全文获取类型
收费全文 | 609篇 |
免费 | 18篇 |
国内免费 | 4篇 |
专业分类
耳鼻咽喉 | 4篇 |
儿科学 | 5篇 |
妇产科学 | 11篇 |
基础医学 | 20篇 |
口腔科学 | 2篇 |
临床医学 | 33篇 |
内科学 | 53篇 |
皮肤病学 | 2篇 |
神经病学 | 12篇 |
特种医学 | 2篇 |
外科学 | 433篇 |
综合类 | 21篇 |
预防医学 | 16篇 |
眼科学 | 1篇 |
药学 | 5篇 |
中国医学 | 10篇 |
肿瘤学 | 1篇 |
出版年
2023年 | 3篇 |
2022年 | 8篇 |
2021年 | 13篇 |
2020年 | 13篇 |
2019年 | 12篇 |
2018年 | 23篇 |
2017年 | 9篇 |
2016年 | 15篇 |
2015年 | 2篇 |
2014年 | 20篇 |
2013年 | 24篇 |
2012年 | 12篇 |
2011年 | 19篇 |
2010年 | 12篇 |
2009年 | 8篇 |
2008年 | 21篇 |
2007年 | 81篇 |
2006年 | 12篇 |
2005年 | 8篇 |
2004年 | 20篇 |
2003年 | 5篇 |
2002年 | 6篇 |
2001年 | 2篇 |
2000年 | 1篇 |
1999年 | 48篇 |
1998年 | 39篇 |
1997年 | 41篇 |
1996年 | 16篇 |
1995年 | 27篇 |
1994年 | 18篇 |
1993年 | 21篇 |
1992年 | 21篇 |
1991年 | 37篇 |
1989年 | 2篇 |
1988年 | 2篇 |
1986年 | 2篇 |
1985年 | 1篇 |
1983年 | 2篇 |
1982年 | 1篇 |
1981年 | 2篇 |
1980年 | 1篇 |
1975年 | 1篇 |
排序方式: 共有631条查询结果,搜索用时 15 毫秒
101.
102.
Aloni Y Evron S Ezri T Medalion B Protianov M Szmuk P Zimlichman R Muggia-Sullam M 《Journal of clinical monitoring and computing》2006,20(4):261-266
Purpose. Morbid obesity caries an increased risk of cardiovascular morbidity and might be associated with intraoperative hemodynamic instability. Based on clinical observation, we hypothesized that during laparoscopic surgery, morbidly obese patients behave hemodynamically similar to the nonobese patients and remain hemodynamically stable. Methods. In a prospective trial, thirty nonobese and tthirty morbidly obese (BMI ≥ 35 kg/m2) patients scheduled for elective laparoscopic surgery were assigned to receive standard balanced anesthesia. We aimed at equianesthetic levels by keeping the BIS (bispectral index) value between 40–50 throughout surgery. End-tidal isoflurane was measured every 5 min. Noninvasive hemodynamic measurements included cardiac index (CI), mean arterial pressure (MAP) and heart rate (HR), recorded every 5 min and at specific predetermined times. Systemic vascular resistance (SVR) was calculated. Episodes of MAP ≤ 60 and MAP ≥ 130 mmHg or HR ≤ 50 and HR ≥ 110 bpm occurring throughout surgery and requiring pharmacological intervention were considered main end-points. Additionally, hemodynamic variables were compared at specific time points and overall throughout surgery. Secondary end-points were CI and SVRI. Results. Heart rate was higher in obese patients in head-up position (79 ± 15 mmHg vs. 65 ± 12 mmHg – P=0.011). SVR was higher in the nonobese group with head-up position (1978 ± 665 dynes s cm−5 vs. 1394 ± 496 dynes s cm−5 P=0.01). Mean overall intraoperative MAP, HR, CI and SVR were similar. There were no episodes of MAP ≤ 60 and ≥130 mmHg or HR ≤ 50 and ≥110 bpm in either of the groups. Conclusion. Our study confirmed our hypothesis that for the most periods of laparoscopic surgery, obese patients are hemodynamically as stable as their nonobese counterparts. 相似文献
103.
M. E. Zimmerman H. Andersson L. Lundell L. Olbe 《Scandinavian journal of gastroenterology》2013,48(3):263-268
Body compositional changes during rapid weight loss and after weight stabilization were prospectively studied in morbidly obese patients undergoing gastroplasty operations. Body composition was studied preoperatively and 6 and 24 months postoperatively in 23 patients by use of a total body counter (40K) and an isotope dilution technique. The mean fat mass, cell mass, and intracellular water (ICW) decreased during the first 6 months (p < 0.001) and remained unchanged at the 24-month test. However, the mean liters of extracellular water (ECW) did not change. Consequently, the ECW/ICW ratio, high in states of malnutrition, rose above postoperative levels. A strong correlation was found between decreases in cell mass and increases in the ECW/ICW ratio. 相似文献
104.
腹腔镜下可调节胃束带术及多学科综合治疗重度肥胖症及其合并症 总被引:1,自引:0,他引:1
目的 评估腹腔镜下可调节胃束带术(LAGB)及多学科(MDT)综合治疗重度肥胖症及其合并症的效果.方法 回顾性分析2009年10月至2011年2月在北京协和医院接受LAGB及MDT综合治疗的16例重度肥胖症患者的临床资料,总结减重及合并症改善情况.结果 16例患者中,15例完成术后3个月回访,平均体重(P=0.000)和BMI(P=0.000)均明显低于术前,额外体重减轻百分比(%EWL)为(25.7±7.4)%.13例完成术后6个月回访,术后6个月平均体重(P=0.001)和BMI(P=0.001)明显低于术前,与术后3个月差异无统计学意义(P=0.103,P=0.053);术后6个月的%EWL为(37.0±14.7)%,明显高于术后3个月的(29.1±6.8)%(P=0.042).6例完成术后12个月回访,术后3个月平均体重明显低于术前(P=0.007),术后6个月与术后3个月差异无统计学意义(P=0.065),术后12个月明显低于术后6个月(P=0.007);术后3个月的平均BMI明显低于术前(P=0.005),术后6个月明显低于术后3个月(P=0.045),术后12个月明显低于术后6个月(P=0.013);术后3、6、12个月的%EWL分别为(29.6±6.8)%、(42.4±14.0)%、(60.4±12.6)%,术后6个月明显低于术后3个月(P=0.028),术后12个月明显低于术后6个月(P=0.001).9例术前合并阻塞性睡眠呼吸暂停低通气综合征的患者,术后自觉症状均明显缓解.16例术前合并代谢综合征的患者中,10例术后病情得到明显改善.9例术前合并高血压的患者中,7例术后停用降压药物,血压恢复正常;1例减少药量,1例改用更缓和的降压药物.8例术前合并2型糖尿病的患者中,7例术后停用降糖药物,血糖恢复正常;1例降糖药物剂量减少.结论 LAGB及MDT综合治疗病态肥胖及其合并症安全有效、切实可行. 相似文献
105.
Elizabeth A. Klingaman Alicia Lucksted Eric S. Crosby Yelena Blank Elana Schwartz 《Journal of sleep research》2019,28(4)
The majority of people with serious mental illness experience insomnia, and insomnia is one of the most frequent reasons for mental health referrals in the Veterans Health Administration. Insomnia also represents a critical obstacle to mental health recovery. Little is known about how military veterans with mental health problems conceptualize their sleep and sleep problems; such information may uncover new avenues for research and treatment. Therefore, the purpose of this study was to explore how veterans with serious mental illness and insomnia experience and understand their sleep, towards the aim of identifying these new avenues. Participants included 20 veterans with insomnia and serious mental illness (i.e. schizophrenia spectrum, bipolar or major depressive disorders, with serious functional impairments). Data were collected via an inductive phenomenological approach using semi‐structured interviews. We identified five themes: Sleep to Recharge; Sleep as a Fight; Sleep as Safety or Escape; Sleep as Dangerous; and Military Influence. Participants' relationship with sleep was complex; many associated it with intrusive and troubling hallucinations, paranoia and military experiences, yet at the same time desired sleep for its potential to liberate them from distress. Military mindsets both helped and hindered sleep. These results extend existing models of insomnia development and maintenance, and illuminate phenomena previously unidentified in this underserved veteran population. Clinical and theoretical implications are discussed, as well as new research directions for enhancing therapeutic efficacy. 相似文献
106.
《The Journal of arthroplasty》2020,35(9):2652-2657
BackgroundPrevious studies have addressed the increased risk of perioperative complications in the obese and morbidly obese populations undergoing total hip arthroplasty. Over the last 15 years, the direct anterior approach has increased in popularity. The purpose of this study is to compare the 90-day perioperative complication rate of total hip arthroplasty performed through the direct anterior approach stratified by body mass index (BMI).MethodsPerioperative complications both intraoperative and up to 90 days postoperative were identified in a case series of 1808 primary total hip arthroplasties performed through a direct anterior approach. The patients were stratified according to BMI. Demographics of age, side, sex, and American Society of Anesthesiologists score were recorded. Medical and surgical complications including National Surgical Quality Improvement Program complications, length of stay, reoperation rate, readmission rate, and length of operation were recorded. Bivariate analysis and analysis of variance were performed.ResultsMorbidly obese patients (BMI > 40) demonstrated increased American Society of Anesthesiologists scores, increased surgical times with statistically significant increase in number of patients with surgical complications, National Surgical Quality Improvement Program complications, deep infection, and wound breakdown. Grading the severity of complications also demonstrated the morbidly obese had a higher risk of experiencing more severe complications. Underweight patients (BMI < 18.5) demonstrated a statistically significant readmission rate.ConclusionIn stratifying patients undergoing the direct anterior approach for total hip arthroplasty by BMI, a greater rate of surgical complications both in number and in severity occurs with the morbidly obese undergoing total hip arthroplasty through a direct anterior approach. 相似文献
107.
Mathus-Vliegen EM 《Best Practice & Research: Clinical Gastroenterology》2008,22(5):839-864
Morbid obesity is a chronic disease of excess fat storage, characterised by premature death and obesity-associated co-morbidities. The results of the current non-surgical treatment to treat obesity are disappointing, but surgical approaches may achieve a durable and longstanding weight loss with resolution and improvement of co-morbidities. Gastrointestinal complaints and digestive complications may, however, increase and may require an actively involved gastroenterologist. 相似文献
108.
High Prevalence of Asymptomatic Esophageal Motility Disorders among Morbidly Obese Patients 总被引:4,自引:1,他引:3
Background: Morbid obesity is becoming more prevalent in the industrialized world. Few data exist regarding the resting lower
esophageal sphincter pressure (LESP) and esophageal motility in relationship to body mass index (BMI). Methods: During a 3-year
period, 111 of 152 morbidly obese patients seeking bariatric surgery completed esophageal manometric testing and questionnaire
regarding esophageal symptoms. Manometric parameters included wave amplitude and duration of esophageal contractions, percentage
of peristaltic function, and resting LESP. Questionnaire data included age, sex, medications, prior medical conditions, and
esophageal symptoms. Results: 88 (79%) of the patients were female; 23 (21%) were male. The mean age was 39.8 years (± 9.9),
the mean BMI was 50.7 kg/m2 (± 9.4). There was a lack of correlation between BMI and LESP (r = 0.04). Abnormal manometric
findings were observed in 68/111 (61%) patients: 28 (25%) had only hypotensive lower esophageal sphincter (LESP < 10 mm Hg);
16 (14%) had nutcracker esophagus (amplitude >180 mm Hg), 15 (14%) had nonspecific esophageal motility disorders, 8 (7%) had
diffuse esophageal spasm (DES), and 1 (1%) had achalasia. Patients with DES had a significantly higher BMI than those with
other motility disorders (P < 0.05). Dysphagia was reported in 7 (6%) patients and chest pain in 1 patient. Heartburn and/or
regurgitation (gastroesophageal reflux disease, GERD) was noted in 35 patients (32%), of whom 18 (51%) had a hypotensive resting
LES. 40 of 68 patients (59%) with abnormal motility tracings did not report any esophageal symptoms. Conclusion: Morbid obesity
per se does not imply an abnormality of LESP. In addition, a majority of morbidly obese patients who were considering bariatric
surgery had no esophageal symptoms but were found to have abnormal esophageal manometric patterns. These findings add support
to the suggestion that morbidly obese patients may have abnormal visceral sensation. 相似文献
109.
Background: Dissatisfied with vertical banded gastroplasty in superobese patients, the authors adopted Salmon's gastroplasty/distal
gastric bypass (DGBP) in 1995. When the Swedish adjustable gastric band (SAGB) became available in Switzerland, the authors
started using that device instead of the gastroplasty because implanting a SAGB is much easier and gastric restriction with
a SAGB is adjustable to the patients' individual demands. Methods: The authors evaluated 40 consecutive patients with SAGB-DGBP
(27 primary and 13 secondary operations) for weight loss and complications, and compared weight loss with that obtained by
SAGB alone. The mean initial body weight was 156.6 kg in women and 188.1 kg in men for primary and 108.2 kg/147.0 kg for secondary
indications, respectively. The band was placed in a high position without tunneling sutures, and DGBP was done with a 50-
to 60-cm common channel and a 60- to 80-cm biliopancreatic limb. Results: Weight loss at 1 year was 33.3% of initial body
weight for primary operations. Weight loss was significantly more than with SAGB-alone cases. Complications were as follows:
no death, no slipping or pouch dilatation; one marginal ulcer, one splenectomy, four cholecystectomies, one Roux-en-O reconstruction,
two band leaks, eight port-related reoperations. Iron or vitamin deficiencies occurred in 75% of patients, with one case of
transient protein malnutrition and one of intermittent diarrhea. Conclusions: The SAGB as gastric restriction in combination
with DGBP can be implanted easily. The new-generation SAGB is safe, but longer follow-up is necessary. SAGB-DGBP is more efficient
than SAGB alone for weight reduction. It is too early to recommend banded DGBP as a primary procedure. However, in cases of
insufficient weight loss after placement of an adjustable band, adding a DGBP without removing the band is an option. Follow-up
by a specialized team is mandatory. 相似文献
110.
Ninh T Nguyen MD Hung S Ho MD FACS Levi S Palmer BS Bruce M Wolfe MD FACS 《Obesity surgery》1999,9(4):403-406
Laparoscopic gastric bypass has been recently introduced as an alternative method to conventional open gastric bypass. This
procedure has been generally limited to patients with a BMI <60 kg/m2 due to the possible technical limitations of the laparoscopic instruments. In this article, we present a patient with super/super
obesity (61 kg/m2) who underwent Rouxen-Y gastric bypass using the laparoscopic approach. 相似文献