全文获取类型
收费全文 | 39069篇 |
免费 | 253篇 |
国内免费 | 12篇 |
专业分类
耳鼻咽喉 | 397篇 |
儿科学 | 434篇 |
妇产科学 | 893篇 |
基础医学 | 6644篇 |
口腔科学 | 1325篇 |
临床医学 | 3611篇 |
内科学 | 4089篇 |
皮肤病学 | 243篇 |
神经病学 | 2778篇 |
特种医学 | 1773篇 |
外科学 | 4472篇 |
综合类 | 216篇 |
一般理论 | 6篇 |
预防医学 | 2356篇 |
眼科学 | 375篇 |
药学 | 5435篇 |
中国医学 | 682篇 |
肿瘤学 | 3605篇 |
出版年
2024年 | 15篇 |
2023年 | 680篇 |
2022年 | 1328篇 |
2021年 | 1428篇 |
2020年 | 1599篇 |
2019年 | 1280篇 |
2018年 | 957篇 |
2017年 | 1187篇 |
2016年 | 1329篇 |
2015年 | 1226篇 |
2014年 | 2394篇 |
2013年 | 1745篇 |
2012年 | 2792篇 |
2011年 | 2583篇 |
2010年 | 2102篇 |
2009年 | 2163篇 |
2008年 | 1982篇 |
2007年 | 1938篇 |
2006年 | 1598篇 |
2005年 | 1237篇 |
2004年 | 1167篇 |
2003年 | 1007篇 |
2002年 | 657篇 |
2001年 | 571篇 |
2000年 | 446篇 |
1999年 | 474篇 |
1998年 | 398篇 |
1997年 | 324篇 |
1996年 | 402篇 |
1995年 | 339篇 |
1994年 | 238篇 |
1993年 | 174篇 |
1992年 | 118篇 |
1991年 | 121篇 |
1990年 | 126篇 |
1989年 | 106篇 |
1988年 | 186篇 |
1987年 | 204篇 |
1986年 | 220篇 |
1985年 | 47篇 |
1984年 | 87篇 |
1983年 | 65篇 |
1982年 | 73篇 |
1981年 | 91篇 |
1980年 | 46篇 |
1979年 | 18篇 |
1978年 | 23篇 |
1977年 | 24篇 |
1976年 | 19篇 |
排序方式: 共有10000条查询结果,搜索用时 0 毫秒
101.
《Burns : journal of the International Society for Burn Injuries》2021,47(8):1844-1850
IntroductionTraditionally, lactated Ringer’s solution (LR) has been utilized for the resuscitation of thermally injured patients via the Parkland or Brooke formulas. Both of these formulas include colloid supplementation after 24 h of resuscitation. Recently, the addition of albumin within the initial resuscitation has been reported to decrease fluid creep and hourly fluids given. Our institution has previously advocated for a crystalloid-driven resuscitation. Given reports of improved outcomes with albumin, we pragmatically adjusted these practices and present our findings for doing so.MethodsOur burn registry, consisting of prospectively collected patient data, was queried for those at least 18 years of age who, between July 2017 and December 2018, sustained a thermal injury and completed a formal resuscitation (24 h). At the attending physician’s discretion, rescue colloid was administered using 25% albumin for those failing to respond to traditional resuscitation (patients with sustained urine output of <0.5 mL/kg over 2–3 h, or unstable vital signs and ongoing fluid administration). We compared the total volume of the crystalloid-only and rescue colloid resuscitation fluids given to patients. We also examined the in/out fluid balances during resuscitation. Statistical analysis was performed using Stata software.ResultsA total of 91 patients with thermal injuries were included: the median age was 40 (IQR 31–57), 73% were male, and 30 patients received rescue albumin. The percentage of total body surface area burned (%TBSA) was greater in those who received rescue albumin (40.3% vs. 34%; p = 0.047). Despite a higher %TBSA in the albumin group, the total LR given during resuscitation was not significantly different between groups (15,914.43 mL vs. 11,828.71 mL; p = 0.129) even when normalized for TBSA and weight (ml LR/kg/%TBSA: 4.31 vs. 3.66; p = 0.129. The average in/out fluid ratio for the rescue group was higher than for the crystalloid group (0.83 ± 0.05 vs. 0.59 ± 0.11; p = 0.06) and returned to normal after colloid administration.ConclusionRescue albumin administration decreases the amount of fluid administered per %TBSA during resuscitation, and also increases end organ function as evidenced by increased urinary output. These effects occurred in patients who sustained larger burns and failed to respond to traditional crystalloid resuscitation. Our findings led us to modify our current protocol and a related prospective study of clinical outcomes. 相似文献
102.
103.
《Arthroscopy》2021,37(12):3477-3478
While trochlear dysplasia is commonly discussed as a major risk factor for recurrent patellar instability, it also has a strong relationship with the development of patellofemoral cartilage lesions. Patellofemoral instability frequently occurs in teens and young adults, and the high prevalence of associated cartilage damage unfortunately sets patients up for the progression of degenerative changes of the patellofemoral joint at an early age. The judicious use of magnetic resonance imaging can help identify the presence of chondral lesions, allowing for urgent management of associated osteochondral fractures or open discussions and patient education about the possibility of performing a cartilage restoration procedure concurrently with patellar stabilization surgery. The location and presence of patellofemoral chondral lesions should be considered when contemplating the concurrent use of tibial tubercle osteotomy as part of the patellar stabilization procedure. 相似文献
104.
105.
Emmanuel Nwachuku Yizhi Shan Prabhu Senthil-Kumar Todd Braun Ryan Shadis Orlando kirton Thai Q. Vu 《American journal of surgery》2021,221(1):240-242
BackgroundClostridioides difficile infection (CDI) is traditionally taught to be an antibiotic associated diarrheal infection. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 h) coupled with a diagnostic test. There is now a new presentation of CDI, including progression to toxic megacolon, in patients without diarrhea.MethodsWe report a case series of 9 surgical patients from a single institution who developed CDI without preceding diarrhea.ResultAll 9 patients had CDI with positive laboratory testing for C. difficile toxin. They, however, presented with a lack of or minimal bowel movements. Six patients had rapid development of abdominal distention, 1 patient had a single episode of watery stool in 3 days, while the other 2 patients presented with constipation. Seven patients received stool softeners, suppositories and/or enemas for presumed constipation. Four patients had a mild course of infection and were successfully treated medically. The other 5 patients developed toxic megacolon, and eventually required total abdominal colectomy. Out of the 5 patients that required total colectomy, 2 expired.ConclusionCDI must be suspected in patients who rapidly develop abdominal distention, vague abdominal complaints or change in bowel function even in the absence of diarrhea, especially if coupled with multi-system organ failure. 相似文献
106.
《Injury》2021,52(11):3327-3333
BackgroundAdult trauma patients with autism spectrum disorder (ASD) may have distinct care needs that have not been previously described. We hypothesized that due to differences in clinical care and disposition issues, injured adults with ASD would have increased lengths of stay, higher mortality, and increased rates of complications compared to adults without ASD.MethodsThe Pennsylvania Trauma Outcomes Study database was queried from 2010-2018 for trauma patients with ASD. Case-control matching was performed for two controls per ASD patient accounting for age, gender, injury mechanism, and injury severity score. Primary outcomes included length of stay, mortality, and complication rate. Univariate analysis compared presentation and clinical care between the two groups. Multivariate regression and Kaplan-Meier curves modeled length of stay. Significance was defined as p < 0.05.ResultsA total of 185 patients with ASD were matched to 370 controls. Age (mean +/- standard deviation) was 33.4 +/- 16.5 years. Gender was 81.1% male. Mechanisms were 88.1% blunt, 5.9% penetrating, and 5.9% burns. Significant clinical differences identified in patients with ASD vs. case-controls included presenting verbal GCS (median [IQR]) (5 [2] vs. 5 [0], p < 0.01), proportion of patients intubated at presentation (20.0% vs. 13.0%, p = 0.031), and hospital length of stay (4 [6] days vs. 3 [4] days, p = 0.002). Adult patients with ASD were less likely to be discharged home and more often discharged to a skilled nursing facility (p < 0.01). There were no differences in mortality, rates of complications, imaging, or operations. Multivariate regression analysis controlling for demographic and clinical differences revealed the diagnosis of ASD independently contributed 3.13 days (95% Confidence Interval: 1.85 to 4.41 days) to injured adults’ length of stay. Kaplan-Meier curves showed injured patients with ASD were less likely to be discharged than case-controls starting from time of admission (log rank test, p < 0.001).ConclusionsThis statewide analysis suggests injured patients with ASD have increased lengths of stay without other clinical or outcome differences. Given significant differences in discharge destination, these findings support early involvement of a multidisciplinary care collaborative. Further research is needed to identify factors that contribute to disparities in care for adults with ASD. 相似文献
107.
108.
109.
Xu Li Siming Li Zhihong Chi Chuanliang Cui Lu Si Xieqiao Yan Lili Mao Bin Lian Bixia Tang Xuan Wang Xue Bai Li Zhou Yan Kong Jie Dai Jun Guo Xinan Sheng 《Urologic oncology》2021,39(1):75.e1-75.e8
PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC. 相似文献
110.