical evaluation of TLR4 antagonists and their potential use in sepsis and a variety of diseases such as atherosclerosis as well as hepatic and renal malfunction.  相似文献
2.
脓毒症相关性急性肺损伤发病机制研究进展   总被引:5,自引:1,他引:4  
急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床上常见的危重病之一,病因多、影响因素复杂、救治困难,病死率高。脓毒症是危重病最主要的死亡原因,也是引起ALI/ARDS的最常见的病因,尽管对脓毒症致ALI/ARDS的机制研究较多,其确切机制尚不完全清楚。本文就脓毒症致急性肺损伤的发病机制进行综述。  相似文献
3.
The physiological regulation of the immune system encompasses comprehensive anti-inflammatory mechanisms that can be harnessed for the treatment of infectious and inflammatory disorders. Recent studies indicate that the vagal nerve, involved in control of heart rate, hormone secretion and gastrointestinal motility, is also an immunomodulator. In experimental models of inflammatory diseases, vagal nerve stimulation attenuates the production of proinflammatory cytokines and inhibits the inflammatory process. Acetylcholine, the principal neurotransmitter of the vagal nerve, controls immune cell functions via the alpha7 nicotinic acetylcholine receptor (alpha7nAChR). From a pharmacological perspective, nicotinic agonists are more efficient than acetylcholine at inhibiting the inflammatory signaling and the production of proinflammatory cytokines. This 'nicotinic anti-inflammatory pathway' may have clinical implications as treatment with nicotinic agonists can modulate the production of proinflammatory cytokines from immune cells. Nicotine has been tested in clinical trials as a treatment for inflammatory diseases such as ulcerative colitis, but the therapeutic potential of this mechanism is limited by the collateral toxicity of nicotine. Here, we review the recent advances that support the design of more specific receptor-selective nicotinic agonists that have anti-inflammatory effects while eluding its collateral toxicity.  相似文献
4.
王长远  秦俭 《中国医药》2011,6(3):276-277
目的 研究乳酸和急性生理学及慢性健康状况评分(APACHEⅡ评分)对老年脓毒症患者预后的评估作用.方法 收集我院急诊科老年脓毒症患者90例,按照入院时血乳酸值分成乳酸升高组56例,乳酸正常组34例,比较2组的病死率、休克发生率、机械通气率和多器官功能障碍综合征(MODS)发生率和APACHEⅡ评分;根据APACHEⅡ评分(<15、15~24、≥25)分为3组,比较3组患者的病情和预后.结果 乳酸升高组患者机械通气率、休克发生率、MODS发生率和病死率均明显高于乳酸正常组(33.9%比5.8%,35.7%比5.8%,42.8%比8.8%,30.3%比2.9%,均P<0.01)、APACHEⅡ评分明显大于乳酸正常组[(24.3±7.5)分比(16.1±5.2)分,P<0.05],随着APACHEⅡ评分增高,患者病情逐渐加重,休克发生率和住院病死率明显升高(P<0.05),患者乳酸水平也明显增高,分别是[(1.7±0.5)、(3.9±0.6)、(6.2±1.3)mmol/L,P<0.05].结论 血乳酸和APACHEⅡ评分都可以评估老年脓毒症患者病情严重程度和预后,两者升高提示预后较差.
Abstract:
Objective To study the prognosis function of lactic acid and acute and chronic physiology health scoreⅡ(APACHEⅡscore) in elderly patients with sepsis. Methods The Clinical data of 90 elderly patients with sepsis were collected at Department of Emergency, Xuanwu Hospital of Capital University of Medical Sciences. Patients with elevated blood lactic acid and 34 cases with normal lactic acid, the differences of fatality rate,shock, mechanical ventilation and MODS incidence and APACHE Ⅱ score were compared between 2 groups. According to APACHE Ⅱ score (<15 scores, 15 -24 scores, ≥25 scores), the patients were divided into three groups,the difference of condition and prognosis were compared among each groups. Results The mechanical ventilation,shock, MODS and APACHE Ⅱ score in elderly septic patients with elevated lactate were significantly higher than those in normal lactic acid group( P < 0.05) with mortality significantly increased(30.3% vs 2.9%, P =0.005).With the APACHE Ⅱ score increasing, the patient's illness was gradually worsened; shock incidence and hospital mortality were increased significantly, P < 0.05. Conclusions The lactic acid levels and APACHE Ⅱ score can effectively assess the patients condition and prognosis, the elderly sepsis patients with elevated blood lactate had a serious condition and poor prognosis.  相似文献
5.
乌司他丁对脓毒血症患者细胞因子的影响   总被引:4,自引:0,他引:4  
目的探讨乌司他丁对脓毒血症患者细胞因子的影响。方法采用前瞻对照研究将84例脓毒血症患者随机分为对照组和治疗组,其中对照组40例,治疗组44例,两组均行常规抗感染和病因治疗。治疗组用乌司他丁20万U溶于20ml生理盐水中静脉注射,每12h一次,连续7天;对照组则予以等量生理盐水作为安慰对照。分别于不同时相(静脉注射UTI前、注射后72h和1周)测试血清肿瘤坏死因子-α(TNF-α)、IL-1、IL-6、IL-8和IL-10水平。结果与对照组相比,治疗组应用乌司他丁后不同时相点的TNF-α、IL-1、IL-6、IL-8均明显降低(P<0.01、P<0.05、P<0.05、P<0.05),而IL-10显著升高(P<0.05)。结论乌司他丁可降低脓毒血症患者TNF-α、IL-1、IL-6和IL-8的水平,而提高IL-10水平,从而达到保护器官的作用。  相似文献
6.
烧伤早期严重感染集束治疗策略的应用   总被引:3,自引:3,他引:0  
目的探讨严重感染集束治疗(SBT)策略在严重烧伤患者早期治疗中的实施情况及作用。方法95例重症烧伤患者,按治疗方式分为对照组43例和观察组52例。记录严重感染、感染性休克发生率、28d病死率和6h、24h集束治疗的依从率,logistic回归分析6h、24h集束治疗指标与感染、感染性休克发生及28d病死率的关系。结果观察组28天病死率、脓毒血症和感染性休克的发生率均明显低于对照组(P〈0.05)。早期目标导向液体治疗(EGDT)是烧伤感染和感染性休克发生的独立相关因素。血气分析测定、EGDT及血管活性药物的使用与28天病死率密切相关(P〈0.05)。烧伤感染、感染性休克的发生和28天病死率均与SBT方案的执行情况密切相关。观察组感染集束治疗指标的依从性仅为51.9%和63.2%。结论SBT方案能减少烧伤感染和感染性休克的发生,降低病死率,但依从性尚亟待提高。  相似文献
7.
脓毒血症患者免疫调理治疗研究   总被引:3,自引:0,他引:3  
目的探讨胸腺肽α1联合血必净对脓毒血症患者免疫功能的影响。方法72例脓毒症患者随即分成治疗组和对照组,对照组参照拯救脓毒症运动中所建议经典治疗方法,治疗组经典治疗基础上加胸腺肽α1联合血必净进行免疫调理治疗,比较两组患者治疗前后APACHEⅡ评分,血浆IL-6水平,T淋巴细胞亚群构成变化,及外周血CD14+单核细胞人类白细胞抗原(HLA-DR)水平变化。结果治疗组患者经免疫调理治疗后APACHEⅡ评分显著降低,其CD14+单核细胞HLA-DR和T细胞亚群CD4+、Th/Ts显著提高,IL-6表达水平明显下降,与对照组比较差异具有显著性(P<0.05)。结论胸腺肽α1联合血必净治疗脓毒症患者,有助于增强机体的免疫防御作用,并抑制过度炎症反应。  相似文献
8.
蔡绚  蔡涛  虞晓红 《中国药房》2008,19(20):1563-1564
目的:观察和评价血必净注射液与注射用头孢哌酮钠/舒巴坦钠协同治疗脓毒症的临床疗效。方法:随机将脓毒症患者分为对照组(75例)与治疗组(79例)。对照组静脉滴注头孢哌酮钠/舒巴坦钠3g,每日2次;治疗组先静脉滴注头孢哌酮钠/舒巴坦钠3g,再静脉滴注血必净注射液100mL,每日2次。7d为1个疗程。结果:治疗组与对照组总有效率分别为94.94%、86.67%,2组有显著性差异(P<0.05)。结论:血必净注射液与头孢哌酮钠/舒巴坦钠协同治疗脓毒症,能够缩短疗程,改善临床症状,提高疗效。  相似文献
9.
重症急性胰腺炎179例综合治疗效果观察   总被引:2,自引:0,他引:2  
目的 探讨重症急性胰腺炎(severe acute pancreatitis,SAP)的综合治疗方法. 方法 对我院179例重症急性胰腺炎的临床资料进行回顾性分析. 结果 179例中治愈167例,治愈率93.3%,死亡12例,其中11例因多器官功能不全综合征(MODS)死亡,1例死于内窥镜下括约肌切开术(EST)后应激性溃疡出血.并发假性胰腺囊肿46例,经B超引导下穿刺引流治愈4例,后期行囊肿内引流术42例治愈.胆源性SAP 82例,胆总管结石8例经手术治愈;入院即行EST治疗74例,症状缓解68例,5例EST治疗无效经手术治愈,1例因EST术后应激性溃疡出血死亡.行腹腔灌洗引流、减压31例,治愈27例,死亡4例;血液透析5例,治愈4例,死亡1例;胰床减压引流、坏死组清除8例,治愈6例,死亡2例;呼吸机支持治疗17例,治愈13例,死亡4例. 结论 SAP的治疗不仅要控制胰腺炎症状,还应对可能或已经发生的并发症进行了积极干预,并需采取个体化多手段的治疗方法,以提高SAP的抢救成功率.  相似文献
10.
活血中药对大鼠脓毒症早期循环及活化蛋白C的影响   总被引:2,自引:0,他引:2  
吕杰  杨劲松  安友仲  刘方 《中国医药》2010,5(3):212-214
目的观察血必净注射液对大鼠全身性感染(Sepsis)早期循环及活化蛋白C的影响。方法盲肠结扎穿孔术制备脓毒症大鼠模型。清洁级雄性sD大鼠75只按随机数字表法分为假手术组、手术组和血必净组,每组25只,各组按处死时间分为术后2、4、6、8、12h组,每组5只。所有实验动物应用10%水合氯醛4ml/kg腹腔注射进行麻醉,并维持镇静,同时监测平均动脉压,并持续补液。假手术组和手术组术后即开始静脉补充生理盐水,血必净组术后1h内给予血必净注射液,之后补充生理盐水。实验动物在规定的时间点取血后处死。血浆血活化蛋白c(APC)含量用大鼠酶联免疫吸附法检测。结果假手术组平均动脉压有轻微下降,但在正常范围内。手术组和血必净组平均动脉压均下降,并逐渐进入休克状态,第11小时和12小时平均动脉压与假手术组相比差异有统计学意义[第11小时:(58.7±7.0)rainHgVS(91.0±8.2)mm与(58.7±8.3)mmHgVS(91.0±8.2)mmHg;第12小时:(48.8±12.9)mmHgVS(83.4±5.5)mmHg与(55.4±4.0)mmHg vs(83.4±5.5)mmHg;P〈0.01或P〈0.05]。但血必净组进入休克时间晚于手术组,且MAP略高于手术组(P〉0.05)。假手术组APC含量没有降低。而手术组的血APC含量在术后2h之后逐渐下降,各时间点均显著低于假手术组(P〈0.01)。血必净组的血APC含量在术后早期逐渐升高,并在术后4h和6h显著高于假手术组和手术组,之后迅速下降,术后12h低于假手术组[(1.800±0.499)μg/LVS(3.418±0.440)μg/L,P〈0.01],但仍高于手术组(P〈0.01)。结论血必净注射液在脓毒症早期对循环功能有一定的改善。在脓毒症早期使用该药对大鼠蛋白c系统有一定的上调作用,可能是其发挥抗炎及改善微循环作用的机制之一。  相似文献
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