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71.
Implantation of pacemakers can be challenging in the context of dilated cardiac chambers and valvular regurgitation. We report a difficult case of single chamber pacemaker implantation in a patient with restrictrive cardiomyopathy resulting in grossly enlarged atria and severe tricuspid regurgitation. In this situation, use of a slittable guiding sheath, more typically used for coronary sinus lead implantation, greatly facilitated rapid and stable deployment of the right ventricular lead.  相似文献   
72.
潘佳  刘丽 《生物磁学》2011,(2):341-343
目的:研究体表胃肠起搏联合多潘立酮治疗餐后不适综合征的疗效。方法:80例餐后不适综合征的患者,随机分为对照组及观察组。对照组40例予以多潘立酮10毫克,三餐前半小时口服;观察组予以多潘立酮10毫克,三餐前半小时口服,同时予以体表胃肠起搏,2次/日,每次45分钟,共2周,采用8导联胃肠电图仪记录患者空腹及进食后的胃电活动,及应用钡条行胃排空试验。分别于治疗前后对其症状、胃肠电图、胃排空情况进行评估。结果:治疗2周后,经胃肠起搏联合多潘立酮治疗的餐后不适综合征患者症状明显改善,较对照组改善更为明显(P〈0.05),胃肠起搏治疗后正常胃电节律百分比较对照组显著改善,实验组胃排空率较对照组改善。结论:体表胃肠起搏联合多潘立酮可显著改善餐后不适综合征患者症状、胃电图参数、胃排空情况.  相似文献   
73.
目的分析并总结采用临时起搏器在实施经皮冠状动脉介入术治疗高风险冠状动脉病变中的应用效果。方法回顾性分析在临时起搏器支持下实施PCI的18例高危病人的临床资料,分析临时起搏器置入以及冠脉介入的操作情况。结果本组病人置入临时起搏电极起搏成功率达到100%。结论联合应用临时起搏器与经皮冠脉介入术治疗急性心肌梗死(AMI)与慢性血管闭塞性病变患者,能够降低经皮冠脉介入术治疗中由于严重心律失常导致的血液动力学改变,使病人尽快恢复正常心率以及各主要脏器的供血,减少患者的病死率,具有较高的安全性,值得在临床上广泛推广应用。  相似文献   
74.
Mathematical modeling of the electric activity of pairs of true (central) and latent (peripheral) sinoatrial pacemaker cells coupled through gap junctions revealed that attenuation of coupling conductance increases the beat phase shift; below a critical conductance there is no synchronization. The phase difference also depends on the type of interacting cells, being maximal for a “central”-“peripheral” cell pair.  相似文献   
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目的:探讨植入心脏起搏器的老年阵发性房颤患者再发房颤(包括无症状性房颤)发生率及左房容积指数对再发房颤的影响。方法:收集2012年1月-2013年12月在我院起搏器门诊长期随访且未服用抗心律失常药物的起搏器术后老年阵发性房颤患者148例,记录基线特征、超声心动图参数及随访期间内房颤发生情况。分别根据左房容积指数及房颤负荷进行分组,应用Cox回归分析探讨起搏器检测的再发房颤及房颤高负荷的危险因素。结果:患者平均随访时间为22.79个月,期间57.43%的患者再发房颤,22.97%的患者为房颤高负荷,15.54%的患者为无症状房颤。多因素Cox回归分析发现左房增大分别是再发房颤及房颤高负荷的独立危险因素。结论:左房容积指数是预测起搏器术后老年阵发性房颤患者房颤复发及房颤高负荷的独立危险因素。  相似文献   
78.
We investigated the development of the sinus node of the heart conduction system by localizing hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (HCN4) and connexin43 (Cx43) in the hearts of fetal day 13 mice. Horizontal serial sections of day 13 whole fetuses were stained by hematoxylin and eosin and immunofluorescence to identify myocardial cells that express HCN4, hyperpolarization-activated cyclic nucleotide-gated cation channel 2 (HCN2) and Cx43. Expression levels of HCN4 and Cx43 were determined by quantitative RT-PCR in both fetal day 13 and adult mice. We found that both Cx43 and HCN4 expressions were located on the cell membranes in the hearts of fetal day 13 mice, but Cx43 was distributed throughout the myocardial cells. HCN4 expression was concentrated mainly in the left dorsal epicardium of the right atrium where Cx43 expression was low or absent. Quantitative RT-PCR demonstrated that HCN4 expression was significantly higher and HCN2 expression was significantly lower in fetal day 13 mice than in adults. We found no statistically significant difference in Cx43 expression between fetal day 13 mice and adults. HCN4 stained myocardial cells in the left dorsal epicardium of the right atrium are the origin of the sinus node and the remainder of the heart conduction system.  相似文献   
79.
Members of the hyperpolarization-activated cation (HCN) channel family generate HCN currents (I(h)) that are directly regulated by cAMP and contribute to pacemaking activity in heart and brain. The four different HCN isoforms show distinct biophysical properties. In cell-free patches from Xenopus oocytes, the steady-state activation curve of HCN2 channels is 20 mV more hyperpolarized compared with HCN1. Whereas the binding of cAMP to a COOH-terminal cyclic nucleotide binding domain (CNBD) markedly shifts the activation curve of HCN2 by 17 mV to more positive potentials, the response of HCN1 is much less pronounced (4 mV shift). A previous deletion mutant study suggested that the CNBD inhibits hyperpolarization-gating in the absence of cAMP; the binding of cAMP shifts gating to more positive voltages by relieving this inhibition. The differences in basal gating and cAMP responsiveness between HCN1 and HCN2 were proposed to result from a greater inhibitory effect of the CNBD in HCN2 compared with HCN1. Here, we use a series of chimeras between HCN1 and HCN2, in which we exchange the NH(2) terminus, the transmembrane domain, or distinct domains of the COOH terminus, to investigate further the molecular bases for the modulatory action of cAMP and for the differences in the functional properties of the two channels. Differences in cAMP regulation between HCN1 and HCN2 are localized to sequence differences within the COOH terminus of the two channels. Surprisingly, exchange of the CNBDs between HCN1 and HCN2 has little effect on basal gating and has only a modest one on cAMP modulation. Rather, differences in cAMP modulation depend on the interaction between the CNBD and the C-linker, a conserved 80-amino acid region that connects the last (S6) transmembrane segment to the CNBD. Differences in basal gating depend on both the core transmembrane domain and the COOH terminus. These data, taken in the context of the previous data on deletion mutants, suggest that the inhibitory effect of the CNBD on basal gating depends on its interactions with both the C-linker and core transmembrane domain of the channel. The extent to which cAMP binding is able to relieve this inhibition is dependent on the interaction between the C-linker and the CNBD.  相似文献   
80.
Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.  相似文献   
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