全文获取类型
收费全文 | 4755篇 |
免费 | 324篇 |
国内免费 | 76篇 |
专业分类
耳鼻咽喉 | 91篇 |
儿科学 | 74篇 |
妇产科学 | 259篇 |
基础医学 | 263篇 |
口腔科学 | 75篇 |
临床医学 | 1072篇 |
内科学 | 230篇 |
皮肤病学 | 9篇 |
神经病学 | 28篇 |
特种医学 | 96篇 |
外科学 | 1112篇 |
综合类 | 1021篇 |
预防医学 | 233篇 |
眼科学 | 134篇 |
药学 | 310篇 |
8篇 | |
中国医学 | 79篇 |
肿瘤学 | 61篇 |
出版年
2024年 | 4篇 |
2023年 | 83篇 |
2022年 | 124篇 |
2021年 | 156篇 |
2020年 | 157篇 |
2019年 | 130篇 |
2018年 | 156篇 |
2017年 | 176篇 |
2016年 | 139篇 |
2015年 | 161篇 |
2014年 | 335篇 |
2013年 | 346篇 |
2012年 | 329篇 |
2011年 | 328篇 |
2010年 | 284篇 |
2009年 | 222篇 |
2008年 | 189篇 |
2007年 | 226篇 |
2006年 | 211篇 |
2005年 | 165篇 |
2004年 | 155篇 |
2003年 | 130篇 |
2002年 | 120篇 |
2001年 | 94篇 |
2000年 | 90篇 |
1999年 | 66篇 |
1998年 | 48篇 |
1997年 | 57篇 |
1996年 | 51篇 |
1995年 | 68篇 |
1994年 | 62篇 |
1993年 | 46篇 |
1992年 | 32篇 |
1991年 | 34篇 |
1990年 | 32篇 |
1989年 | 20篇 |
1988年 | 17篇 |
1987年 | 15篇 |
1986年 | 11篇 |
1985年 | 14篇 |
1984年 | 24篇 |
1983年 | 10篇 |
1982年 | 7篇 |
1981年 | 4篇 |
1980年 | 9篇 |
1979年 | 2篇 |
1978年 | 7篇 |
1977年 | 6篇 |
1974年 | 1篇 |
1972年 | 1篇 |
排序方式: 共有5155条查询结果,搜索用时 0 毫秒
91.
Ultrasound evaluation of the impact of cricoid pressure versus novel ‘paralaryngeal pressure’ on anteroposterior oesophageal diameter
下载免费PDF全文
![点击此处可从《Anaesthesia》网站下载免费的PDF全文](/ch/ext_images/free.gif)
P. Andruszkiewicz J. Wojtczak L. Wroblewski M. Kaczor D. Sobczyk I. Kowalik 《Anaesthesia》2016,71(9):1024-1029
To assess the degree to which cricoid pressure (Sellick manoeuvre) actually compresses the oesophagus, we measured the effect of cricoid pressure and paralaryngeal pressure on the outer anteroposterior diameter of the upper oesophagus with ultrasound in 39 healthy volunteers. The mean (SD) outer anteroposterior oesophageal diameter was 0.77 (0.11) cm with no pressure, 0.79 (0.13) cm with the application of cricoid pressure of 30 N and 0.68 (0.12) cm with the application of paralaryngeal pressure of 30 N (p < 0.0001). If cricoid pressure does not reduce the anteroposterior diameter of the oesophagus, it is difficult or impossible to explain the efficacy of the Sellick manoeuvre. However, paralaryngeal pressure decreases this diameter and has the potential to occlude the upper oesophagus. 相似文献
92.
目的:介绍特殊全面部骨折手术中一种经颌下置管全麻的方法并探讨其适应症及注意事项。方法:7例全面部骨折、无法实施鼻插全麻患者,口插全麻并稳定后制备口底与颌下间隧道并将气管导管导出颌下、固定。手术结束后将导管导回口腔。结果:所有患者口腔插管和口底导出均顺利,导管位置无改变,双肺呼吸音对称。术中麻醉平稳,管理方便,不影响手术操作。术后局部无气肿、感染、气道阻塞、神经损伤。结论:在无法鼻插全麻前提下,经颌下置管全麻避免了气管切开,同时满足了颌骨骨折术中咬合对位的要求,是特殊全面部骨折麻醉手段的有效方法。 相似文献
93.
David L. Murphy Thomas D. Rea Andrew M. McCoy Michael R. Sayre Carol E. Fahrenbruch Lihua Yin Benjamin A. Tonelli Aaron M. Joffe Steven H. Mitchell 《The American journal of emergency medicine》2019,37(5):937-941
Purpose
In hospital-based studies, patients intubated by physicians while in an inclined position compared to supine position had a higher rate of first pass success and lower rate of peri-intubation complications. We evaluated the impact of patient positioning on prehospital endotracheal intubation in an EMS system with rapid sequence induction capability. We hypothesized that patients in the inclined position would have a higher first-pass success rate.Methods
Prehospital endotracheal intubation cases performed by paramedics between 2012 and 2017 were prospectively collected in airway registries maintained by a metropolitan EMS system. We included all adult (age?≥?18?years) non-traumatic, non-arrest patients who received any attempt at intubation. Patients were categorized according to initial positioning: supine or inclined. The primary outcome measure was first pass success with secondary outcomes of laryngoscopic view and challenges to intubation.Results
Of the 13,353 patients with endotracheal intubation attempted by paramedics during the study period, 4879 were included for analysis. Of these, 1924 (39.4%) were intubated in the inclined position. First pass success was 86.3% among the inclined group versus 82.5% for the supine group (difference 3.8%, 95% CI: 1.5%–6.1%). First attempt laryngeal grade I view was 62.9% in the inclined group versus 57.1% for the supine group (difference 5.8%, 2.0–9.6). Challenges to intubation were more frequent in the supine group (42.3% versus 38.8%, difference 3.5%, 0.6–6.3).Conclusion
Inclined positioning was associated with a better grade view and higher rate of first pass success. The technique should be considered as a viable approach for prehospital airway management. 相似文献94.
95.
M. Kotoda T. Oguchi K. Mitsui S. Hishiyama K. Ueda A. Kawakami T. Matsukawa 《Anaesthesia》2019,74(8):1041-1046
This study investigated displacement of the tracheal tube caused by different methods of intubating stylet removal, using in-vitro experiments and mathematical analysis. In the first in-vitro experiment, we measured the distance travelled by the tube tip during stylet extraction. Then, we investigated the ideal technique for stylet extraction using mathematical analysis, which would cause minimal tube displacement. Then, using a training manikin, we measured the force applied to the vocal cords and stylet extraction force during tracheal intubation. When the stylet was extracted along a straight path towards the stylet end, the distance travelled by the tube tip significantly increased as the bending angle increased. Mathematical analysis revealed that the stylet should be diagonally extracted (in the sagittal plane) at an appropriate angle, rather than along a straight path towards the direction of the stylet end. In simulated tracheal intubation, extraction force and force applied to the vocal cords both significantly increased as the bending angle increased. Compared with the ‘hockey stick’-shaped stylet, the arcuate-shaped stylet resulted in reduced force. Our results indicate the potential risk for vocal cord injury when using hockey stick-shaped stylets with large bending angles. 相似文献
96.
Paul A. Baker 《Anaesthesia and Intensive Care Medicine》2019,20(1):42-51
Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts. 相似文献
97.
《Egyptian Journal of Anaesthesia》2014,30(1):59-65
BackgroundThe Air-Q intubating laryngeal airway is a new supraglottic airway device which overcomes some of the limitations inherent to the intubating laryngeal mask airway (ILMA Fastrach™) for tracheal intubation. Previous studies showed lower success rate of the Air-Q™ versus ILMA Fastrach™. This study was conducted to illustrate new maneuvers for increasing the success rate of Air-Q™ versus ILMA Fastrach™ and compare between both devices.MethodsOne-hundred and seventy adult patients, ASA I or II, aged >16 years old undergoing elective surgery under general anesthesia were divided randomly into 2 equal groups (85 each). Group A: using Air-Q ILA size 3.5 or size 4.5 Group B: using ILMA size 4 or size 5 according to the manufacturer’s recommendations for body weight in both groups. The time and the total success rate of blind intubation through them in 2 attempts only were recorded. In Group A, extension of the head with cricoid pressure was applied. The hemodynamic response to devices insertion and the complications related to both devices were compared.ResultsIn Group A, the total success rate in 2 attempts was 94.12%, while in Group B, it was 96.47%. However, this difference was not statistically significant. The first attempt success rate was 81.18% in Group A, while it was 82.35% in Group B. The total time to intubate the hemodynamic response to device insertion and the incidence of complications (sore throat, trauma and hoarseness of voice) showed no statistically significant difference between both groups.ConclusionThis study showed that extension of the head with cricoid pressure greatly increases the success rate of blind intubation through the Air-Q to 94.12% versus the ILMA Fastrach 96.47% with no statistically significant difference between both devices. 相似文献
98.
目的探讨序贯性建立人工气道对重症脑损伤患者救治中的安全性的影响。方法选取2010-04-2014-03入住重症医学科(ICU)时APACHE-Ⅱ评分≥15分、4分≤GCS≤8分、ICU住院时间≥3d、估计气管插管超过3~7d者的重症脑损伤患者44例,随机分为2组,分别按不同方法实施气道开放,试验组采用序贯气道开放法,即在气管切开导管置入气管内之前仍保留气管插管,待气切导管完全正确放置,再拔除气管插管,全过程始终使用呼吸机辅助通气,常规组在气管切开造口过程中不使用呼吸机辅助通气,仅吸氧4~8L/min;观察2组患者的操作时间、APACHE-Ⅱ评分、生命体征、术后24h NSE水平、血气分析以及随访3个月的GOS评分。结果 (1)2组患者入科时、气管切开术前APACHE-Ⅱ、HR、RR、Bp、SpO2比较差异无统计学意义(P0.05);气管切开造口术后与入科时APACHE-Ⅱ、SpO2相比差异均有统计学意义(P0.05);同时气管切开术后APACHE-Ⅱ、HR、RR、Bp、SpO2在2组患者间的差异均有统计学意义(P0.05)。(2)2组患者入科时以及气管切开前血气分析中的pH、PaO2、PaCO2和术后NSE水平差异均无统计学意义(P0.05);气管切开造口术后与入科时相比升高,差异有统计学意义(P0.05);对比2组患者的气管切开术后pH、PaO2、PaCO2和术后NSE水平差异具有统计学意义(P0.05)。(3)2组患者3个月后生存质量相比差异有统计学意义(P0.05)。结论重症脑损伤患者因长期呼吸机辅助通气,采取序贯性人工气道开放法能确保其安全性,改善预后,提高抢救成功率。 相似文献
99.
王李刚 《临床心身疾病杂志》2014,(4):103-105
目的:探讨脑室外引流术后并发颅内感染的影响因素。方法对105例经额脑室前角穿刺脑室外引流术患者的临床资料进行回顾性分析。结果在排除年龄、性别、手术耗时等干扰因素的情况下:(1)置管时间>10 d者颅内感染率最高(16.0%),其次是≥7 d者(12.5%),<7 d者最低(10.0%)。(2)单侧外引流颅内感染率低于双侧外引流(10.5%/16.7%)。(3)引流管在原切口的颅内感染率最高(23.1%),距原切口3 cm-5 cm的感染率最低(9.5%)。(4)未预防性应用抗生素的感染率最高(10.7%),术后3d鞘内注射感染率最低(4.5%)。结论脑室外引流术后并发颅内感染受影响因素众多,对患者进行全面的观察和治疗,可有效避免或减少颅内感染的发生。 相似文献
100.
目的探究在院前心脏停搏患者应用气管插管和球囊辅助呼吸进行急救的效果。方法选自本院2010年2012年进行院前急救的心脏停搏患者共50例,以随机的方式分为对照组与观察组,每组各有患者25例。对照组患者接受气管插管辅助呼吸,观察组患者接受球囊人工通气治疗。对比2组患者的各项临床指标。结果相对于对照组患者,观察组患者在建立通气时间方面有显著优越性,二者对比具有统计学意义(P<0.05);其余各项临床指标对比无统计学意义(P>0.05)。结论对心脏停搏患者进行院前急救的时候,应用球囊或者气管插管的急救方法,在临床效果对比方面相似,但是球囊辅助呼吸建立通气的时间要比气管插管短很多。 相似文献