Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Aust Crit Care. 2019 May;32(3):223-228. doi: 10.1016/j.aucc.2018.03.006. Epub 2018 Apr 19.
Critical care patients have many risk factors for acute cholecystitis (AC). However, less data are available regarding newly developed AC in critically ill patients.
To investigate the clinical features of AC occurring in critically ill patients after admission to an intensive care unit (ICU).
We performed a retrospective cohort study from January 2006 to August 2016 at a tertiary care university hospital. We included patients diagnosed with AC with or without gallstones after ICU admission. All cases of AC were confirmed by gastroenterologists or general surgeons. We excluded patients with AC diagnosed before or at the time of ICU admission.
A total of 38 patients were diagnosed with AC after ICU admission between January 2006 and August 2016. Seventeen (44.7%) had acute acalculous cholecystitis, while 21 (55.3%) had acute calculous cholecystitis. The median age was 73 years (interquartile range = 63-81 years), and 22 (57.9%) patients were male. The most common reason for ICU admission was pneumonia or sepsis. The median interval from ICU admission to diagnosis of AC was 11 days (interquartile range = 4.8-22.8 days). Before AC diagnosis, almost 90% of patients used total parenteral nutrition, 68% used opioids, 76% were mechanically ventilated, and 42% received vasoactive drugs. More than half of patients underwent cholecystectomy, and all surgically resected gallbladders had pathology results for cholecystitis. Gangrenous cholecystitis was observed in five patients with acute calculous cholecystitis. The overall mortality was 42.1%, and 1/3 of these deaths were directly associated with AC. The average length of stay in the ICU and hospital was 26.5 and 44.5 days, respectively.
The development of AC in the ICU should be carefully monitored, especially in patients who have been infected and admitted to the ICU for more than 10 days. Proper diagnosis and treatment at a critical time could be lifesaving.
危重症患者有许多急性胆囊炎（AC）的危险因素。然而，关于重症监护病房（ICU）中危重症患者新发 AC 的数据较少。
调查 ICU 入院后发生的危重症患者 AC 的临床特征。
我们对 2006 年 1 月至 2016 年 8 月在一家三级护理大学医院进行了回顾性队列研究。我们纳入了 ICU 入院后确诊有或无胆囊结石的 AC 患者。所有 AC 病例均由胃肠病学家或普外科医生确诊。我们排除了 ICU 入院前或入院时确诊为 AC 的患者。
2006 年 1 月至 2016 年 8 月期间，共有 38 例患者在 ICU 入院后被诊断为 AC。17 例（44.7%）为急性非结石性胆囊炎，21 例（55.3%）为急性结石性胆囊炎。中位年龄为 73 岁（四分位距 = 63-81 岁），22 例（57.9%）为男性。入住 ICU 的最常见原因是肺炎或败血症。从 ICU 入院到 AC 诊断的中位时间为 11 天（四分位距 = 4.8-22.8 天）。在 AC 诊断之前，近 90%的患者接受了全肠外营养，68%的患者使用了阿片类药物，76%的患者接受了机械通气，42%的患者使用了血管活性药物。超过一半的患者接受了胆囊切除术，所有手术切除的胆囊均有胆囊炎的病理结果。5 例急性结石性胆囊炎患者出现坏疽性胆囊炎。总体死亡率为 42.1%，其中 1/3 的死亡直接与 AC 相关。ICU 和住院的平均住院时间分别为 26.5 天和 44.5 天。
应密切监测 ICU 中 AC 的发生，特别是在感染且 ICU 住院时间超过 10 天的患者。在关键时刻进行适当的诊断和治疗可能会挽救生命。
