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71.
Retrospective review of the preoperative biliary and gastrointestinal evaluation for gastric bypass surgery 总被引:1,自引:0,他引:1
Vincent W. Vanek M.D. C.N.S.P. F.A.C.S. Michele Catania R.N. B.S.N. Kimberly Triveri R.D. L.D. Robert W. Woodruff Jr M.D. 《Surgery for obesity and related diseases》2006,2(1):839-22
BACKGROUND: The purpose of this study was to analyze the frequency and results of preoperative biliary and gastrointestinal (GI) evaluation of patients undergoing Roux-en-Y gastric bypass (RYGB). METHODS: Retrospective review of the preoperative evaluation of 144 consecutive RYGB patients. RESULTS: Cholecystectomy had already been performed in 43 (30%) patients; 22% of those patients with an intact gallbladder had cholelithiasis. Ten patients (7%) had an upper GI x-ray (UGI), and 94 patients (65%) had an esophagogastroduodenoscopy (EGD). Abnormalities were found in 40% of the UGIs and 84% of the EGDs. A total of 96 patients (67%) were tested for Helicobacter pylori; 11% were positive. Twenty-one patients (15%) underwent preoperative colonoscopy; 48% were abnormal, but most of the abnormalities were not clinically significant. Three patients had barium enema x-ray, which was normal in all cases. CONCLUSIONS: The preoperative biliary and GI evaluation of bariatric surgery patients should include a routine ultrasound of the gallbladder. Routine preoperative EGD will detect a significant number of abnormalities that should be treated, but should rarely alter the bariatric surgical procedure or result in denial of bariatric surgery. Many abnormalities will be asymptomatic. Patients should be routinely screened for H. pylori and, if positive, treated before bariatric surgery. Lower GI evaluation should be performed selectively based on the patient's symptoms, physical findings, and guidelines for colorectal cancer and polyp screening. 相似文献
72.
Sajja Lokeswara Rao Mannam Gopichand Sompali Sriramulu Reddy Karri Venkata Ravirala Bala Raju Raju Bhupathiraju Soma Raju Penmetcha Krishnam 《Indian Journal of Thoracic and Cardiovascular Surgery》2004,20(4):173-177
Background Cardiopulmonary bypass (CPB) may contribute to the complications and it is assumed that eliminating cardiopulmonary bypass
has the potential of reducing post operative morbidity after coronary artery bypass grafting (CABG). The study was carried
out to compare mortality and morbidity in the off-pump and on-pump CABG groups.
Methods We prospectively analysed 200 patients undergoing CABG. Group A consists of 100 patients underwent multi-vessel off-pump CABG
and group B consists of 100 patients underwent CABG with CPB. The incidence of complications (mortality, re-exploration for
bleeding, myocardial infarction, atrial fibrillation, neurological events, new onset renal failure (s. creatinine>1.6 mg/dL)
pulmonary complications, length of ICU stay and hospital stay were recorded, analysed and compared.
Results OPCAB patients received 2.73±0.61 grafts/patient and on-pump CABG patients received 3.39±0.75 grafts/patient (p value<0.00001). There was no significant statistical difference in mortality, incidence of stroke between OPCAB and CABG
with CPB patients. Length of ICU stay was 32.84±4.22 vs 44.85±7.18 hrs (p value<0.00001) and hospital stay was 6.52±0.69 vs 7.94±0.92 days (p value<0.00001) between group A and group B respectively. Incidence of atrial fibrillation was less in OPCAB group 7% vs 12%
although it was statistically not significant (p value 0.33). It was observed in our study that there was no significant deference in worsening of existing renal failure
between on-pump CABG and OPCAB 6% vs 2% (P value 0.28). Blood utilization was significantly less in OPCAB group (p value<0.001).
Conclusion There was no statistically significant difference in terms of mortality, incidence of stroke and new onset renal failure in
both groups. But there was lesser incidence of post operative atrial fibrillation, worsening of existing renal failure in
off-pump group though statistically not significant. There was significant reduction in blood utilization, length of ICU and
hospital stay in OPCAB group. 相似文献
73.
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
74.
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
75.
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
76.
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
77.
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
78.
79.
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
80.
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