全文获取类型
收费全文 | 1151篇 |
免费 | 65篇 |
国内免费 | 1篇 |
专业分类
耳鼻咽喉 | 8篇 |
儿科学 | 27篇 |
妇产科学 | 17篇 |
基础医学 | 103篇 |
口腔科学 | 8篇 |
临床医学 | 129篇 |
内科学 | 185篇 |
皮肤病学 | 10篇 |
神经病学 | 108篇 |
特种医学 | 88篇 |
外科学 | 313篇 |
综合类 | 21篇 |
一般理论 | 2篇 |
预防医学 | 77篇 |
眼科学 | 16篇 |
药学 | 51篇 |
肿瘤学 | 54篇 |
出版年
2022年 | 9篇 |
2021年 | 23篇 |
2020年 | 9篇 |
2019年 | 12篇 |
2018年 | 19篇 |
2017年 | 11篇 |
2015年 | 18篇 |
2014年 | 31篇 |
2013年 | 34篇 |
2012年 | 63篇 |
2011年 | 52篇 |
2010年 | 31篇 |
2009年 | 20篇 |
2008年 | 42篇 |
2007年 | 40篇 |
2006年 | 48篇 |
2005年 | 50篇 |
2004年 | 61篇 |
2003年 | 40篇 |
2002年 | 59篇 |
2001年 | 47篇 |
2000年 | 59篇 |
1999年 | 51篇 |
1998年 | 10篇 |
1997年 | 9篇 |
1996年 | 8篇 |
1995年 | 10篇 |
1994年 | 11篇 |
1992年 | 29篇 |
1991年 | 20篇 |
1990年 | 23篇 |
1989年 | 25篇 |
1988年 | 19篇 |
1987年 | 13篇 |
1986年 | 23篇 |
1985年 | 21篇 |
1984年 | 6篇 |
1983年 | 11篇 |
1982年 | 10篇 |
1981年 | 10篇 |
1980年 | 5篇 |
1979年 | 14篇 |
1978年 | 16篇 |
1977年 | 13篇 |
1976年 | 8篇 |
1975年 | 10篇 |
1974年 | 11篇 |
1973年 | 8篇 |
1968年 | 6篇 |
1965年 | 4篇 |
排序方式: 共有1217条查询结果,搜索用时 15 毫秒
1.
2.
3.
Replacement of the ascending aorta. Early and late results 总被引:1,自引:0,他引:1
B W Lytle S S Mahfood D M Cosgrove F D Loop 《The Journal of thoracic and cardiovascular surgery》1990,99(4):651-7; discussion 657-8
From 1978 through 1987, 225 patients underwent operations that included replacement of the ascending aorta. One hundred twenty-three patients underwent composite aortic valve and ascending aortic replacement, 30 had aortic valve replacement with separate graft replacement of the ascending aorta, and 72 underwent replacement of the ascending aorta without aortic valve replacement. Thirty-one (13.8%) in-hospital deaths occurred. Univariate testing of preoperative and operative variables followed by logistic regression analyses identified miscellaneous aortic disease, coronary artery bypass grafting, aortic arch replacement, emergency operation, surgical date (1978 to 1983), and age (all p less than 0.05) as factors having independent association with in-hospital mortality. Follow-up of in-hospital survivors (mean interval 46 months, range 8 to 123 months) documented an overall 5-year survival rate of 76%, 83% after primary operation and 37% after reoperation. Univariate analyses followed by multivariate testing indicated that previous operation (p less than 0.0001) and a history of preoperative neurologic symptoms (p = 0.021) were associated with decreased late survival. At follow-up 88% of late survivors were free of symptoms. Seven patients have undergone reoperation 1 day to 69 months postoperatively. Although the in-hospital mortality for operations that include ascending aortic replacement exceeds that for isolated aortic valve replacement, the late death rate and rate of reoperation are low. 相似文献
4.
Early laparoscopic cholecystectomy for acute cholecystitis 总被引:4,自引:0,他引:4
Background: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial.
Methods: One hundred ninety-four patients with acute cholecystitis were reviewed. The conversion rates for the various number of days
of symptoms before surgery were analyzed. The conversion rate dramatically increased from 3.6% for those patients with 4 days
of symptoms to 26% for those patients with 5 days of symptoms. The mean number of days of symptoms prior to surgery in those
patients who underwent successful laparoscopic cholecystectomy was 4.1 as compared to 8.0 in those patients who required open
cholecystectomy (p < 0.0001). Based on this data the patients were divided into two groups. Group 1 consisted of 109 patients who underwent
laparoscopic cholecystectomy within 4 days of onset of symptoms and group 2 consisted of 85 patients who underwent laparoscopic
cholecystectomy after more than 4 days following onset of symptoms.
Results: The conversion rate from laparoscopic to open cholecystectomy was 15%. The conversion rate for group 1 was 1.8% as compared
to 31.7% for group 2 (p < 0.0001). Indications for conversion were inability to identify the anatomy secondary to inflammatory adhesions (68%), cholecystoduodenal
fistula (18%), and bleeding (14%). The major complication rate for group 1 was 2.7% as compared to 13% for group 2 (p= 0.007). The mortality rate for all patients with attempted laparoscopic cholecystectomy for acute cholecystitis was 1.5%.
The average procedure time for group 1 was 100 ± 37 min vs 120 ± 55 min in group 2. The average number of postoperative hospital
days in group 1 was 5.5 ± 2.7 days as compared to 10.8 ± 2.7 days in group 2.
Conclusions: We advocate early laparoscopic cholecystectomy within 4 days of onset of symptoms to decrease major complications and conversion
rates. This decreased conversion rate results in decreased length of procedure and hospital stay.
Received: 28 March 1996/Accepted: 12 September 1996 相似文献
5.
Intraoperative cholangiography revisited. 总被引:2,自引:0,他引:2
B W Pace J Cosgrove B Breuer I B Margolis 《Archives of surgery (Chicago, Ill. : 1960)》1992,127(4):448-450
The charts of 1351 patients undergoing cholecystectomy at our institutions from 1985 through 1989 were reviewed retrospectively to evaluate the indications for and the success of intraoperative cholangiography. A total of 800 patients underwent intraoperative cholangiography. They were divided into two groups based on the absence (CR-) or presence (CR+) of clinical and/or operative criteria suggestive of the existence of common bile duct stones. Intraoperative cholangiography in CR- patients was of limited benefit, being negative (normal) in 95.7%, true-positive (abnormal) in 3.3%, and false-positive in 1%. False-positive intraoperative cholangiography resulted in unnecessary common bile duct explorations. Intraoperative cholangiography in CR+ patients proved useful, avoiding unnecessary common bile duct exploration in 55%. In those select CR+ patients with palpable common bile duct stones or cholangitis, little additional information was gained by the intraoperative cholangiography. We conclude that routine screening intraoperative cholangiography in CR- patients be reconsidered, as should the use of intraoperative cholangiography in CR+ patients with a palpable common bile duct stone or cholangitis. Intraoperative cholangiography in the remainder of CR+ patients proved beneficial and should be continued. 相似文献
6.
7.
Mo Therese Hannah Ellen R. Gritz David K. Wellisch Pat Fobair Richard T. Hoppe Joan R. Bloom Guo-Wen Sun Anna Varghese Malcolm D. Cosgrove David Spiegel 《Psycho-oncology》1992,1(2):89-103
This study compares the effects of the cancer experience on various aspects of marital and sexual functioning (e.g., communication, emotional support, body image, sexual satisfaction and frequency) for two groups of long-term cancer survivors (testicular cancer and Hodgkin's disease) and their spouses. Comparisons between the two patient groups showed significantly more survivors of Hodgkin's disease than testicular cancer reporting the emergence of special issues and changes in the marital relationship. No differences emerged between the spouse groups on sexual functioning variables; however, spouses of survivors of Hodgkin's disease were more likely than spouses of survivors of testicular cancer to report the development of special issues and communication difficulties. A substantial proportion of both survivor groups disclosed negative changes in body image and sexual frequency. Majorities of both survivors and spouses acknowledged that the illness had drawn them closer together. When representative marital/sexual functioning variables were used to predict Family Environment Scale (FES) scores for survivors and for spouses, changes in the spouse's importance, influence of the illness on the relationship, and changes in sexual frequency emerged as significant predictors. The clinical significance of long-term changes in marital and sexual functioning for the couple and the need for therapeutic interventions are discussed. 相似文献
8.
Hypertension is common after a cardiac operation and may result in postoperative hemorrhagic and other complications. Most often this problem has been treated using manually controlled doses of intravenous sodium nitroprusside. To evaluate the clinical impact of an automated closed-loop administration system on patients after cardiotomy, a prospective trial was conducted at nine clinical centers. Patients with hypertension were managed by either manual nitroprusside titration (n = 532) or a closed-loop automated titration system (n = 557). Patient groups were not significantly different in age, weight, or height. Moreover, the types of surgical procedures were comparable: primary coronary artery bypass grafting, 59.2% and 58.9%, manual group versus automated group; repeat coronary artery bypass grafting, 10.5% and 8.6%, respectively; valve procedures, 11.3% and 15.1%, respectively; and other cardiac procedures, 19.0% and 17.4%, respectively (all p = not significant). The automated group showed a significant reduction in the number of hypertensive episodes per patient (1.8 +/- 0.2 versus 0.6 +/- 0.07; p = 0.0001. At the same time, the number of hypotensive episodes per patient was reduced with automated closed-loop titration (0.40 +/- 0.05 versus 0.30 +/- 0.03; p = 0.02). Chest tube drainage (866 +/- 37 mL versus 693 +/- 23 mL [mean +/- standard error of the mean]; p = 0.0001), percentage of patients receiving transfusion (40.0% versus 33.0%; p = 0.02), and total amount transfused (2.4 +/- 0.12 units versus 2.0 +/- 0.10 units; p = 0.0003) were all reduced significantly by the use of an automated titration system.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
9.
Cavernous angiomas of the spinal cord 总被引:7,自引:0,他引:7
G R Cosgrove G Bertrand S Fontaine Y Robitaille D Melanson 《Journal of neurosurgery》1988,68(1):31-36
Five cases of histologically verified cavernous angiomas of the spinal cord are reported. Acute lower-extremity sensory disturbance was the initial symptom in four patients, and one presented with weakness of the hand. Progressive neurological deficit occurred in all patients, but the clinical course and outcome were extremely variable. Myelography revealed an intramedullary lesion in two cases but was completely normal in three; magnetic resonance imaging was diagnostic in these patients. Subtotal removal was accomplished in two cases, and myelotomy and biopsy were carried out in three. Four of the cavernous angiomas were located in the cervicothoracic region, whereas one was found in the thoracolumbar cord. All of the patients exhibited characteristic gross and microscopic features as well as hemosiderin-laden macrophages indicating remote hemorrhage. The diagnostic, therapeutic, and prognostic implications of this rare condition are discussed. 相似文献
10.
Noncardiogenic pulmonary edema in liver transplant recipients is usually secondary to TRALI (transfusion related acute lung injury) or liver ischemic-reperfusion injury. If persistent, the resultant hypoxemia is associated with increased ventilator days, prolonged length of stay (intensive care and hospital) and increased 28-day mortality. Ventilation strategies for the management of hypoxemia in acute lung injury include moderate to high levels of PEEP (positive and expiratory pressure) and prone ventilation (PV). Such strategies have theoretical adverse effects on graft perfusion. Evidence does however exist to demonstrate that maintenance of cardiac output and correct positioning of the prone patient to allow abdominal excursion can negate the deleterious effects of PEEP and PV. A liver transplant recipient became profoundly hypoxemic on our intensive care unit following the onset of noncardiogenic pulmonary edema. A risk-benefit assessment performed at the time deemed that the potential adverse effects of PEEP and PV were outweighed by the life-threatening nature of hypoxemia. The patient's condition improved following prone positioning and application of PEEP (10-15 cm H(2)O). We conclude that such ventilation strategies are appropriate in hypoxemic liver transplant recipients if an appropriate risk-benefit assessment is performed. 相似文献