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1.
Elizabeth D. Krebs Robert B. Hawkins J. Hunter Mehaffey Clifford E. Fonner Alan M. Speir Mohammed A. Quader Jeffrey B. Rich Leora T. Yarboro Nicholas R. Teman Gorav Ailawadi 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1533-1542.e2
Objectives
Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.Methods
Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00.Results
A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality.Conclusions
Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight. 相似文献2.
《Clinical neurophysiology》2020,131(4):859-865
ObjectiveWe examined selected peripheral and spinal nerves of children aged between two and seven years.MethodHigh resolution ultrasound was performed in 116 children (2–7 years of age) at 19 predefined landmarks of median, ulnar, tibial, fibular, sural and radial nerves, the vagus as well as cervical spinal nerve 5 and 6. Further, side-to-side measuring and grey-scale analysis was done at selected nerve sites.ResultsNerves of children were on average smaller than those of adults. Nerve growth correlates significantly with age in all nerves, the mean values were similar in the age of two to four years and five to seven years. Body mass index (BMI) and gender showed moderate effect at some nerve sites, however not uniformly in all. A side-to-side difference of up to 30% in median, and up to 20% in tibial nerve can occur in healthy individuals. Grey-scale analysis for echointensity has been performed in median, ulnar and tibial nerves.ConclusionNerve size increases with age, BMI and gender have moderate effect. A side-to-side-difference of up to 30% can exist.SignificanceReference values of nerve cross-sectional area, side-to-side-difference and echo intensity are necessary to detect nerve pathology in children as well as in adults. 相似文献
3.
4.
目的 探讨员工援助计划服务对心内科护士职业认同感、职业价值观、职业压力的影响。 方法 选择2018年1-3月我院心内科护理人员58名,为其实施员工援助计划服务,评价实施前后心内科护士的职业认同感、职业价值观、职业压力感知、职业压力反应。 结果 实施后,心内科护士工作压力源各维度评分、压力感知与压力反应各维度得分均较实施前下降(P<0.05);职业价值观各维度及职业认同感各维度评分均较实施前显著提高(P<0.001)。 结论 员工援助计划可提高心内科护士职业认同感、职业价值观,缓解其职业压力感知以及职业压力反应。 相似文献
5.
C. Bokemeyer K. Oechsle J.-T. Hartmann 《European journal of clinical investigation》2005,35(S3):26-31
6.
Allison A. Yates 《Nutrition Research And Practice》2007,1(2):89-93
Many countries such as The Republic of Korea have established their own nutritional standards, collectively termed Nutrient Reference Values(NRVs), and they vary due to the science which was reviewed, the purposes for which they are developed, and issues related to nutrition and food policy in the country. The current effort by the Codex Alimentarius Committee on Nutrition and Foods for Special Dietary Uses (CNFSDU) to update the NRVs that were established following the Helsinki Consultation in 1988 represents an opportunity to develop a set of reference values reflecting current scientific information to be used or adapted by many countries. This paper will focus on possible approaches to selecting or developing reference values which would serve the intended purpose for nutrition labeling to the greatest extent possible. Within the United States, the Food and Drug Administration (U.S. FDA) is currently reviewing regulations on nutrition labeling to better address current health issues, and is expected to enter into a process in the next few months to begin to explore how best to update nutrient Daily Values (DVs), most of which are still based on the Recommended Dietary Allowances (RDAs) of the Food and Nutrition Board, U.S. National Academy of Sciences, last reviewed and revised in 1968. In this presentation, I review the current purposes in the U.S. for nutrition labeling as identified in the 1938 Food, Drug, and Cosmetic Act as amended, the scientific basis for current nutrition labeling regulations in the United States, and the recommendations made by the recent Committee on Use of Dietary Reference Intakes in Nutrition Labeling of the Institute of Medicine (2003) regarding how to use the DRIs in developing new DVs to be used on the label in the United States and Canada. Based on these reviews, I then provide examples of the issues that arise in comparing one approach to another. Much of the discussion focuses on the appropriate role of nutrient labeling within the Nutrition Facts panel, one of the three major public nutrition education tools in the United States (along with MyPyramid and Dietary Guidelines for Americans). 相似文献
7.
不同检测方法预测白内障术后视力的观察 总被引:1,自引:0,他引:1
目的 评价各种检测方法在预测白内障术后视功能恢复的作用。方法 白内障197例(214眼)术前行闪光视网膜电图(F-ERG)、闪光视诱发电位(BVEP)、视网膜计、光定位、色觉及注视性质等综合检测,术后3月复查最佳矫正视力。结果 术前F—ERG的b波、F—VEP的P1波、潜视力、色觉均与术后视力存在显著相关性,其中F-ERG、F—VEP、潜视力预测术后视力的可靠性分别为62.6%、79.0%、60.6%。但排除白内障完全成熟及高龄者(超过80岁),潜视力预测的可靠性则达82.6%。结论 对于非完全成熟及非高龄者,视网膜计是术前预测白内障术后视力比较理想的方法,而对于完全浑浊及高龄者,视网膜计检查结果的准确性欠佳,应结合F-ERG、F-VEP、色觉及注视性质等多方面因素进行综合讲价。 相似文献
8.
东莞市正常儿童头发中微量元素含量参考值的研究 总被引:1,自引:0,他引:1
目的探讨东莞市区幼儿园3~7岁学龄前正常儿童头发中微量元素含量均值,以此作为东莞市区儿童头发中微量元素正常参考值.方法采取在群体自愿参加者中,选出经体检无重要脏器病变,营养一般,身高、体重在均值以上(称正常儿童).在枕后贴发根部剪0.5g头发检测其锌、铁、钙、铜、锰、铅元素含量.结果在1125例受检儿童中(称普查儿,占适龄儿95%).筛选出621例儿童,占总受检儿童的55.2%.这621例正常儿中,他们头发中锌、铁、钙、铜、锰、铅元素的含量分别为:93.473μg/g、29.710μg/g、779.50μg/g、9.773μg/g、3.222μg/g、9.251μg/g.结论检测的结果显示,2003年东莞市区正常儿童与2003年普查儿童相比,正常儿童发中微量元素含量明显升高,但差异无统计学意义.2003年东莞市正常儿童发中微量元素均值与广州市正常儿童相比,显著低于广州市正常儿童.由此可见,正常儿童发中微量元素含量均值受地域影响而有较大差异.东莞市区儿童发中微量元素含量应参照东莞市正常儿童发中微量元素含量均值较为合理. 相似文献
9.
Henryk Barthel Michael Wiener Claudia Dannenberg Simone Bettin Bernhard Sattler Wolfram H. Knapp 《European journal of nuclear medicine and molecular imaging》1997,24(10):1245-1252
This study addresses the question of whether the normal range for distribution of local cerebral blood flow (lCBF) in adults
can be transferred to the 4- to 15-year-old age group. Twenty-three children (age: 4–15 years; mean 11±3 years, group I) and
10 adults (age: 27–56 years; mean 45±10 years, group II) without evidence of cerebrovascular disease or other brain diseases
underwent technetium-99m ethyl cysteinate dimer single-photon emission tomography. Counts in cortical and subcortical regions
of interest (ROIs) were related to those in cerebellar ROIs (= 100%). Relative cortical activity in group I exceeded that
in group II, particularly in left parietal (107.6%±9.8% vs 84.1%±12.4%), left frontal (97.7%±6.7% vs 79.4%±8.9%) and left
temporal areas (99.7%±7.4% vs 84.9%±10.1%) and in the cingulate cortex (112.1%±9.1% vs 95.9%±10.1%, P<0.05). Cerebral activity uptake per injected dose was inversely correlated with age in 19 children of group I (r = –0.77, P<0.001). In group I, there was also an inverse correlation between age and the relative local count density in the parietal
(r = –0.42 to –0.57), frontal (r = –0.48), temporal (r = –0.42 to –0.58) and occipital cortex (r = –0.44). In these cortical regions relative counts differed when subgroups of children aged 4–10 and 11–15 years were analysed.
It is concluded that there are systematic differences between 4- to 15-year-old children and adults with regard to normal
lCBF. Diagnostic use of perfusion agents has to consider age-adjusted normal flow maps; normal ranges should be determined
separately for the age groups 4–10 and 11–15 years.
Received 23 March and in revised form 11 July 1997 相似文献
10.
18F-FDG PET/CT显像正常腹部消化器官的标准摄取值分析 总被引:6,自引:0,他引:6
目的分析^18F-脱氧葡萄糖(FDG)PET/CT显像正常腹部消化器官标准摄取值(SUV)的变化范围.方法60例要求行PET/CT检查的健康人,按体重7.77 MBq/kg静脉注射^18F-FDG,PET采集为三维模式,每个床位3 min.对腹部肝、胆囊、脾、胰腺、胃、盲肠、结肠和直肠进行半定量分析,各器官的SUV由横断面测量,准确定位时参考同机CT.结果正常腹部消化器官^18F-FDG摄取有较大差异,其中摄取较高者SUV平均值(SUVavg)依次为直肠、肝、乙状结肠、回盲部和脾、升结肠,SUV最大值(SUVmax)依次为直肠、乙状结肠、肝、回盲部、升结肠、脾.结论PET/CT显像能较好地识别腹部消化器官;熟悉正常腹部消化器官^18F-FDG摄取的差异,对判读图像十分重要. 相似文献