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21.
上腔静脉综合征的外科治疗 总被引:5,自引:0,他引:5
目的报告5例上腔静脉综合征外科治疗经验及体会。方法2例行颈内静脉-大隐静脉转流术,3例行颈外静脉-大隐静脉转流术。结果无术后并发症及手术死亡。术后近期疗效满意5例,远期疗效满意2例。结论外科手术治疗上腔静脉综合征能明显改善患者的预后;但由于上腔静脉综合征病因、梗阻部位和范围不同,手术方法应有所选择。 相似文献
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Summary The validity of clinical studies on shunt-treated hydrocephalic patients is often hindered by inhomogeneity of the patient population examined, technical devices used, or by other specific factors. In an effort to introduce a homogeneous clinical study on hydrocephalic patients 66 hydrocephalic newborns and infants have been treated exclusively with CORDIS Orbis-Sigma Valve (OSV) System (CORDIS Corporation, Miami, USA) in 1990–1995. The results are compared with an equivalent group of 53 children treated with CODMAN Holter Valve (HV) System (CODMAN Inc., Randolph, USA) during a similar 5-year-period (e.g., 1986–1991). Searching for different reasons of shunt insufficiency in both groups demonstrates a more than double risk of shunt complication for ventriculo-atrial HV treated patients (VA-HV) in comparison with those treated ventriculo-peritoneally with OSV System (VP-OSV): 4.22 versus 1.98 mean surgical procedures per person. The different revision and survival rates are discussed and specific problems are mentioned. 相似文献
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本文报告2例布加氏综合征经肝裸区腔房转流术.2例均为Hirooka Ib型,术毕测下腔静脉压力,分别由术前2.75kPa和3.73kPa降至1.67kPa和1.87kPa.术后症状体征迅速消失.随访50和24个月效果良好,说明满意的压力降低是手术成功的重要标准.Hirooka Ia,Ib,Ic及Ⅳ型首选本术式的优点是:①移植人工血管短,通畅率高;②不易受压;③符合正常血液动力学;④只一个切口,创伤较小. 相似文献
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本文报道了肠系膜上静脉与下腔静脉侧侧分流术7例,并介绍了手术的体会,认为应解剖、暴露肠系膜上静脉“外科干”与相应平面的下腔静脉,清除两者间的增生组织,缩短两者的间距,才易取得手术成功。本术既可使门静脉压下降适中,又对门静脉向肝血流干扰较小,且对组织损伤较轻。 相似文献
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目的:寻求Arnold—Chiari畸形合并脊髓空洞症的病因、发病机制和确实合适的手术方案及术式。方法:通过回顾性分析天津医科大学总医院神经外科在1990年至2003年间收治的143例病例,对比不同手术方式术前术后MRI和临床症状的变化,寻找其间的规律。结果:术前MRI显示,有空洞者比单纯小脑扁桃体下疝者后颅窝更加紧密。术后症状均缓解,MRI显示空洞均减小,但后颅窝减压术者可见小脑扁桃体回缩,而脊髓空洞一腹腔分流术者小脑扁桃体回缩不明显。结论:Arnold—Chiari畸形合并脊髓空洞症是多因素引起的疾病,不能以单一因素来解释。脊髓蛛网膜下腔,特别是颅颈结合部的脑脊液循环障碍,是各种病因的共同点。因此,解除脑脊液循环障碍是治疗这种疾病的关键环节和最终目的。 相似文献
27.
目的:观察慢性肺心病急性发作期患者的肺内分流率(Qs/Qt)的变化。方法:用2100型肺功能仪作为减压装置,让患者吸入纯氧20min后,使用血气分析仪进行吸氧前后血气分析,并计算Qs/Qt值。结果:31例患者中,仅2例Qs/Qt正常,29例均增高。并以Qs/Qt为应变量,PaO2、PaCO2及SaO2为自变量,进行逐步回归,得出方程式。结论:低氧血症患者测定Qs/Qt,结合不同病因,有利于参估和选择合理的给氧方式,包括吸氧浓度。 相似文献
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The authors describe 32 children between 2 and 15 years of age who had hydrocephalus that was only clinically manifest late in life. The clinical picture of these children did not suggest an obvious increase in intracranial pressure; instead, the presenting signs were rather nonspecific and included macrocrania, mild psychomotor retardation, unsteady gait, increased muscle tone and deep tendon reflexes in the lower limbs, impaired ocular movement, epilepsy, and endocrine dysfunction. Their histories suggest the possible causes of the ventricular dilation in about one third of the cases were: perinatal hemorrhage, leptomeningitis, neurofibromatosis, and untreated aneurysm of the great vein of Galen. In 20 patients, however, no positive anamnestic findings were reported. CT scan revealed triventricular dilation in more than half of the cases; tetraventricular dilation was present in 6 patients, and biventricular dilation in the remaining subjects. All children underwent CSF shunting, which resulted in complete recovery in all but 2 cases. The most frequently recorded surgical complication was postoperative subdural effusion (7 subjects), which required surgical treatment in only 2 cases.Presented at the 15th Annual Scientific Meeting of the International Society for Pediatric Neurosurgery, New York, 1987 相似文献
30.
We develop tidal-ventilation pulmonary gas-exchange equations that allow pulmonary shunt to have different values during expiration and inspiration, in accordance with lung collapse and recruitment during lung dysfunction (Am. J. Respir. Crit. Care Med. 158 (1998) 1636). Their solutions are tested against published animal data from intravascular oxygen tension and saturation sensors. These equations provide one explanation for (i) observed physiological phenomena, such as within-breath fluctuations in arterial oxygen saturation and blood-gas tension; and (ii) conventional (time averaged) blood-gas sample oxygen tensions. We suggest that tidal-ventilation models are needed to describe within-breath fluctuations in arterial oxygen saturation and blood-gas tension in acute respiratory distress syndrome (ARDS) subjects. Both the amplitude of these oxygen saturation and tension fluctuations, and the mean oxygen blood-gas values, are affected by physiological variables such as inspired oxygen concentration, lung volume, and the inspiratory:expiratory (I:E) ratio, as well as by changes in pulmonary shunt during the respiratory cycle. 相似文献