Boland G W, Slater G, Lu D S, Eisenberg P, Lee M J, Mueller P R
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
AJR Am J Roentgenol. 2000 Apr;174(4):973-7. doi: 10.2214/ajr.174.4.1740973.
We evaluated sonographic abnormalities of the gallbladder other than acalculous cholecystitis across a broad range of intensive care unit (ICU) patients.
Fifty-five consecutive patients (age range, 18-94 years old; mean age, 56 years; 33 men, 22 women), who were admitted to the ICU with a variety of diagnoses, underwent sonography of the gallbladder twice a week. Patients with gallbladder calculi were excluded from the study. The gallbladder was examined for the recognized sonographic features of acalculous cholecystitis: gallbladder wall thickening, gallbladder distention, intramural gallbladder lucencies (striated gallbladder wall), pericholecystic fluid, gallbladder sludge, and Murphy's sign. These findings were correlated with clinical and laboratory parameters that are associated with acalculous cholecystitis: fever, WBC, liver function tests, levels of serum bilirubin, mechanical ventilation status, and administration of parenteral nutrition, narcotic analgesics, antibiotics, and pressor agents.
Eleven of the 55 patients were found to have gallbladder calculi and were excluded from the study. Thirty-seven (84%) of the remaining 44 patients had at least one sonographic abnormality while in the ICU. Twenty-five (57%) of the 44 patients had as many as three abnormalities found on sonography, and six (14%) of 44 patients had four or five sonographic findings of gallbladder abnormalities while in the ICU. No statistically significant correlation was found among any of these sonographic abnormalities and the clinical and laboratory parameters.
Gallbladder abnormalities are frequently seen on sonography in ICU patients, even if these patients are not suspected of having acalculous cholecystitis; therefore, sonography appears to be of limited value in diagnosing acalculous cholecystitis in ICU patients.
我们评估了广泛的重症监护病房（ICU）患者中除无结石性胆囊炎之外的胆囊超声异常情况。
连续55例患者（年龄范围18 - 94岁；平均年龄56岁；男性33例，女性22例）因各种诊断入住ICU，每周接受两次胆囊超声检查。胆囊结石患者被排除在研究之外。检查胆囊有无无结石性胆囊炎公认的超声特征：胆囊壁增厚、胆囊扩张、胆囊壁内透亮区（条纹状胆囊壁）、胆囊周围积液、胆囊淤泥及墨菲氏征。这些发现与无结石性胆囊炎相关的临床和实验室参数相关：发热、白细胞、肝功能检查、血清胆红素水平、机械通气状态以及胃肠外营养、麻醉性镇痛药、抗生素和升压药的使用情况。
55例患者中有11例被发现有胆囊结石，被排除在研究之外。其余44例患者中有37例（84%）在ICU期间至少有一项超声异常。44例患者中有25例（57%）超声检查发现多达三项异常，44例患者中有6例（14%）在ICU期间有四项或五项胆囊异常的超声表现。这些超声异常与临床和实验室参数之间均未发现统计学上的显著相关性。
ICU患者中胆囊异常在超声检查中很常见，即使这些患者未被怀疑患有无结石性胆囊炎；因此，超声检查在诊断ICU患者的无结石性胆囊炎方面似乎价值有限。
