Boland G, Lee M J, Mueller P R
Department of Radiology, Massachusetts General Hospital, Boston 02114.
New Horiz. 1993 May;1(2):246-60.
The development of acute cholecystitis in the ICU is now a well-recognized complication of many acute illnesses that precipitate ICU admission and may also result as a complication of the subsequent treatment. The etiology of the disease remains obscure and, unlike acute cholecystitis outside the ICU setting, most cases are acalculous and not associated with gallstones. The disease may often go unrecognized due to the complexity of the patient's medical and surgical problems. Clinical examination is often unhelpful, as many patients are receiving mechanical ventilation and have decreased mental awareness. Biochemical markers are nonspecific and contribute to the delay in diagnosis and treatment. Early diagnosis is essential to avoid the high rates of associated morbidity and mortality. The diagnosis is usually made by radiologic tests, most often by sonographic examination of the gallbladder, which can be performed at the bedside. However, radiologic findings may also be nonspecific. The treatment involves gallbladder drainage by percutaneous cholecystostomy, which is usually curative in acalculous cholecystitis. Interval cholecystectomy is indicated for the remaining patients with gallstone-associated cholecystitis.
重症监护病房（ICU）内急性胆囊炎的发生现已成为许多导致患者入住ICU的急性疾病的一种公认并发症，并且也可能作为后续治疗的并发症出现。该疾病的病因仍不明确，与ICU环境外的急性胆囊炎不同，大多数病例为无结石性的，且与胆结石无关。由于患者医疗和外科问题的复杂性，该疾病常常未被识别。临床检查往往无济于事，因为许多患者正在接受机械通气且意识下降。生化标志物不具有特异性，这导致诊断和治疗延迟。早期诊断对于避免高发病率和死亡率至关重要。诊断通常通过影像学检查做出，最常见的是对胆囊进行超声检查，这可以在床边进行。然而，影像学表现也可能不具有特异性。治疗包括通过经皮胆囊造瘘术进行胆囊引流，这通常对无结石性胆囊炎具有治愈作用。对于其余患有胆结石相关性胆囊炎的患者，则需择期行胆囊切除术。
