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排序方式: 共有291条查询结果,搜索用时 15 毫秒
1.
《Resuscitation》2015
AimTo determine the effectiveness of ventilations in bystander cardiopulmonary resuscitation (BCPR) and to identify the factors associated with ventilation-only BCPR.MethodsFrom out-of-hospital cardiac arrest (OHCA) data prospectively collected from 2005 to 2011 in Japan, we extracted data for 210,134 bystander-witnessed OHCAs with complete datasets but no prehospital involvement of physician [no BCPR, 115,733; ventilation-only, 2093; compression-only, 61,075; and conventional (compressions+ventilations) BCPR, 31,233] and determined the factors associated with 1-month neurologically favourable survival using simple and multivariable logistic regression analyses. In 91,885 patients with known BCPR durations, we determined the factors associated with ventilation-only BCPR.ResultsThe rate of survival in the no BCPR, ventilation-only, compression-only and conventional group was 2.8%, 3.9%, 4.5% and 5.0%, respectively. After adjustment for other factors associated with outcomes, the survival rate in the ventilation-only group was higher than that in the no BCPR group (adjusted OR; 95% CI, 1.29; 1.01–1.63), but lower than that in the compression-only (0.76; 0.59–0.96) or conventional groups (0.70; 0.55–0.89). Conventional CPR had the highest OR for survival in almost all OHCA subgroups. The adjusted OR (95% CI) for survival after dividing BCPR into ventilation and compression components was 1.19 (1.11–1.27) and 1.60 (1.51–1.69), respectively. Older guidelines, female sex, younger patient age, bystander-initiated CPR without instruction, early BCPR and short BCPR duration were associated with ventilation-only BCPR.ConclusionsVentilation is a significant component of BCPR, but alone is less effective than compression in improving neurologically favourable survival after OHCAs. 相似文献
2.
Yosuke Homma Takashi Shiga Hiraku Funakoshi Dai Miyazaki Atsushi Sakurai Yoshio Tahara Ken Nagao Naohiro Yonemoto Arino Yaguchi Naoto Morimura 《The American journal of emergency medicine》2019,37(2):241-248
Objective
This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms.Methods
This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes.Results
Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96–0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92–0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival.Conclusions
While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed. 相似文献3.
Yuji Morimoto Osamu Kemmotsu Koichi Kitami Izumi Matsubara Ichiro Tedo 《Journal of anesthesia》1995,9(1):22-26
We evaluated whether we could predict the neurologic outcome in 55 out-of-hospital cardiac arrest patients using auditory
brainstem responses (ABR). ABR patterns were classified into one of 3 types by evaluation of 5 components: type 1, with all
5 components; type 2, lack of at least one response between the 2nd and 5th components; type 3, with only the first component
or no response. The relation between the ABR patterns on the 3rd day following resuscitation and the neurologic outcome on
hospital discharge was evaluated. The specificity that the 5 awake patients had type-1 ABR was 38%. The sensitivity that the
10 brain dead patients had type-3 ABR was 60%. In the type-1 ABR patients, the negative predictive value that the patients
were awake was 100%. In the type-3 ABR patients, the negative predictive value that the patients became brain dead was 90.9%.
These results suggest that ABR on the 3rd post-resuscitation day may not be useful for predicting if patients are awake or
become brain dead, although the loss of components may be a sign of morbidity, and the presence of the 2nd or later components
indicates possible future prevention of brain death. 相似文献
4.
Miloslav Pleskot Radka HazukovaHana Stritecka Eva Cermakova 《Archives of gerontology and geriatrics》2011,53(2):e88
Patient's age belongs to the independent prognostic factors of patients after out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the influence of age on 5-year survival in professionally cardio-pulmonary resuscitated patients with “primary cardiac” etiology OHCA. In this analysis of prospective multi-centric study, from April 1, 2002 until August 31, 2004, a total of 560 patients were included (aged 16-97 years) from the East Bohemian region, for whom a professional cardio-pulmonary resuscitation for OHCA was attempted. In the age subgroup <70 years there were 307 patients and in the age subgroup ≥70 years there were 253 patients. Of the subgroup <70 years, 29 patients (10%) survived to year 5 (58% from the 50 patients surviving to day 30), and in the subgroup ≥70 years, we had 4 patients surviving to year 5 (2%) (29% from the 14 patients surviving to day 30), respectively (Fisher‘s exact test; comparison in the all resuscitated patients: p < 0.001, in the population surviving to day 30: p = 0.071). In conclusion, there was a trend towards a worse outcome in 5-year survival following OHCA in the patients aged ≥70 years. Nevertheless, these data support that prognosis OHCA of elders is not associated with universal dismal outcome. 相似文献
5.
Mihir A. Kelshiker Jamil Mayet Beth Unsworth Darlington O. Okonko 《Current Cardiology Reviews》2013,9(4):316-324
Out-of-hospital cardiac arrest (OHCA) has attracted increasing attention over the past years because outcomes
have improved impressively lately. The changes for neurological intact outcomes has been poor but several areas have
achieved improving survival rates after adjusting their cardiac arrest care. The pre-hospital management is certainly key
and decides whether a cardiac arrest patient can be brought back into a spontaneous circulation. However, the whole chain
of resuscitation including the in-hospital care have improved also. This review describes aetiologies of OHCA, risk and
potential protective factors and recent advances in the pre-hospital and in-hospital management of these patients. 相似文献
6.
Akira Yamashita Tetsuo Maeda Yasuhiro Myojo Yukihiro Wato Keisuke Ohta Hideo Inaba 《The American journal of emergency medicine》2018,36(12):2203-2210
Purpose
To investigate temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts and their association with survival after bystander-witnessed out-of-hospital cardiac arrests (OHCAs).Methods
We retrospectively analyzed the neurologically favorable 1-month survival and the parameters related to dispatcher assisted cardiopulmonary resuscitation (DA-CPR) and bystander CPR (BCPR) for 227,524 OHCA patients between 2007 and 2013 in Japan. DA-CPR sensitivity for OHCAs, bystander's compliance to DA-CPR assessed by the proportion of bystanders who follow DA-CPR, and performance of BCPR measured by the rate of bystander-initiated CPR in patients without DA-CPR were calculated as indices of resuscitation efforts.Results
Performance of BCPR was only similar to temporal variations in the survival (correlation between hourly paired values, R2 = 0.263, P = 0.01): a lower survival rate (3.4% vs 4.2%) and performance of BCPR (23.1% vs 30.8%) during night-time (22:00–5:59) than during non-night-time. In subgroup analyses based on interaction tests, all three indices deteriorated during night-time when OHCAs were witnessed by non-family (adjusted odds ratio, 0.73–0.82), particularly in non-elderly patients. The rate of public access defibrillation for these OHCAs markedly decreased during night-time (adjusted odds ratio, 0.49) with delayed emergency calls and BCPR initiation. Multivariable logistic regression analyses revealed that the survival rate of non-family-witnessed OHCAs was 1.83-fold lower during night-time than during non-night-time.Conclusions
Dispatcher-assisted and bystander-initiated resuscitation efforts are low during night-time in OHCAs witnessed by non-family. A divisional alert system to recruit well-trained individuals is needed in order to improve the outcomes of night-time OHCAs witnessed by non-family bystanders. 相似文献7.
《Archives of Cardiovascular Diseases》2022,115(11):552-561
BackgroundPatients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated.MethodsAll consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores.ResultsAmong 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; P = 0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88–0.98; P = 0.010 and OR 0.61; 95% CI 0.41–0.89; P = 0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18–3.73; P = 0.011) were independent risk factors for major bleeding.ConclusionThe classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population. 相似文献
8.
9.
《Resuscitation》2015
ObjectiveGasping is common after cardiac arrest, and its frequency decreases over time. The aim of this study was to conduct a meta-analysis to evaluate the association of gasping and survival to discharge in patients who suffered out-of-hospital cardiac arrest.MethodsRelevant studies were identified by searching in PubMed, Medline, Embase, OVID, Web of Science and Google Scholar. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to assess the association of gasping and on out-of-hospital cardiac arrest outcomes. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.ResultsIndividual patient data was obtained from 10,797 participants suffered out-of-hospital cardiac arrest in five cohort studies of 4 articles. A fixed effects model suggested that patients with gasping were 3.525 times (95% CI: 3.028–4.104; P < 0.01) more likely to survive to discharge than those without gasping, and there was no heterogeneity among studies (P = 0.564). Also it may be a favorable factor for return of spontaneous circulation (RR: 2.170; 95% CI: 1.691, 2.785) with high heterogeneity (Q = 5.26; P = 0.022).ConclusionsFindings of this meta-analysis demonstrated that gasping is common after cardiac arrest, and is associated with increased survival to discharge. Patients who are cardiac arrest with gasping should be promptly resuscitated. 相似文献
10.
Matilde Winther-Jensen Jesper Kjaergaard Niklas Nielsen Michael Kuiper Hans Friberg Helle Søholm 《Scandinavian cardiovascular journal : SCJ》2016,50(5-6):305-310
AbstractObjectives. We investigated whether comorbidity burden of comatose survivors of out-of-hospital cardiac arrest (OHCA) affects outcome and if comorbidity modifies the effect of target temperature management (TTM) on final outcome. Design. The TTM trial randomized 939 patients to 24?h of TTM at either 33 or 36?°C with no difference regarding mortality and neurological outcome. This post-hoc study of the TTM-trial formed a modified comorbidity index (mCI), based on available comorbidities from the Charlson comorbidity index (CCI). Results. Bystander cardiopulmonary resuscitation (CPR) decreased with higher comorbidity group, p?=?0.01. Comorbidity groups were univariately associated with higher mortality compared to mCI0 (HRmCI1: 1.55, CI: 1.25–1.93, p?<?0.001, HRmCI2: 2.01, CI: 1.55–2.62, p?<?0.001, HRmCI ≥ 3: 2.16, CI: 1.57–2.97, p?<?0.001). When adjusting for confounders there was a consistent, nonsignificant association between level of comorbidity and mortality (HRmC11: 1.17, CI: 0.92–1.48, p?=?0.21, HRmCI2: 1.28, CI: 0.96–1.71, p?=?0.10, HRmCI ≥ 3: 1.37, CI: 0.97–1.95, p?=?0.08). There was no interaction between comorbidity burden and level of TTM on outcome, p?=?0.61. Conclusion. Comorbidity burden was associated with higher mortality following OHCA, but when adjusting for confounders, the influence was no longer significant. The association between mCI and mortality was not modified by TTM. Comorbidity burden is associated with lower rates of bystander cardiopulmonary resuscitation after OHCA. 相似文献