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21.
本文报道用二维超声心动图对主动脉瓣关闭不全124例进行病变鉴别诊断。就其图象特征结合X线所见,心音图等进行了鉴别诊断的探讨。其中,有风湿性心脏病111例;感染性心内膜炎4例;冠状动脉粥样硬化性心脏病5例;马凡氏综合征2例;左室假腱索2例。认为此项检查对主动脉瓣关闭不全病变鉴别诊断有一定的价值。 相似文献
22.
Stefan Ockert Hardy Schumacher Dittmar Böckler Katrin Malcherek Jochen Hansmann Jens Allenberg 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):725-730
Background and aims Since the introduction of endovascular aortic aneurysm repair (EVAR) for aortic aneurysms, the number of juxtarenal aortic
aneurysms (JRA) has been growing steadily due to selection bias (neck morphology for EVAR). This case-match study compares
the perioperative outcome and midterm results of suprarenally clamped JRA with infrarenal aortic aneurysms (AAA).
Methods From 1997 to 2004, patients who received open surgery with suprarenal clamping for JRA were included in the study and compared
to matched patients with infrarenal clamping (AAA). Measurements analyzed were the in-hospital mortality and morbidity. Midterm
results were obtained through clinical investigation and magnetic resonance angiography imaging.
Results Thirty-five patients (mean age, 68.4 years; 30 male and 5 female) received suprarenal cross-clamping for JRA. The overall
in-hospital mortality for JRA and for the controls (AAA) with elective aortic repair was 4.5% (6.1% JRA; 3% AAA, p = 0.058). The morbidity of JRA was elevated according to the rate of pulmonary complications (p = 0.021) and the need for re-operation (p = 0.019). The mean follow-up time was 2.3 years (range, 8–96 months). At follow-up, 28 patients (80%) from the JRA group
and 29 patients from the AAA group (82.9%) were alive.
Conclusion Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate
without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms. 相似文献
23.
P. Neary C. Hurson D. O. Briain A. Brabazon D. Mehigan T. V. Keaveny S. Sheehan 《Colorectal disease》2007,9(2):166-172
OBJECTIVE: Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients. METHOD: Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6-year period. RESULTS: A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross-clamp time, intra-operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients. CONCLUSION: In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality. 相似文献
24.
主动脉缩窄及主动脉弓离断的电子束CT诊断 总被引:12,自引:0,他引:12
目的:探讨电子束CT诊断先天性主动脉缩窄和主动脉弓离断的价值。材料和方法:共10例病人,年龄6—18岁,均经手术证实。对所有患儿行EBCT增强扫描,并对图像行三维重建。结果:10例病人术前均得到正确诊断,其中8例为主动脉缩窄,2例为主动脉弓离断。EBCT均显示了全部8例主动脉缩窄及其缩窄的程度、形态,并显示缩窄处与左锁骨下动脉的关系。其中6例(75%)为局限性狭窄,2例(25%)形成中-重度长管状狭窄。合并畸形有:3例合并动脉导管未闭,1例合并室间隔缺损,1例合并肺动脉狭窄,1例合并二尖瓣狭窄,2例同时合并动脉导管未闭和室间隔缺损。2例主动脉弓离断病例,均合并有动脉导管未闭、室间隔缺损和肺动脉狭窄。EBCT均显示升主动脉与降主动脉呈分离状。结论:EBCT作为一种无创性检查方法,对先天性主动脉病变的诊断有重要价值,并能同时显示合并的胸部大血管异常。 相似文献
25.
血管内修复术创伤性小,可应用于治疗多种主动脉疾病,如动脉瘤和主动脉夹层。经食管超声心动图(TEE)对主动脉疾病很敏感。术前可通过TEE找到撕裂的内膜片、发现内膜破口、区分类型、区分真假腔及了解心脏状况。术中TEE用于引导导管插至正确位置、观察支架放置过程、监测心功能和室壁运动状况、评价手术疗效。术后随诊通过TEE观察支架内血流情况、检出并发症如内漏等。 相似文献
26.
Yoshimasa Sakamoto Kazuhiro Hashimoto Hiroshi Okuyama Shinichi Ishii Takahiro Inoue Katsushi Kinouchi Takayuki Abe 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(9):465-469
Objective The objective of the present study was to compare long-term results of single aortic valve replacement (AVR) with mechanical
(St. Jude Medical valves: standard) and biologic (the Carpentier-Edwards pericardial) prostheses. Method: Between 1995 and 2002, 95 patients who underwent single AVR with mechanical (n=46) or biologic (n=49) prostheses were enrolled
in this study. The mean age at the operation was 54.0±9.6 years (range: 20 to 69 years) with the mechanical and 68.8±7.1 years
(range: 44 to 85 years) with the biologic prosthesis. Results: The 9-year actuarial survival rate, which was calculated by taking perioperative mortality into account, was 90.3±4.6% for
patients with mechanical valves and 87.6 ±4.8% for patients with bioprostheses, with no difference between the two groups
(p=0.342). The 9-year freedom rate from thromboembolism, reoperation, endocarditis was 94.8+3.6%, 100% and 97.8 ±2.2% for
patients with mechanical valves and 98.0 ±2.0%, 97.5 ±3.4% and 95.0 ±3.4% for those with bioprostheses, respectively. After
9 years, freedom from cardiac death averaged 97.8% in the group with mechanical valves compared with 95.3% in those with bioprostheses
(p=0.541). Conclusion: We conclude that the mid-term durability of the Carpentier-Edwards pericardial valve in the aortic position for the elderly
is excellent. Nevertheless, the risk of tissue valve reoperation progressively increases with time, and a longer follow-up
may be necessary to provide its value compared with the mechanical valves in a country like Japan with a high life expectancy.
(Jpn J Thorac Cardiovasc Surg 2005; 53:465-469) 相似文献
27.
老年腹主动脉瘤非手术治疗的长期超声随访研究 总被引:5,自引:0,他引:5
目的超声随访观察经非手术治疗的老年腹主动脉瘤的发展变化规律。方法超声随访诊断明确、病历及影像学资料完整的老年腹主动脉瘤非手术治疗患者37例,按首次发现时瘤体大小分3组,定期测量并记录各组腹主动脉扩张最明显处横切面直径,计算年增长量。结果37例腹主动脉瘤首次发现时瘤径大小平均为4.68cm,随访年限0.5~11年,平均6.1年,瘤径平均每年增长0.47cm。14例瘤径小于4.0cm,平均年增长0.23cm,15例瘤径小于6.0cm,平均年增长0.37cm,8例瘤径大于6.0cm,平均年增长0.67cm。随访期间死亡5例,其中因动脉瘤破裂死亡2例,破裂前瘤径大小分别为8.35cm、8.91cm。7例随访期间因瘤径短期内明显增大而行腹主动脉瘤腔内支架隔绝术。结论老年腹主动脉瘤瘤径小于6.0cm者随增龄增长缓慢,大于6.0cm者随增龄增长快,应进行积极的外科干预。 相似文献
28.
应用同种动脉治疗主动脉根部病变 总被引:4,自引:0,他引:4
报告5例采用同种动脉(HAV)治疗5例主动脉根部病变(主动脉瓣狭窄1例,关闭不全4例)。男3例,女2例;年龄13~47岁。病因为细菌性心内膜炎2例(包括先天主动脉瓣二瓣化畸型1例),Marfan综合征2例,风湿性主动脉瓣关闭不全1例。术中采用同种主动脉全根置换3例(Bentall手术),其中1例用HAV上的二尖瓣前叶加宽主动脉瓣环(Manouguian手术),余2例用自体肺动脉移置主动脉根部,另取同种肺动脉做原位移置(Ross手术)。结果死亡1冽,4例存活,且无并发症发生。术后超声心动图提示主动脉根部良好,无主动脉瓣反流。随访2.5~3.5年疗效满意。 相似文献
29.
复合带瓣人工血管替换升主动脉和主动脉瓣(24例报告) 总被引:1,自引:0,他引:1
报告24例升主动脉瘤伴主动脉瓣关闭不全行升主动脉和主动脉瓣替换及冠状动脉开口移植术(Bental术22例,底盘法2例)。13例伴有升主动脉夹层分离,对其中8例DeBakeyI型者,以Teflon毡条内外加固主动脉切端后吻合。13例用人工血管周围间隙与右心耳吻合以控制升主动脉吻合之外的出血。3例以人工血管片环包主动脉吻合口控制局部广泛渗血及出血。2例术毕不能脱离体外循环死亡,手术死亡率83%。随访平均218个月,2例死于蛛网膜下腔出血,1例右股动脉栓塞经手术治愈;其余病人康复良好,心功能(NYHA)I~II级。 相似文献
30.
利多氟嗪加强间断缺血心停搏心肌的保护作用 总被引:1,自引:1,他引:0
通过对16条犬常温下用利多氟嗪(lidoflazine)预处理加强间断主动脉阻断心停搏心肌保护作用的实验研究。16条犬随机分为对照组和实验组。结果发现,实验组心脏血流动力学的恢复要明显优于对照组。二组间心肌组织ATP、腺苷和肌苷以及冠脉回流液中CPK、CPK-MB、LDH、SOD和MDA值均有显著性差异(P>0.05)。作者认为,冠脉搭桥术中采用间断缺血心停搏时加用利多氟嗪有利于保存心肌能量,减轻心肌再灌注损伤和术后迅即恢复心脏功能。 相似文献