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1.
背景 我国基层全科医生的离职意愿较高,调查其离职意愿并分析影响因素,可以为减少基层卫生人才流失提供思路。目前,完成"5+3"模式(5年临床医学本科教育+3年住院医师规范化培训)培养的订单定向医学毕业生逐步履约进入基层工作,而针对该部分全科医生离职意向的研究相对较少。 目的 调查贵州省"5+3"模式订单定向医学毕业生回归基层工作后的离职意愿及影响因素,为完善吸引卫生人才留任、建设基层全科医生队伍相关政策提供依据。 方法 以贵州省截至2020年底已完成"5+3"模式培养并履约到基层医疗卫生机构工作的2015—2017级订单定向医学毕业生为研究对象。于2021-01-20至2021-02-10对其开展电子问卷调查,内容包括毕业生的一般情况、职业满意度、离职意愿、服务期满后职业方向。共回收问卷347份,其中有效问卷311份,问卷有效回收率为89.6%。采用单因素分析及多元逐步线性回归分析全科医生离职意愿的影响因素。 结果 贵州省"5+3"订单定向医学毕业生的整体离职意愿得分为(3.98±0.98)分,具有离职倾向者229例(73.6%)。不同性别、单位地理位置、每日工作量者的离职意愿得分比较,差异有统计学意义(P<0.05)。多元逐步线性回归分析显示,单位负责人对待下属的方式、在工作中获得的成就感、对当前收入满意程度、家人对工作的支持程度、当地激励政策执行程度是"5+3"订单定向医学毕业生离职意愿的影响因素(P<0.05)。服务期满后,计划留任原基层医疗卫生机构者12例(3.9%),计划去其他基层医疗卫生机构者21例(6.7%),计划离开基层去上级医院工作者196例(63.0%),计划攻读全日制硕士学位者60例(19.3%)。 结论 贵州省"5+3"模式订单定向医学毕业生的离职意愿较高,预计服务期满后基层全科人才流失较多,需从提高收入、重视全科医生心理需求、优化全科医生培养与使用、发展基层医疗卫生机构、加强全科宣传等方面着手改善。 相似文献
2.
J. Oliveira-Santos R. Santos C. Moreira S. Abreu L. Lopes C. Agostinis-Sobrinho G. Stratton J. Mota 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2019,29(8):783-792
Background and aimsThe long-term relations between excessive adiposity in early childhood and unfavourable cardiometabolic profiles in later ages are not yet completely understood. We aimed to assess the associations between birth weight (BW) and BMI from 6 months to 6 years of age, with biomarkers indicative of low-grade inflammation, insulin resistance and lipid profiles in adolescence.Methods and resultsRetrospective school-based study with 415 Portuguese adolescents (220 girls), mean age of 14.08 ± 1.6 years old. Anthropometric data from birth to 6 years old was extracted from individual child health book records. Actual weight and height were measured and BMI calculated. Participants were classified at each time point as normal weight or overweight according to WHO reference values. Biomarkers were obtained from venous blood samples. Linear regressions were used to explore the associations between the biomarkers and early life anthropometric indicators. From 2 years onwards, BMI associated positively with the inflammatory score and HOMA-IR in adolescence. Children who were overweight/obese from 2 to 6 years of age presented significantly higher inflammatory score and HOMA-IR later in adolescence. TC/HDL ratio was also positively associated with BMI from the age of 5 years onwards. The associations between BMI and cardiometabolic outcomes remained positive in adolescence, with overweight adolescents presenting a higher inflammatory score, HOMA-IR and TC/HDL than normal weight adolescents.ConclusionA high BMI from an early age was consistently associated with worse inflammatory and lipid profiles and insulin resistance in adolescence. No associations were found between BW and the same studied outcomes. 相似文献
3.
可逆性后部脑病综合征(PRES)是一组异质性疾病,需要结合临床及神经影像学共同诊断。其病因复杂,发病机制不甚明确,高血压和钙调神经蛋白抑制剂是公认的危险因素。但对于儿童来说,其本身的基础疾病可能对此症的发生起决定性作用。PRES的临床表现与病变位置有关,头颅磁共振成像是首选的检查。其治疗的关键是迅速诊断,如诊治不及时,部分患者将发生不可逆的神经系统损害而遗留后遗症,甚至导致死亡。 相似文献
4.
To study the effect of sorbinil on the alteration of the blood-retinal barrier, 32 adult-onset, non-insulin-dependent diabetic patients with minimal or no retinopathy were randomly assigned to receive either oral sorbinil (250 mg once a day) or a placebo for 6 mo. All patients underwent fundus photography, fluorescein angiography, and vitreous fluorophotometry before treatment and at 3 and 6 mo after treatment. Vitreous fluorophotometry data showed that the alteration of the blood-retinal barrier increased significantly less in the sorbinil-treated group compared with the placebo group during the 6-mo study period. Side effects were limited to hypersensitivity reactions, with skin rash and fever, in only 2 of the 16 patients who received the drug. These hypersensitivity reactions disappeared with discontinuation of the medication. Aldose-reductase inhibition may play an important role in stabilization of the blood-retinal barrier in early diabetic retinopathy. 相似文献
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6.
A Todo-Bom A Mota Pinto V Alves S Vale Pereira M Santos Rosa 《Journal of investigational allergology & clinical immunology》2007,17(2):107-112
BACKGROUND: Asthma is a chronic inflammatory disorder of the airways. The persistence of airway inflammation depends on a decrease in apoptosis of T lymphocytes and eosinophils and survival of these activated cells. T lymphocytes expressing gamma delta receptors can be identified in human lungs and play an important role in immune defence against pathogens and in the regulation of chronic inflammation. Aging is associated with evidence of some immune dysregulation. OBJECTIVE: The aim of this study was to analyze the apoptosis receptors of T lymphocytes in long-lasting asthma, to establish their correlation with activation markers such as CD25+ and human leukocyte antigen (HLA)-DR+, and to analyze the gama delta T cell expression in this disease. METHODS: A group of 64 individuals (group A) who had had asthma for more than 30 years (mean age [+/-SD] 72 +/- 5 years) and 61 healthy individuals acting as controls--group B with 41 individuals (mean age 79 +/- 7 years) and group C with 20 individuals (mean age 38 +/- 12 years) were included in the study. All subjects underwent clinical evaluation and spirometric testing. Peripheral blood cells were stained with monoclonal antibodies anti-CD3, anti-CD4, anti-CD8, anti-CD25, anti-TCR gamma delta, anti-HLA-DR and anti-CD95. Statistical comparisons were performed between the asthmatics and the elderly control group and between the elderly control group and the adult control group. RESULTS: The average percentage of predicted forced expiratory volume in the first second was 73.6 gamma delta 25.3. The mean values of T cell receptors for asthma group A vs elderly control group B vs adult control group C respectively, were the following: CD3, 74.9+/-7 vs. 74.8 +/- 8.8 (P=ns) vs. 76.7 +/- 4.2 (P=ns); CD4, 48.8 +/- 8.7 vs. 43.5 +/- 10.2 (P=ns) vs. 44.8 +/- 3.8 (P=ns); CD8, 23.3 +/- 7.9 vs. 25.7 +/- 10.2 (P=ns) vs. 25.6 +/- 4.5 (P=ns); CD25, 14.3 +/- 5.9 vs. 22.4 +/- 7.8 (P = .0001) vs. 5.5 +/- 2.4 (P = .0001); TCR gamma delta, 2.8 +/- 2.1 vs. 4.1 +/- 3.3 (P < .05) vs. 4.6 +/- 2.1 (P=ns); HLA-DR, 18.4 +/- 9.2 vs. 17.8 +/- 5.9 (P=ns) vs. 15.4 +/- 5.1 (P=ns) and CD95, 49.3 +/- 13.7 vs. 52.6 +/- 12.1 (P=ns) vs. 13.8 +/- 10.8 (P = .0001). CONCLUSIONS: The immunological and inflammatory changes related to ageing may cause an increase in CD95 and CD25 T cell expression. In asthma, blood cells may express increased activation and apoptosis markers but in elderly patients taking steroids, these receptors remain within normal ranges. The number of gamma delta T cells may be lower in long-lasting asthma, and have a limited modulatory effect on allergic inflammatory reactions. The evaluation of patients with long-lasting asthma should take into account the immunological and inflammatory changes present in the elderly in order to avoid results being misinterpreted. 相似文献
7.
《灵枢·官针》是关于中医古典针法的经典文献,其中所论刺痹法,内容丰富,手法多样,至今对临床仍有重要指导意义.刺痹法共有九种,毛刺法刺皮肤治浮痹,合谷刺刺肌肉治肌痹,恢刺与关刺刺筋腱治筋痹,输刺与短刺刺骨治疗骨痹.特殊操作类又有多针、多向刺法的齐刺、傍针刺和烧针刺法的焠刺,以治疗各种经久不愈的痹痛.研究这些古刺法,对于提高痹证的治疗效果,具有一定的指导意义. 相似文献
8.
目的观察应用微创清除术救治高血压脑出血的临床疗效。方法对68例高血压脑出血患者采用随机分成内科组(33例,采用控制血压治疗脑水肿等方法)和微创组(35例,采用微创清除术治疗)。采用格拉斯神经功能缺损评分量表及日常生活能力量表评分比较两组的近期(1个月)和远期(6个月)疗效。结果微创组近期优良率(60%)和远期良好率以上(70.3%)高于内科组(30.3%、46.2%%),差异有显著性(P<0.05,P<0.01);微创组近期死亡率(14.3%)明显低于内科组(54.5%),差异有显著性(P<0.01)。结论高血压脑出血采用微创清除术疗效优于内科治疗。 相似文献
9.
通过具体的实验数据,讨论在药代动力学实验中如何加入曲线下面积(AUC)的计算,以帮助学生理解并掌握这一概念;在实验室设置不同剂量组,给药后比较剂量与浓度是否呈等比例关系,以此加深学生对于一级动力学消除及其临床意义的理解。 相似文献
10.
目的探讨预适应锻炼对新兵急进高原后脑功能的改善作用。方法120名新兵随机分为4组:对照组、面罩组、运动组和面罩复合运动组。在进入高原前,面罩复合运动组佩带低氧呼吸器小步快走10 min,休息5 min后重复进行,上、下午各进行4次,连续进行7 d;面罩组、运动组分别只佩带低氧呼吸器或单纯运动。在空运进入高原后,比较进高原前、后的神经行为核心测试组合系统指标的改变,并对急性高原反应症状进行分析。结果使用低氧呼吸器复合小步快走5 min时动脉血氧饱和度可降到(80.5±5.7)%,达到预缺氧的目的。新兵进入3 658 m高原后,对照组、面罩组和运动组的数字跨度、目标追踪测试分值明显下降(P<0.05),而面罩复合运动组无明显改变(P>0.05);各组进藏前、后的简单反应时、数字译码和视觉保留均无显著性改变(P>0.05),手敏捷度则显著提高(P<0.05)。对照组、面罩组、运动组和面罩复合运动组的急性高原反应发病率分别为13.3%、20.0%、20.0%、3.3%。结论进入高原前,应用低氧呼吸器辅以适当运动,能改善急进高原人群的即时听觉记忆能力和手部运动的速度及准确性,避免部分脑功能的损害,并使急性高原反应发病率呈降低趋势。 相似文献