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1.
目的:比较等渗透剂量的7.5%高渗盐水(hypertonic saline,HTS)和20%甘露醇治疗颅高压的疗效。方法:当患者的颅内压(intracranial pressure,ICP)超过20 mm Hg时,一组患者接受了4 m L/kg 7.5%HTS(HTS组,n=27),另外一组患者接受了0.5 g/kg 20%甘露醇(甘露醇组,n=31)的降颅压治疗,两种药物均经深静脉在30 min内快速滴注完成。用药期间,连续监测患者ICP,平均动脉压(mean arterial pressure,MAP)、脑灌注压(cerebral perfusion pressure,CPP)及中心静脉压(central venous pressure,CVP)。记录有效降颅压持续时间、ICP最大降幅及其时间,用药前及用药后1 h、3 h、6 h抽血查电解质和血浆渗透压等。结果:静脉快速滴注7.5%HTS和20%甘露醇后,两者均可有效降低ICP(P0.05)。两组在控制颅高压的有效率、起效时间及ICP降幅无统计学差异(P0.05),但HTS组的作用持续时间要明显长于甘露醇组(P0.05)。两组渗透压较用药前相比均有显著上升(P0.05)。用药前后,两组MAP、CPP和CVP变化无统计学差异(P0.05)。结论:等渗透剂量的7.5%HTS与20%甘露醇均可有效降低患者的ICP,两者降颅压效果相当,均可作为治疗颅内高压的一线治疗药物。  相似文献   
2.
目的:探讨颅内动脉瘤开颅术后发生肺部感染的危险因素。方法:回顾性分析在我院接受开颅手术治疗的211例颅内动脉瘤患者的性别、年龄、吸烟史、糖尿病史、高血压病史、Hunt-Hess分级、动脉瘤部位、动脉瘤直径、手术时机及术后肺部感染的情况,对可能导致肺感染的因素行X2检验及Logistic回归分析。结果:单因素分析显示影响颅内动脉瘤患者术后肺感染的因素主要包括年龄、吸烟、糖尿病、Hunt-Hess分级(P0.05)。多因素Logistic回归分析结果显示影响颅内动脉瘤患者开颅术后发生肺部感染的因素为吸烟和Hunt-Hess分级。结论:吸烟、高Hunt-Hess分级是影响颅内动脉瘤开颅术后发生肺部感染的独立危险因素。  相似文献   
3.
Intraluminal thrombus (ILT) is present in 75% of clinically-relevant abdominal aortic aneurysms (AAAs) yet, despite much research effort, its role in AAA biomechanics remains unclear. The aim of this work is to further evaluate the biomechanics of ILT and determine if different ILT morphologies have varying mechanical properties.  相似文献   
4.

Object

The wall thickness of intracranial aneurysms (IAs) is heterogeneous. Although thinning of the IA wall is thought to contribute to IA rupture, the underlying mechanism remains poorly understood. Recently, imaging mass spectroscopy (IMS) has been used to reveal the distribution of phospholipids in vascular diseases. To investigate the feature of phospholipid composition of IA walls, we conducted IMS in a rat model of experimentally induced IA.

Material and methods

IAs were surgically induced in 7-week-old male rats and analyzed by IMS in negative-ion mode.

Results

A molecule at m/z 885.5 was more abundant in the thickened wall than in the thinned wall (P = 0.03). Multiple-stage mass spectroscopy revealed the molecule to be phosphatidylinositol containing stearic acid and arachidonic acid (PI 18:0/20:4). Immunohistochemistry indicated that vascular smooth muscle cells (SMCs) in the thickened wall had dedifferentiated phenotypes. To investigate the relationship between accumulation of PI (18:0/20:4) and phenotypic changes in SMCs, we subjected primary mouse aortic SMCs to liquid chromatography–tandem mass spectrometry. Notably, dedifferentiated SMCs had 1.3-fold more PI (18:0/20:4) than partly differentiated SMCs.

Conclusions

Our study demonstrated the heterogeneity in phospholipid composition of the aneurysmal walls using experimentally induced IAs. PI (18:0/20:4) accumulated at high levels in the thickened aneurysmal wall where synthetic dedifferentiated SMCs exist, suggesting that this phospholipid may be involved in the phenotypic switching of medial SMCs in the IA wall.  相似文献   
5.
6.
Here we extend the global, closed-loop, mathematical model for the cardiovascular system in Müller and Toro (2014) to account for fundamental mechanisms affecting cerebral venous haemodynamics: the interaction between intracranial pressure and cerebral vasculature and the Starling-resistor like behaviour of intracranial veins. Computational results are compared with flow measurements obtained from Magnetic Resonance Imaging (MRI), showing overall satisfactory agreement. The role played by each model component in shaping cerebral venous flow waveforms is investigated. Our results are discussed in light of current physiological concepts and model-driven considerations, indicating that the Starling-resistor like behaviour of intracranial veins at the point where they join dural sinuses is the leading mechanism. Moreover, we present preliminary results on the impact of neck vein strictures on cerebral venous hemodynamics. These results show that such anomalies cause a pressure increment in intracranial cerebral veins, even if the shielding effect of the Starling-resistor like behaviour of cerebral veins is taken into account.  相似文献   
7.
Treatment options for abdominal aortic aneurysm (AAA) include highly invasive open surgical repair or minimally invasive endovascular aneurysm repair (EVAR). Despite being minimally invasive, some patients are not suitable for EVAR due to hostile AAA morphology. Fenestrated-EVAR (F-EVAR) was introduced to address these limitations of standard EVAR, where AAA is treated using a Fenestrated Stent Graft (FSG). In order to assess durability of F-EVAR, displacement forces acting on FSGs were analysed in this study, based on patient-specific geometries reconstructed from computed tomography (CT) scans. The magnitude and direction of the resultant displacement forces acting on the FSG were numerically computed using computational fluid dynamics (CFD) with a rigid wall assumption. Although displacement force arises from blood pressure and friction due to blood flow, numerical simulations elucidated that net blood pressure is the dominant contributor to the overall displacement force; as a result, time dependence of the resultant displacement force followed pressure waveform very closely. The magnitude of peak displacement force varied from 1.9 N to 14.3 N with a median of 7.0 N. A strong positive correlation was found between inlet cross-sectional area (CSA), anterior/posterior (A/P) angle and the peak displacement force i.e. as inlet CSA or A/P angle increases, the magnitude of resultant displacement increases. This study manifests that while loads exerted by the pulsatile flow dictates the cyclic variation of the displacement force, its magnitude depends not only on blood pressure but also the FSG morphology, with the latter determining the direction of the displacement force.  相似文献   
8.
Erythropoietin has been shown to promote tissue regeneration after ischaemic injury in various organs. Here, we investigated whether Erythropoietin could ameliorate ischaemic spinal cord injury in the mouse and sought an underlying mechanism. Spinal cord ischaemia was developed by cross-clamping the descending thoracic aorta for 7 or 9 min. in mice. Erythropoietin (5000 IU/kg) or saline was administrated 30 min. before aortic cross-clamping. Neurological function was assessed using the paralysis score for 7 days after the operation. Spinal cords were histologically evaluated 2 and 7 days after the operation. Immunohistochemistry was used to detect CD34(+) cells and the expression of brain-derived neurotrophic factor and vascular endothelial growth factor. Each mouse exhibited either mildly impaired function or complete paralysis at day 2. Erythropoietin-treated mice with complete paralysis demonstrated significant improvement of neurological function between day 2 and 7, compared to saline-treated mice with complete paralysis. Motor neurons in erythropoietin-treated mice were more preserved at day 7 than those in saline-treated mice with complete paralysis. CD34(+) cells in the lumbar spinal cord of erythropoietin-treated mice were more abundant at day 2 than those of saline-treated mice. Brain-derived neurotrophic factor and vascular endothelial growth factor were markedly expressed in lumbar spinal cords in erythropoietin-treated mice at day 7. Erythropoietin demonstrated neuroprotective effects in the ischaemic spinal cord, improving neurological function and attenuating motor neuron loss. These effects may have been mediated by recruited CD34(+) cells, and enhanced expression of brain-derived neurotrophic factor and vascular endothelial growth factor.  相似文献   
9.
An aortic aneurysm(AA) is a silent but life-threatening disease that involves rupture. It occurs mainly in aging and severe atherosclerotic damage of the aortic wall. Even though surgical intervention is effective to prevent rupture, surgery for the thoracic and thoraco-abdom-inal aorta is an invasive procedure with high mortality and morbidity. Therefore, an alternative strategy for treatment of AA is required. Recently, the molecular pathology of AA has been clarified. AA is caused by an imbalance between the synthesis and degradation of extracellular matrices in the aortic wall. Chronic inflam-mation enhances the degradation of matrices directly and indirectly, making control of the chronic inflamma-tion crucial for aneurysmal development. Meanwhile, mesenchymal stem cells(MSCs) are known to be ob-tained from an adult population and to differentiate into various types of cells. In addition, MSCs have not only the potential anti-inflammatory and immunosuppres-sive properties but also can be recruited into damagedtissue. MSCs have been widely used as a source for celltherapy to treat various diseases involving graft-versus-host disease, stroke, myocardial infarction, and chronicinflammatory disease such as Crohn's disease clinically.Therefore, administration of MSCs might be availableto treat AA using anti-inflammatory and immnosup-pressive properties. This review provides a summary ofseveral studies on "Cell Therapy for Aortic Aneurysm"including our recent data, and we also discuss the pos-sibility of this kind of treatment.  相似文献   
10.
目的:探讨颅内静脉系统血栓形成(CVT)的临床表现、影像学特征以及治疗方法对临床诊断的意义。方法:回顾性分析首都医科大学宣武医院收治的6例CVT患者的临床表现及影像学特征与治疗方法。结果:6例临床表现无特殊,4例经MRI+MRV确诊,3例DSA检查确诊,1例介入治疗,4例抗凝治疗,2例保守,无死亡患者。结论:静脉系统血栓形成临床症状缺乏特异性,临床遇到急性起病的头痛、呕吐,伴或不伴有局灶性神经功能缺损或癫痫发作、意识障碍的青中年人,应高度怀疑CVT。早期应用抗凝、溶栓等治疗方法,对改善预后具有较高的临床应用价值。  相似文献   
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