Castañón-González J A, Castillo-Rodríguez G, Tanus-Hajj J, Valencia-Jiménez E
Unidad de Cuidados Intensivos y Medicina Critica.
Gac Med Mex. 1995 Jul-Aug;131(4):469-75.
To describe three cases of acute acalculous cholecystitis (AAC) in critically ill patients.
Admission charts of critically ill patients who required advanced life support in the intensive care unit and fulfilled three or more of the following ultrasonographic or tomographic diagnostic criteria for AAC were reviewed: 1. Gallbladder wall thickness > 4 mm with an increase in its volume (vesicular hydrops), 2. Pericholecystic fluid, 3. Subserosal edema, 4. Sloughing of the mucosa, 5. Abscence of calculi.
Three men that met the criteria for AAC were identified from a total of 490 admission charts. The median age was 49 years, the average APACHE II at admission was 17 points. The median time in the ICU before development of AAC was 24 days. All patients had leukocytosis. The three cases were resolved by percutaneous cholecystostomy and external biliary drainage.
The incidence of AAC in our ICU is one s case per 160 admissions or 0.6%. Shock, use of vasopressor drugs, narcotics and mechanical ventilation with PEEP are frequent in patients who subsequently develop AAC. Percutaneous cholecystostomy with external biliary drainage constitutes a safe and definitive treatment when there is no gangrene of the gallbladder wall.
描述危重症患者中三例急性非结石性胆囊炎（AAC）的情况。
回顾了在重症监护病房需要高级生命支持且符合以下三项或更多AAC超声或断层扫描诊断标准的危重症患者的入院病历：1. 胆囊壁厚度>4mm且胆囊体积增大（胆囊积水）；2. 胆囊周围积液；3. 浆膜下水肿；4. 黏膜脱落；5. 无结石。
从总共490份入院病历中识别出三名符合AAC标准的男性患者。中位年龄为49岁，入院时平均急性生理与慢性健康状况评分系统II（APACHE II）为17分。发生AAC前在重症监护病房的中位时间为24天。所有患者均有白细胞增多症。三例患者均通过经皮胆囊造瘘术和体外胆道引流治愈。
我们重症监护病房中AAC的发生率为每160例入院患者中有1例，即0.6%。在随后发生AAC的患者中，休克、使用血管升压药、麻醉药以及采用呼气末正压通气（PEEP）进行机械通气的情况很常见。当胆囊壁无坏疽时，经皮胆囊造瘘术加体外胆道引流是一种安全且有效的治疗方法。
