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经结膜下穹隆至上颌窦插管术治疗泪道阻塞的临床研究 总被引:1,自引:0,他引:1
采用经结膜囊下穹隆至上颌窦插管的术式引流泪液,治疗泪道阻塞引起的溢泪症,获得较为满意的效果。手术的主要步骤是:局麻后于结膜囊下穹隆内1/3区作一4mm长的结膜切口,自筋膜下分离至眶线下5mm。从切口伸入上颌窦骨钻钻通上颌窦顶壁,插入长短适度的义管,并向管内注入生理盐水,证实有液体流入鼻咽部后,固定义管。术后定期冲洗,无需拆线,应用这种术式治疗泪道阻塞引起的溢泪症218眼,其中溢泪完全消失151眼占82.1%,溢泪减轻的27眼占14.6%,总效率96.7%。 相似文献
3.
This study was designed to evaluate the routine use of a gum elastic bougie for tracheal intubation. The median time to intubation with the gum elastic bougie while simulating an 'epiglottis only' view was only 10 s longer than the time taken during conventional intubation with an optimum view. Three of the patients required a gum elastic bougie-assisted intubation after attempts at conventional visual intubation had failed. There was no significant difference in the incidence of postoperative sore throat and hoarseness between the two groups. We recommend that anaesthetists should use the gum elastic bougie whenever a good view of the glottis is not immediately obtained. 相似文献
4.
Effect of fentanyl on the circulatory responses to orotracheal fibreoptic intubation 总被引:1,自引:0,他引:1
The effectiveness of fentanyl in attenuating the pressor and heart rate response to orotracheal fibreoptic intubation under general anaesthesia was assessed in 60 healthy patients undergoing elective surgery. Patients were randomly assigned to receive either fibreoptic intubation with or without fentanyl 6 micrograms.kg-1 or traditional Macintosh intubation with fentanyl 6 micrograms.kg-1. A standardised general anaesthetic was administered which included temazepam premedication, thiopentone, atracurium, oxygen, nitrous oxide and isoflurane. The pressor response to fibreoptic intubation was suppressed in those patients who received fentanyl and was similar to that seen in the Macintosh-fentanyl group of patients. The heart rate response to fibreoptic intubation was also significantly reduced in the patients who received fentanyl, but, in contrast, was still significantly greater than that in the Macintosh-fentanyl group. Fentanyl 6 micrograms.kg-1 appears to have a useful place in attenuating the cardiovascular effects of fibreoptic intubation under general anaesthesia. 相似文献
5.
Difficulties in removing the tracheal tube from the trachea are relatively uncommon. We report here a case of difficult extubation which was precipitated by pulling off the pilot balloon and valve assembly in order to deflate the cuff. 相似文献
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Cardiovascular responses to insertion of the laryngeal mask 总被引:6,自引:0,他引:6
We have compared, in 40 healthy patients, the cardiovascular responses induced by laryngoscopy and intubation with those produced by insertion of a laryngeal mask. Anaesthesia was induced with thiopentone and maintained with enflurane and nitrous oxide in oxygen; vecuronium was used for muscle relaxation. Arterial pressure was measured with a Finapres monitor. The mean maximum increase in systolic arterial pressure after laryngoscopy and tracheal intubation was 51.3% compared with 22.9% for laryngeal mask insertion (p less than 0.01). Increases in maximum heart rate were similar, (26.6% v 25.7%) although heart rate remained elevated for longer after tracheal intubation. We conclude that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious. 相似文献
8.
A patient with a previous surgical history of a cleft lip and palate repair and a pharyngeal flap pharyngoplasty was admitted for repair of mandibular prognathism. Following induction of anaesthesia, it was impossible to advance the nasotracheal tube into the oropharynx. Using a dental mirror and retrograde tracheal intubation equipment, under direct vision, the nasotracheal tube was finally advanced into the oropharynx. 相似文献
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10.
Accidental bronchial intubation An analysis of AIMS incident reports from 1988 to 1994 inclusive 总被引:2,自引:0,他引:2
Accidental bronchial intubation was examined in the first 3947 cases reported to the Australian Incident Monitoring Study and was found to have accounted for 154 (3.7%) of the total incidents reported. Most incidents were detected in the operating theatre (93.5%) and during maintenance of anaesthesia (77.9%), by unexplained oxygen desaturation alone (63.6%). Capnography remained normal or unremarkable during 88.5% of the episodes. One-third of cases were associated with head or neck surgery and possible flexion of the patient's head. A RAE tube was used in 20% of incidents, a greater frequency than occurred in the study overall. A third party was implicated in 36 (23.4%) of cases. Ninety per cent of cases were considered preventable. Major morbidity occurred in three cases and unplanned intensive care admission was required in a further five. Almost two-thirds (61.1%) of the incidents might have been avoided by the proposed markings on the tracheal tube. We conclude that when arterial desaturation occurs at any stage during anaesthesia the possibility of bronchial intubation must be considered. Asymmetrical ventilation may be difficult to detect clinically and in most cases there is no change in capnography. 相似文献