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51.
Survey of postoperative analgesia following ambulatory surgery 总被引:4,自引:0,他引:4
N. RAWAL J. HYLANDER R-A. NYDAHL I. OLOFSSON A. GUPTA 《Acta anaesthesiologica Scandinavica》1997,41(8):1017-1022
Background: The quality of pain relief during the first 48 hours following ambulatory surgery has been poorly documented. This questionnaire study was performed to evaluate the nature and severity of pain after the patient leaves the hospital. Methods: 1100 patients in the age group 5–88 years who underwent ambulatory surgery during a period of 6months were asked to complete a questionnaire 48 h after the end of the operation. In thecase of children, parents were asked to complete a similar questionnaire. The questions were related to pain experienced during the first 48 h after surgery and to the nature andseverity of postoperative complications. Results: A total of 1035 out of the 1100 patients returned the questionnaire, 94.1%. Overall the majority (65%) of patients had only mild pain at home; however, patients undergoing certain types of surgery had moderate-to-severe pain: inguinal hernia surgery (62% patients), orthopaedic surgery (41%), hand surgery (37%) and varicose vein surgery (36%). In these patients the severity of pain did not decrease during the 2-day study period. About 10% patients had more severe pain than they had anticipated, and 20% had difficulty in sleeping at night due to severe pain. Despite this, over 95% of patients were satisfied with man-agement of postoperative pain. Nausea (20%), tiredness (20%) and vomiting (8%) were the commonest complications reported during the first 48 h. A significant association was found between the administration of a general anaesthetic and the incidence of nausea postoperatively. A large number of patients were alone at home after the operation (28.4%); some (3.8%) had no access to a relative or friend in case of need. Conclusion: Our results show that about 35% of day-surgery patients experience moderate-to-severe pain at home in spite of analgesic medication. About 20% of patients had sleep problems due to severe pain. However, only 5% of patients were dissatisfied. Better analgesic techniques are necessary for patients undergoing certain types of surgery. Patient information and follow-up routines need to be improved. 相似文献
52.
Pain following tonsillectomy is an important problem. It is caused by the surgical trauma of excision and haemostasis. Numerous surgical and pharmacological solutions have been tried, with disappointing results. Fibrin sealant is a widely used atraumatic haemostatic agent. This study aims to determine whether tonsillectomy with fibrin sealant haemostasis results in less post-operative pain than that with the conventional technique of diathermy. Fifty consecutive adult patients undergoing tonsillectomy were prospectively studied. They were randomized to receive either fibrin sealant or diathermy haemostasis. Other pain variables were controlled. Pain was measured by a visual linear analogue scale and inter-incisor distance on both the day of operation and the first post-operative day. The patients and pain measurer were blind to the randomization. The results showed that tonsillectomy with fibrin sealant haemostasis was significantly (P < 0.05) less painful than that with diathermy on both days studied and by both methods of pain measurement 相似文献
53.
10例椎管内转移癌病人曾长期使用大剂量镇痛药难以奏效,而少数病例便采用硬膜外腔注射吗啡2~4mg疼痛缓解仅1h。采用硬膜外腔灌注氨甲喋呤配伍高渗盐水,使抗癌药直接与肿瘤接触,几分钟内杀死癌细胞,加之高渗盐水能促使肿瘤和神经干脱水,肿瘤体积缩小和破坏,改善局部动脉缺血和组织水肿,从而减轻或消除肿瘤对神经根的压迫,缓解和消除神经痛。 相似文献
54.
Anterior lumbar fusion using a hybrid interbody graft 总被引:3,自引:0,他引:3
Summary This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels)
utilizing a “hybrid” interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft
bone. The average age at surgery was 38 years (range 17–64 years), and follow-up averaged 1.4 years (range 1.0–2.4 years).
Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion
combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior
fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar
facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence
of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest
follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS
fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation
was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected
for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative
values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of
the hybrid graft. Incorporation of the allograft portion of the graft is slow and was felt to be complete in only 7 of the
73 levels at follow-up. We conclude that the hybrid interbody graft technique is a safe and reliable method for performing
anterior lumbar interbody fusions and should be combined with some type of posterior fixation. Long-term follow-up will be
required to assess the behaviour of the allograft until incorporation is complete. 相似文献
55.
Summary The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients,
five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete
or discrete annular tears that are not filled at the time of injection. Later (2–12 h in this study), dye leakage occurs through
these lesions, thereby precipitating the discogenic pain This phenomenon may be missed and is probably more common than previously
believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint
is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient
questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic
information following this study. 相似文献
56.
Philip Harber Laura Pea Paul Hsu Elizabeth Billet Deborah Greer Katty Kim 《American journal of industrial medicine》1994,25(4):519-526
Back pain among nurses is a common problem. Prior studies of this problem have been based on cross-sectional or retrospective data. This 18-month prospective study involving nurses newly graduated from nursing school investigated personal, worksite, and training factors associated with future risk of back pain. Each nurse underwent a preliminary interview and periodic follow-ups to identify those with back injuries. Contingency tables and logistic regression analyses demonstrated that prior significant back pain episodes (evidenced by previous job changes because of back pain, frequent medication use, etc.) were associated with increased future risk. Training at nursing school or on the job did not have a protective effect. This pilot study therefore suggests factors useful in placement and counseling of new nurses and indicates the need for further implementation of mechanical lift assist device use. © 1994 Wiley-Liss, Inc. 相似文献
57.
Industrial back belts and low back pain: Mechanisms and outcomes 总被引:1,自引:0,他引:1
The recent increased utilization of industrial back belts as personal protective equipment in the workplace has generated considerable controversy among occupational health and safety professionals in the United States. The purpose of this article is to review the literature regarding proposed mechanisms of action of these devices and studies related to outcome of belt utilization in the prevention of low back pain and disability in the workplace. At the present time, neither the suspected mechanisms of action nor the efficacy of these devices in the primary, secondary, and tertiary prevention of work-related low back pain has been adequately demonstrated in clinical trials. As a result, generally accepted guidelines regarding the safe use of belts in the occupational setting have not been established. Based on this review it is recommended that further well-controlled, prospective, randomized clinical trials are necessary to evaluate the effectiveness of these devices as personal protective equipment. During the interim, the decision to prescribe belts to employees in the workplace should be at the discretion of an adequately trained occupational health care provider. These devices should not be provided as an alternative to appropriate administrative and/or engineering controls. 相似文献
58.
Patricia Kudo Katie Dainty Michael Clarfield Larry Coughlin Pauline Lavoie Constance Lebrun 《Journal of orthopaedic research》2006,24(2):115-123
Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis. 相似文献
59.
In a study to elucidate molecular mechanisms in pain, substance P-like immunoreactivity (SP-LI) was measured in lumbar CSF from 75 patients with lower back pain. Two samples – one before and one after lidocaine treatment – were obtained from each patient, and total SP-LI was measured in unfractionated (no HPLC) samples. SP-LI data were separated into three categories: placebo responders, pharmacological responders, and pharmacological non-responders. A significant difference was observed between the total SP-LI measurement of first and second samples of pharmacological non-responders. Distribution of SP-LI immunoreactive molecular species in two CSF patient samples (no ODS) was analyzed with a combination of reversed phase (RP) HPLC and RIA. Immunoreactivity in collected HPLC fractions was measured at calibrated retention times of synthetic SP-sulfoxide (SP-O), SP, and SP5–11. Qualitative and quantitative differences in those HPLC-RIA metabolic profiles were observed within and between those two patients' samples. These data indicate that the type and amount of SP metabolism and SP precursor-processing differs in CSF between these two representative patients and within the short amount of time elapsed between acquiring these two samples. 相似文献
60.
V. Wewer C. Strandberg A. Pærregaard P. A. Krasilnikoff 《European journal of pediatrics》1997,156(10):787-788
We report on our experience with routine abdominal ultrasonography in 120 children (aged 3–15 years) with recurrent abdominal
pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities:
gallbladder stone (n = 2), splenomegaly (n = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases.
Conclusion The diagnostic value of abdominal ultra‐sonography in unselected children with recurrent abdominal pain is low. However,
the direct visualization of the abdominal structures as being normal may be helpful to the parents and the child in their
understanding and acceptance of the benign nature of recurrent abdominal pain.
Received: 19 March 1996 / Accepted: 29 January 1997 相似文献