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This article presents local protocols for antithrombotic therapy used in a tertiary care institution—the cardiocenter of a university hospital. The protocols were discussed in detail among the whole team of physicians of the cardiocenter. This article addresses cardiac conditions requiring hospitalization whenever antithrombotic therapy is indicated. These protocols do not include antithrombotic therapy in other medicinal disciplines (e.g., orthopedics, surgery). These protocols are mostly based on the current guidelines of the European Society of Cardiology (ESC). The partial differences between the ESC guidelines and this text are usually based on the results of the latest clinical trials, which have not yet been included in the ESC guidelines. 相似文献
56.
Hyperglycemia exaggerates ischemia-reperfusion-induced cardiomyocyte injury: reversal with endothelin antagonism 总被引:8,自引:0,他引:8
Verma S Maitland A Weisel RD Li SH Fedak PW Pomroy NC Mickle DA Li RK Ko L Rao V 《The Journal of thoracic and cardiovascular surgery》2002,123(6):1120-1124
OBJECTIVES: We have previously demonstrated an importance of endothelin-1 in diabetic patients undergoing bypass surgery. Recent evidence suggests that cardiomyocytes might also produce endothelin-1, which might directly impair myocyte contractility by increasing intracellular calcium levels. Because hyperglycemia is a potent stimulus of endothelin-1 production, we hypothesized that increased production, action, or both of endothelin-1 might be a mediator of direct cardiomyocyte injury in diabetes. Therefore we studied the effects of endothelin receptor blockers (BQ-123 and bosentan) on hyperglycemia-induced endothelin-1 production and cellular injury after ischemia-reperfusion. METHODS: Using a human ventricular heart cell model of simulated ischemia-reperfusion, we studied the effects of normoglycemia (5 mmol/L, 48 hours) and hyperglycemia (25 mmol/L, 48 hours) on cellular injury and endothelin-1 production. Furthermore, the effects of selective endothelin-A and mixed endothelin-A/B receptor antagonism (with BQ-123 and bosentan, respectively) were evaluated. RESULTS: Cellular injury, as assessed by means of trypan blue uptake, was higher in human ventricular heart cells subjected to hyperglycemia and simulated ischemia-reperfusion injury (P =.01); this effect was prevented with both BQ-123 and bosentan (P =.01). In addition, heart cells from the hyperglycemic group elaborated more endothelin-1 after ischemia-reperfusion (P =.02). CONCLUSIONS: Endothelin-1 production and cellular injury were greater in human ventricular heart cells subjected to hyperglycemic conditions and simulated ischemia-reperfusion. These effects are mediated by endothelin-A receptors because both BQ-123 and bosentan exerted similar degrees of protection. Endothelin receptor blockade is a novel strategy to improve the resistance of the diabetic heart to cardioplegic arrest and reperfusion. 相似文献
57.
Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock 总被引:15,自引:0,他引:15
BACKGROUND: Postcardiotomy cardiogenic shock occasionally develops in patients who have undergone cardiac procedures. We report our experience using extracorporeal membrane oxygenation (ECMO) in adult patients with postcardiotomy cardiogenic shock, and analyze the factors that affected outcomes for these ECMO patients. METHODS: We retrospectively reviewed the medical records of ECMO patients. RESULTS: From August 1994 to May 2000, 76 adult patients (48 men, 28 women; mean age, 56.8+/-15.9 years) received ECMO support for postcardiotomy cardiogenic shock at the National Taiwan University Hospital. The mean ECMO blood flow was 2.53+/-0.84 L/min. The cardiac operations included coronary artery bypass grafting (n = 37), coronary artery bypass grafting and valvular operation (n = 6), valvular operation alone (n = 14), heart transplantation (n = 12), correction of congenital heart defects (n = 3), implantation of a left ventricular assist device (n = 2), and aortic operations (n = 2). Fifty-four patients received ECMO support after intraaortic balloon pumping, but 22 patients directly received ECMO support. Two patients were bridged to heart transplantation and two bridged to ventricular assist devices. Thirty patients died on ECMO support. The causes of mortality included brain death (n = 3), refractory arrhythmia (n = 2), near motionless heart (n = 2), acute graft rejection (n = 1), primary graft failure (n = 1), uncontrolled bleeding (n = 5), and multiple organ failure (n = 16). Twenty-two patients were weaned off ECMO support but presented intrahospital mortality. The cause of mortality included brain death (n = 1), sudden death (n = 4), and multiple organ failure (n = 17). Twenty patients were weaned off ECMO support and survived to hospital discharge. During the follow-up of 33+/-22 months, all were in New York Heart Association functional status I or II except two cases of late deaths. Among the ECMO-weaned patients, "dialysis for acute renal failure" was a significant factor in reducing the chance of survival. CONCLUSIONS: The ECMO provided a satisfactory partial cardiopulmonary support to patients with postcardiotomy cardiogenic shock, and allowed time for clinicians to assess the patients and make appropriate decisions. 相似文献
58.
Nakamura T Maruyama K Kashiwabara H Sunayama K Ohata K Fukazawa A Yasumi K Sugimura H Nakamura S 《Surgery today》2002,32(3):282-284
We report herein a rare case of diverticulitis causing a high serum level of carbohydrate antigen (CA) 19-9. A 52-year-old
man was admitted to our hospital with lower abdominal pain. Laboratory data showed evidence of inflammation and a high serum
level of CA 19-9 (370 U/ml). Computed tomography demonstrated thickening of the wall of the sigmoid colon. He was diagnosed
as having diverticulitis of the sigmoid colon and was treated with antibiotics. Although his symptoms improved, the presence
of a malignancy such as colorectal cancer could not be completely ruled out because of the persistently high serum level of
CA19-9. A laparotomy was performed and the sigmoid colon was found to be adherent to the bladder. Under a diagnosis of diverticulitis,
a sigmoidectomy was performed. Pathological examination revealed diverticulitis of the sigmoid colon, but there was no evidence
of malignancy in the resected specimen. The serum CA19-9 level decreased to normal postoperatively and immunohistochemical
staining revealed CA19-9 antigen in the cytoplasm of the diverticular epithelium. Therefore, a possible explanation for the
high level of this tumor marker was diverticulitis of the sigmoid colon.
Received: June 6, 2001 / Accepted: September 11, 2001 相似文献
59.
Introduction
Survival in patients with refractory heart failure greatly improves after heart transplantation (HTx).Objective
To evaluate the rate of unplanned readmission within the first year post-HTx and the causes of such readmission.Patients and Methods
From January 2005 to June 2008, the 112 patients who underwent HTx were regularly followed up at our hospital. A protocol biopsy was performed every week during the first month, then every 3 months during the first year. Any unplanned readmission was discussed in detail in a transplantation meeting. Data were collected from review of medical records.Results
The rate of unplanned readmission was 19.3% in 2005, 21.5% in 2006, 22.2% in 2007, and 20.3% in 2008. Infection was the primary cause leading to unplanned readmission in 2005 (51.5%), 2006 (42.9%), and 2008 (30.7%). Rejection was the primary cause leading to readmission in 2007 (40%). Other causes included fluid retention, pericardial effusion, anemia, and systemic diseases.Conclusion
To reduce unplanned readmissions and to promote quality of life and long-term survival, health professionals must meticulously monitor the adverse effects of treatments including immunosuppression agents and concomitantly used medications. 相似文献60.
Kim JH Kim KW Gwon DI Ko GY Sung KB Lee J Shin YM Song GW Hwang S Lee SG 《Transplantation proceedings》2011,43(5):1790-1793