Hospital al Home Unit, Hospital Clínico San Carlos, C/Prof. Martín Lagos, s/n 28040, Madrid, Spain.
Eur J Intern Med. 2012 Jan;23(1):e10-3. doi: 10.1016/j.ejim.2011.07.012. Epub 2011 Aug 27.
Patients with acute cholecystitis are treated in Hospital. The aim of the study was to analyze the security and efficacy of treating not-operated-on patients with acute cholecystitis in Hospital in the Home (HIH).
Prospective study from January 2010 to May 2011 including all patients diagnosed with acute cholecystitis, not operated on and without comorbidities admitted to HIH Unit from the Emergency Department Short Stay Unit and Observation Unit. Patients were treated with ertapenem for at least one week. Intravenous treatment was followed by oral therapy to complete 14 days of antibiotic treatment. Patient characteristics, clinical course, need for return to hospital during admission to HIH, and admission to hospital in the month after discharge from HIH are analyzed.
25 patients were included. Mean age was 59 years (34-82). Upon arrival to the Emergency Department, all patients suffered abdominal pain, 60% had fever, and 32% vomiting. 48% of patients had a leukocyte count over 13,000 cells/μl. All patients had cholelithiasis and a distended gallbladder. 56% showed thickening of the gallbladder wall. Fluid accumulation around the gallbladder was noted in 16% of the cases. Murphy's sign proved positive in 44%. All patients showed a favorable course. No patient required hospital readmission during stay in HIH or in the month after discharge. All patients expressed their satisfaction with treatment at home.
Patients with acute cholecystitis and without comorbidities can be safely and effectively treated in HIH after a short monitoring period in hospital.
患有急性胆囊炎的患者在医院接受治疗。本研究的目的是分析在家庭住院（HIH）中不接受手术的急性胆囊炎患者的安全性和疗效。
这是一项从 2010 年 1 月至 2011 年 5 月进行的前瞻性研究，纳入所有从急诊部短期留观病房和观察病房诊断为急性胆囊炎、未接受手术且无合并症的患者。所有患者均接受厄他培南至少治疗一周。静脉治疗后采用口服治疗，完成 14 天的抗生素治疗。分析患者特征、临床过程、在 HIH 住院期间需要返回医院的情况以及从 HIH 出院后一个月内的住院情况。
共纳入 25 例患者。平均年龄为 59 岁（34-82 岁）。入急诊时，所有患者均有腹痛，60%有发热，32%有呕吐。48%的患者白细胞计数超过 13000 个/μl。所有患者均有胆石症和胆囊扩张。56%的患者胆囊壁增厚。16%的患者有胆囊周围积液。44%的患者墨菲征阳性。所有患者均有良好的病程。在 HIH 住院期间或出院后一个月内，无患者需要再次住院。所有患者均对家庭治疗表示满意。
在医院短期监测后，患有急性胆囊炎且无合并症的患者可安全有效地在 HIH 中进行治疗。
