全文获取类型
| 收费全文 | 260篇 |
| 免费 | 9篇 |
| 国内免费 | 1篇 |
专业分类
| 耳鼻咽喉 | 1篇 |
| 儿科学 | 5篇 |
| 基础医学 | 10篇 |
| 临床医学 | 29篇 |
| 内科学 | 100篇 |
| 皮肤病学 | 1篇 |
| 神经病学 | 5篇 |
| 外国民族医学 | 3篇 |
| 外科学 | 24篇 |
| 综合类 | 25篇 |
| 预防医学 | 9篇 |
| 眼科学 | 1篇 |
| 药学 | 47篇 |
| 中国医学 | 8篇 |
| 肿瘤学 | 2篇 |
出版年
| 2023年 | 4篇 |
| 2022年 | 3篇 |
| 2021年 | 9篇 |
| 2020年 | 2篇 |
| 2019年 | 21篇 |
| 2018年 | 35篇 |
| 2017年 | 7篇 |
| 2016年 | 9篇 |
| 2015年 | 5篇 |
| 2014年 | 28篇 |
| 2013年 | 26篇 |
| 2012年 | 15篇 |
| 2011年 | 22篇 |
| 2010年 | 13篇 |
| 2009年 | 11篇 |
| 2008年 | 15篇 |
| 2007年 | 20篇 |
| 2006年 | 7篇 |
| 2005年 | 9篇 |
| 2004年 | 3篇 |
| 2003年 | 3篇 |
| 2002年 | 3篇 |
排序方式： 共有270条查询结果，搜索用时 796 毫秒
261.
目的:系统评价沙库巴曲缬沙坦(sacubitril valsartan,SV)对比血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitors,ACEI)或血管紧张素受体拮抗剂(angiotensin receptor blockers,ARB)治疗心梗后心衰(post myocardial infarction heart failure,P-MI-HF)的有效性与安全性。方法:检索中国知网和PubMed等数据库自建库起至2021年12月有关SV(试验组)对比ACEI/ARB(对照组)治疗P-MI-HF的随机对照研究(randomised controlled trial,RCT)。采用Cochrane评价手册对纳入文献质量进行评价,采用Stata 14.0软件进行Meta分析。结果:共纳入15项RCT,Meta分析结果显示,试验组患者在左室射血分数[WMD=5.53,95%CI(3.93,7.13),P＜0.01]、左室舒张末内径[WMD=-2.91,95%CI(-4.05,-1.77),P＜0.01]、N末端B型利钠肽原[WMD=-358.40,95%CI(-446.62,-270.19),P＜0.01]、6分钟步行试验[WMD=66.57,95%CI(21.29,111.84),P＜0.01]和主要不良心血管事件发生率[RR=0.58,95%CI(0.45,0.74),P＜0.01]方面均优于对照组,且安全性良好。亚组分析结果显示行经皮冠状动脉介入治疗组的效果更好。结论:SV治疗P-MI-HF在提高患者心功能、改善心室重构和远期预后等方面较ACEI/ARB效果更优,且安全性良好。但由于纳入研究总体质量一般,该结果有待更严谨的RCT进一步证明。 相似文献
262.
目的通过单次及多次给药的协同降压作用,探索复方药物组成及用药剂量。方法采用自发性高血压模型大鼠(SHR)作为研究对象,给药后观测血压、心率、尿量和肾功能等水平,检测数据用SPSS 20.0软件进行统计学分析。结果各受试物对SHR均有显著的降压作用,并且合用均较单用的降压作用明显。结论沙坦类降压药与美托法宗合用有一定的协同降压作用,其降压作用与复代文相当,但利尿作用则较复代文弱,提示对电解质紊乱有一定预防作用。 相似文献
263.
Dae-Hee Kim Ran Heo Mark D. Handschumacher Sahmin Lee Yun-Sil Choi Kyu-Ri Kim Yewon Shin Hong-Kyung Park Joyce Bischoff Elena Aikawa Jong-Min Song Duk-Hyun Kang Robert A. Levine Jae-Kwan Song 《JACC: Cardiovascular Imaging》2019,12(4):665-677
Objectives
This study hypothesized that compensatory mitral leaflet area (MLA) adaptation occurs in patients with persistent atrial fibrillation (AF) without left ventricular (LV) dysfunction but has limitations that augment mitral regurgitation (MR). The study also explored whether asymmetrical annular dilation is matched by relative leaflet enlargement.Background
Functional MR occurs in patients with AF and isolated annular dilation, but the relationship of MLA adaptation with annular area (AA) is unknown.Methods
Three-dimensional echocardiographic images were acquired from 86 patients with quantified MR: 53 with nonvalvular persistent AF (23 MR+ with moderate or greater MR, 30 MR?) without LV dysfunction or dilation and 33 normal controls. Comprehensive 3-dimensional analysis included total diastolic MLA, adaptation ratios of MLA to annular area and MLA to leaflet closure area, and annular and tenting geometry.Results
Total MLA was 22% larger in patients with AF than in controls, thus paralleling the increased AA. However, as AA increased, adaptive indices (MLA/AA ratio and ratio of MLA to closure area) plateaued, becoming lowest in MR+ patients (ratio of MLA to closure area = 1.63 ± 0.17 controls, 1.60 ± 0.11 MR?, 1.32 ± 0.10 MR+; p < 0.001). MR increased as the ratio of MLA to closure area decreased (R2 = 0.68; p < 0.001). The posterior-to-anterior MLA ratio remained constant, whereas the posterior-to-anterior mitral annulus perimeter increased (1.21 ± 0.16 controls, 1.32 ± 0.20 MR?, 1.46 ± 0.19 MR+; p < 0.001). Multivariate MR determinants were annular area, total MLA to closure area, and posterior-to-anterior perimeter ratios.Conclusions
MLA adaptively increases in AF with isolated annular dilation and normal LV function. This compensatory enlargement becomes insufficient with greater annular dilation, and the leaflets fail to match asymmetrical annular remodeling, thereby increasing MR. These findings can potentially help optimize therapeutic options and motivate basic studies of adaptive growth processes. 相似文献264.
Edward Sze Zainab Samad Allison Dunning Kristen Bova Campbell Zak Loring Brett D. Atwater Karen Chiswell Joseph A. Kisslo Eric J. Velazquez James P. Daubert 《Journal of the American College of Cardiology》2018,71(3):306-317
Background
Patients with left bundle branch block (LBBB) often respond to cardiac resynchronization therapy (CRT) with left ventricular ejection fraction (LVEF) improvement. Guideline-directed medical therapy (GDMT), not CRT, is first-line therapy for patients with reduced LVEF with LBBB. However, there are little data on how patients with reduced LVEF and LBBB respond to GDMT.Objectives
This study examined patients with cardiomyopathy and sought to assess rates of LVEF improvement for patients with LBBB compared to other QRS morphologies.Methods
Using data from the Duke Echocardiography Laboratory Database, the study identified patients with baseline electrocardiography and LVEF ≤35% who had a follow-up LVEF 3 to 6 months later. The study excluded patients with severe valve disease, a cardiac device, left ventricular assist device, or heart transplant. QRS morphology was classified as LBBB, QRS duration <120 ms (narrow QRS duration), or a wide QRS duration ≥120 ms but not LBBB. Analysis of variance testing compared mean change in LVEF among the 3 groups with adjustment for significant comorbidities and GDMT.Results
There were 659 patients that met the criteria: 111 LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%). Adjusted mean increase in LVEF over 3 to 6 months in the 3 groups was 2.03%, 5.28%, and 8.00%, respectively (p < 0.0001). Results were similar when adjusted for interim revascularization and myocardial infarction. Comparison of mean LVEF improvement between patients with LBBB on GDMT and those not on GDMT showed virtually no difference (3.50% vs. 3.44%). The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB.Conclusions
LBBB is associated with a smaller degree of LVEF improvement compared with other QRS morphologies, even with GDMT. Some patients with LBBB may benefit from CRT earlier than guidelines currently recommend. 相似文献265.
目的:探讨ACEI/ARB治疗对高血压伴心房颤动(AF)患者血清hs-CRP的影响及其临床意义。方法:以高血压并AF的85例患者为房颤组,高血压、窦性心律的54例患者为窦律组,按是否接受ACEI/ARB治疗分成窦律非治疗组26例、窦律治疗组28例、房颤非治疗组42例和房颤治疗组43例,比较各组血清hsCRP。结果 :房颤非治疗组血清hs-CRP显著高于窦律非治疗组(P0.05);窦律组内血清hs-CRP差异无统计学意义(P0.05);房颤治疗组血清hs-CRP明显低于房颤非治疗组(P0.05)。结论:高血压伴房颤患者血清hsCRP升高,ACEI/ARB治疗可降低其hs-CRP水平。 相似文献
266.
Wouter Ouwerkerk Aeilko H. Zwinderman Leong L. Ng Biniyam Demissei Hans L. Hillege Faiez Zannad Dirk J. van Veldhuisen Nilesh J. Samani Piotr Ponikowski Marco Metra Jozine M. ter Maaten Chim C. Lang Pim van der Harst Gerasimos Filippatos Kenneth Dickstein John G. Cleland Stefan D. Anker Adriaan A. Voors 《Journal of the American College of Cardiology》2018,71(4):386-398
Background
Heart failure guidelines recommend up-titration of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blockers (ARBs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) to doses used in randomized clinical trials, but these recommended doses are often not reached. Up-titration may, however, not be necessary in all patients.Objectives
This study sought to establish the role of blood biomarkers to determine which patients should or should not be up-titrated.Methods
Clinical outcomes of 2,516 patients with worsening heart failure from the BIOSTAT-CHF (BIOlogy Study to Tailored Treatment in Chronic Heart Failure) were compared between 3 theoretical treatment scenarios: scenario A, in which all patients are up-titrated to >50% of recommended doses; scenario B, in which patients are up-titrated according to a biomarker-based treatment selection model; and scenario C, in which no patient is up-titrated to >50% of recommended doses. The study conducted multivariable Cox regression using 161 biomarkers and their interaction with treatment, weighted for treatment-indication bias to estimate the expected number of deaths or heart failure hospitalizations at 24 months for all 3 scenarios.Results
Estimated death or hospitalization rates in 1,802 patients with available (bio)markers were 16%, 16%, and 26%, respectively, in the ACE inhibitor/ARB up-titration scenarios A, B, and C. Similar rates for beta-blocker and MRA up-titration scenarios A, B, and C were 23%, 19%, and 24%, and 12%, 11%, and 24%, respectively. If up-titration was successful in all patients, an estimated 9.8, 1.3, and 12.3 events per 100 treated patients could be prevented at 24 months by ACE inhibitor/ARB, beta-blocker, and MRA therapy, respectively. Similar numbers were 9.9, 4.7, and 13.1 if up-titration treatment decision was based on a biomarker-based treatment selection model.Conclusions
Up-titrating patients with heart failure based on biomarker values might have resulted in fewer deaths or hospitalizations compared with a hypothetical scenario in which all patients were successfully up-titrated. 相似文献267.
268.
Comparative Risk of Angioedema With Sacubitril-Valsartan vs Renin-Angiotensin-Aldosterone Inhibitors
《Journal of the American College of Cardiology》2023,81(4):321-331
BackgroundData on angioedema risk among sacubitril-valsartan (SV) users in real-world settings are limited.ObjectivesWe sought to evaluate the risk of angioedema among SV new users compared with angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor-blocker (ARB) new users separately.MethodsWe conducted a propensity score–matched cohort study, comparing SV new users (no use of SV, ACE inhibitor, ARB 6 months before) and SV new users with prior use (within 183 or 14 days) of ACE inhibitor or ARB (ACE inhibitor–SV and ARB-SV users; recent ACE inhibitor–SV and recent ARB-SV users, respectively) vs ACE inhibitor and ARB new users separately.ResultsCompared with ACE inhibitor, SV new (HR: 0.18; 95% CI: 0.11-0.29) and ACE inhibitor–SV users (HR: 0.31; 95% CI: 0.23-0.43) showed lower risk of angioedema. On the other hand, there was no difference in angioedema risk when SV new users (HR: 0.59; 95% CI: 0.35-1.01) or ARB-SV users (HR: 0.85; 95% CI: 0.58-1.26) were compared with ARB new users. Compared with SV new users, ACE inhibitor–SV users (HR: 1.62; 95% CI: 0.91-2.89) trended toward higher angioedema risk, which intensified when the ACE inhibitor to SV switch occurred within 14 days (recent ACE inhibitor–SV) (HR: 1.98; 95% CI: 1.11-3.53). Similarly, ARB-SV users (HR: 2.03; 95% CI: 1.16-3.54) experienced an increased risk compared with SV new users, which intensified for the more recent switchers (recent ARB-SV) (HR: 2.45; 95% CI: 1.36-4.43).ConclusionsWe did not observe an increased risk of angioedema among SV new users compared with ACE inhibitor or ARB users. However, there was an increased risk of angioedema among SV users who recently switched from ACE inhibitor or ARB compared with SV new users. 相似文献
269.
270.