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71.
改良超滤技术在体外循环中的应用 总被引:13,自引:5,他引:8
目的 观察改良动、静脉超滤技术在体外循环 (CPB)中作用及效果。方法 4 8例病人随机分为两组 ,各 2 4例 ,超滤组于CPB停机后 ,待血液动力学基本稳定时 ,使体内血液经动脉供血管经超滤器超滤后进入右房。对照组不行改良动、静脉超滤。结果 术后输入库血量对照组 5 90ml,超滤组 310ml(P <0 .0 1)。超滤组平均滤出液5 4 0ml,术后血细胞比容、血小板、血浆蛋白、纤维蛋白与超滤前比速度增高 (P <0 .0 1)。结论 改良动、静脉超滤技术有利于术后多余水分排出 ,可减少术后并发症和输血量 ,适用于小体重、血液稀释度大的婴幼儿和长时间CPB者。 相似文献
72.
Geoffrey G Hallock 《CANADIAN JOURNAL OF PLASTIC SURGERY》2003,11(2):67-69
The use of the radial artery as an alternative vascular conduit for coronary bypass surgery has become increasingly popular. The plastic surgery experience with radial forearm flaps has shown that sacrifice of the radial artery is not always a benign maneuver. The potential morbidity after using this conduit donor site in terms of hand dysfunction or wound healing problems can be significant, and frequently must ultimately be addressed as part of the role of the reconstructive surgeon. Case examples of skin necrosis, subsequent forearm wound infection and hypertrophic scarring after radial artery harvest are presented to introduce this as a real concern and to allow a review of the entire spectrum of potential problems in this regard. Any selection process where the radial artery may be chosen as the coronary revascularization conduit must anticipate these known donor site complications. 相似文献
73.
Summary Effects of STA-MCA anastomosis on two patients with neovascular glaucoma due to occlusion of the internal carotid artery are presented. Both patients improved in visual acuity and central retinal artery pressure as well as in signs of transient ischaemic attack. Postoperative angiography showed a marked decrease in collateral flow through the ophthalmic artery, which is reversed from the normal direction, with the development of blood flow through the anastomosis. Discussion is offered indicating that the lack of collateral flow through both the anterior and posterior communicating arteries is important in addition to occlusion of the internal carotid artery in order to produce full-blown ischaemic oculopathy such as venous stasis retinopathy, neovascular glaucoma or rubeosis iridis. It is stressed that EC-IC bypass surgery should be performed soon after the appearance of ischaemia and before the development of neovascular glaucoma or rubeosis iridis in order to obtain normal vision. In ischaemic oculopathy the results of EC-IC bypass can be evaluated objectively and quantitatively by many noninvasive neuro-ophthalmological tests which are important in discussing the efficacy of the bypass surgery. 相似文献
74.
Bruce F. Waller Charles M. Orr James Van Tassel Thomas Peters Edward Fry James Hermiller Larry D. Grider 《Clinical cardiology》1997,20(1):67-74
Catheter balloon angioplasty is a well accepted form of nonsurgical treatment of acutely and chronically obstructed coronary artery vessels. It is also the centerpiece for various new intervention techniques. Their morphologic effect on the site of obstruction has been termed “remodeling.” Part V of this six-part series focuses on remodeling effects of balloon angioplasty on obstructed young (≤ 1 year) and old (> 1 year) saphenous vein bypass grafts. 相似文献
75.
J. Boldt H. A. Adams B. Zickmann D. Kling G. Hempelmann 《European journal of clinical pharmacology》1990,38(5):431-436
Summary The release of endogenous catecholamines in aorto-coronary bypass graft patients receiving either 0.5 mg/kg enoximone (n=10), 4.0 mg/kg theophylline (n=10) or saline solution (control,n=10) has been studied, as well as certain haemodynamic parameters. Adrenaline (A) and noradrenaline (NA) concentrations were
not significantly changed by the administration of enoximone. Theophylline caused a small increase in NA (+ 40% in the 1st
min) and a marked increase in A (approximately + 7000% in the 1st min), which still remained elevated at the end of the investigation
period (+ 220% in the 30th min). The major haemodynamic effects of enoximone were a significant increase in cardiac index
(CI; + 35%) and a decrease in pulmonary capillary wedge pressure (PCWP; −27%), pulmonary artery pressure (PAP; −21%), RVEDV
and RVESV, while the heart rate (HR) remained almost unchanged. The dominant haemodynamic effects of theophylline were an
increase in HR (+ 26%; arrhythmia in 3 patients), PAP (+ 22%), and RVEDV (+ 19%), while REVESV (+ 26%), MAP (−16%), CI (−14%),
and RVEF (−15%) fell significantly.
It is concluded that the haemodynamic actions of enoximone are not mediated by catecholamine release, whereas the adverse
cardiovascular effects of theophylline might partly be explained by the significant increase in plasma adrenaline. 相似文献
76.
77.
Background: The gastric bypass operation has evolved since 1966 when it was first introduced. The purpose of this study was
to determine the present state of gastric bypass by consensus among the members of the American Society for Bariatric Surgery
(ASBS). Method: A questionnaire was sent to all members of the ASBS. Forty-three percent responded reporting over 41,200 cases.
Results: Results were analyzed by using χ2 tests with a null hypothesis. Surgeons agreed on several technical aspects, preferring a vertical to a horizontal stapleline;
estimating, rather than measuring, the pouch volume at an average of 22 cc. Few surgeons divide the short gastric vessels,
and only 25% of surgeons polled use a restrictive ring or band proximal to the gastroenterostomy. Most surgeons calibrate
the gastroenterostomy, reporting a preferred average diameter of 12.3 cm. There was no consensus regarding forming the gastroenterostomy,
58% preferring hand-sewn and 42% stapled anastomoses. There was no consensus regarding dividing the gastric pouch from the
bypassed stomach: Conclusion: The preferred gastric bypass is vertical, with the pouch estimated at 20-25 cc, and the gastroenterostomy
calibrated at 12 mm diameter. The short gastric vessels need not be divided, and restrictive bands or rings are not preferred.
This technique of gastric bypass should be used as the control procedure when modifications are tested in future trials. Randomized
prospective studies are suggested to probe the benefits of division of the stomach pouch from the bypassed stomach. 相似文献
78.
The Workup for Bariatric Surgery Does Not Require a Routine Upper Gastrointestinal Series 总被引:1,自引:0,他引:1
Andrew J Ghassemian Kenneth G MacDonald MD Paul G Cunningham MD Melvin Swanson PhD Brenda M Brown MRA Patricia G Morris BSN Walter J Pories MD 《Obesity surgery》1997,7(1):16-18
Background: Morbid obesity is a serious disease that afflicts over five million Americans, threatening their health with such
co-morbidities as diabetes, arthritis, pulmonary failure and stroke. Surgery is the only effective therapy, providing long-term
control of weight, diabetes, pulmonary failure, and hypertension for as long as 14 years. Because the operation presents a
major expense, this study examined whether X-ray examination of the gut could be omitted safely as a cost-saving measure.
Methods: The records of 814 consecutive morbidly obese patients who underwent gastric bypass were reviewed to determine: (1)
whether these individuals had undergone an upper gastro-intestinal (GI) series, and (2) if these studies influenced therapy
or caused cancellation or postponement of surgery. Results: Of the 814 patients, 657 (80.7%) underwent a preoperative GI radiography.
Of these examinations, 393 (59.8%) were normal, with the following abnormalities in the remaining 264: hiatal hernia, 164;
esophageal reflux, 39; Schatzki's ring, 18; small bowel diverticula, four; renal stones, four; malrotation, three; gall stones,
two; pyloric ulcer, one; possible pelvic mass, one; calcified leiomyoma, one; and dysphagial lusoria, one. None of these findings
resulted in cancellation or a delay in surgery. Conclusions: The upper GI series can be safely omitted from the routine preoperative
evaluation of patients undergoing gastric bypass. At a cost of $741.00 per examination, this change represents significant
potential savings. Similar evaluations of other routine preoperative tests may well provide a better basis for the evaluation
of these complex patients. 相似文献
79.
Katsumi Harasawa Osamu Kemmotsu Takahisa Mayumi Yoshiteru Kawano 《Journal of clinical monitoring and computing》1997,13(1):19-24
Objective. Tympanic temperature can be obtained instantaneously using an infrared emission detection (IRED) thermometer. Its accuracy has been documented in a variety of clinical settings, but its performance at low body temperatures is still unknown. In this study we evaluated its performance during coronary artery revascularization surgery in which mild hypothermic cardiopulmonary bypass (CPB) was used. Methods. Thirty adult patients undergoing coronary artery bypass graft surgery were enrolled in the study. Tympanic temperature obtained using IRED thermometry (Tt1) was compared with core temperatures from the esophagus (Te), and venous blood of CPB (Tv) before, during, and after CPB. We also measured tympanic temperature using a thermocouple probe (Tt2) in 16 of the 30 patients in order to study the agreement between the two methods. Values for correlation coefficients and limits of agreement were computed to assess the degree of agreement among the temperatures obtained. Results. The highest agreement with Tv during CPB was obtained from Tt1 (r = 0.94, 0.41 ± 1.73, limits of agreement) and from Te (0.91, 0.36 ± 2.46). Tt1 also showed good agreement with Tt2 during surgery. Conclusions. Infrared tympanic thermometry is a reliable, alternative method to measure tympanic temperature and may be useful to assess core temperature in both normothermic and mild hypothermic conditions. 相似文献
80.
体外静脉—静脉转流下原位肝移植围术期酸碱,生化的变化 总被引:9,自引:2,他引:7
目的:观察体外静脉转流下原位肝移植围术期酸碱和生化的变化。方法:7例病人行原位肝移植术,在无肝期行体外静脉-静脉转流,监测围术期酸碱和生化指标。结果:(1)与术前相比,pH各期有所下降,但仍维持在正常范围,BE和SBC在转流60分钟及关腹时降低;与转流前期相比。pH以后各期变化不大。术期pH在7.35~7.45范围之内;(2)血糖在各期都升高,血钙降低,体温逐渐降低;(3)血钾在肝血管开放后一过性增高,由3.17mmol/L升至3.53mmol/L。结论;体外静脉转流下原位肝移植术,术中酸碱和生化变化轻微,避免了明显的代谢性酸中毒和高血钾,但体温和血糖变化明显。 相似文献