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41.
The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis 总被引:4,自引:0,他引:4
Criteria defining the <it>systemic inflammatory response
syndrome</it> (SIRS) were used to assess prospectively 270 clinical
episodes in which blood cultures were taken from patients in general
medicine. SIRS, severe sepsis and septic shock occurred in 149 (55%), 13
(5%) and 9 (3%) episodes, respectively. However, evidence of organ
hypoperfusion indicating severe sepsis was recorded as sought in only 26%
of episodes of SIRS. Crude mortality at 28 days increased sequentially as
more SIRS criteria were met, rising from 12% in non-SIRS blood culture
episodes, to 36% when all four criteria were met. Mortality from severe
sepsis and septic shock was 38% and 56%, respectively. In 61/64 (95%)
episodes of clinically important bacteraemia, patients fulfilled SIRS
criteria when the blood culture was taken. However, the positive predictive
value of SIRS for predicting bacteraemia was only 7%. Patients who did not
fulfill SIRS criteria when blood cultures were taken were at low risk of
bacteraemia and comprised 45% (121/270) of the study population. Three
patients in this low-risk group had bacteraemia. Mortality in bacteraemic
patients with severe sepsis or septic shock who were initially treated with
ineffective antibiotics for up to 48 h was 80%, compared to 42% in those
always treated appropriately.
相似文献
42.
Can we identify termination of resuscitation criteria in cardiac arrest due to drowning: results from the French national out‐of‐hospital cardiac arrest registry 下载免费PDF全文
Hervé Hubert PhD Joséphine Escutnaire MSc Pierre Michelet MD PhD Evgéniya Babykina PhD Carlos El Khoury MD PhD Karim Tazarourte MD PhD Christian Vilhelm PhD Lahcen El Hiki PhD Benjamin Guinhouya PhD Pierre‐Yves Gueugniaud MD PhD on behalf GR‐RéAC 《Journal of evaluation in clinical practice》2016,22(6):928-935
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Superiority of closed suction drainage for pancreatic trauma. A randomized, prospective study. 下载免费PDF全文
T C Fabian K A Kudsk M A Croce L W Payne E C Mangiante G R Voeller L G Britt 《Annals of surgery》1990,211(6):724-730
During a 42-month period, 65 patients sustaining pancreatic injuries were treated. They were randomized on alternate days (two separate trauma teams) to receive sump (S) or closed suction (CS) drainage. Twenty-eight patients were randomized to S and 37 to CS; there were six early deaths, which precluded drainage analysis, leaving 24 evaluable S patients and 35 CS patients. Penetrating wounds occurred in 71% and blunt in 29%. No significant differences appeared between the groups with respect to age, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), or grade of pancreatic injury. Twelve patients in each group required resection and drainage for grade III injuries, with the remaining patients receiving external drainage alone. Five of twenty-four S patients versus one of thirty-five CS patients developed intra-abdominal abscesses (p less than 0.04). We conclude that septic complications after pancreatic injury are significantly reduced by CS drainage. Bacterial contamination via sump catheters is a major source for intra-abdominal infections after pancreatic trauma. 相似文献
48.
Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital
RM Banda AS Muula GR Gwaza DC Namarika KC Ng'oma FE Chintolo H Yamakazi AP Muyco 《Malawi medical journal : the journal of Medical Association of Malawi》2001,13(3):27-29
A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central Hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics. 相似文献
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