A: ;B: 1 3 :(1) : (2) : :1 : (5μg/kg ) A: ( ) ( );B: ;2 :, ( ) ;3 :PaO 2 /FiO 2 2 <300 mmhg(1 mmhg=0.133kpa);4 : >2 mg/dl;5 :IN

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26 10 805 201810 Vol26No10P805 ChinJIntegrTrad WestMedDig Oct2018 doi:10.3969/j.issn.1671-038x.2018.10.01 : ; ; :R575.6 :A :1671-038X(2018)10-0805-07 (acutecholecystitis) 2, 2.1, 2.1.1, ;,,2011, [1] [9-11] 2013 :,, [2] 2017 10%~20% 2.

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2.3 3 CT :1 ;2 ;3 ;4 2.3.1 : 2 2, :1 ;2 ;3 3.

2 A: ;B: 1 3 :(1) : (2) : :1 : (5μg/kg ) A: ( ) ( );B: ;2 :, ( ) ;3 :PaO 2 /FiO 2 2 <300 mmhg(1 mmhg=0.133kpa);4 : >2 mg/dl;5 :INR>1.5;6 : /L A:,( ), 4 ;5 ;6 ;7 ( );B: ( ), :1 ;2,, (2) ( ) :1 ; CT :1 ;2 ;3 ; : 2 2, :1 ;2 ;3 3.2 (1) ;4 :1 ;2 ;3 ;5 :1 ;2 ;3 ; :1 : (2),Murphy ;2 :,CRP,WBC ;3 : 1 + 2,3 WBC, > /L;2 ;3 3d;4, (3) : : (1) :1 ;2 :1 ;2 ;3 ; :1 ;2 :1 ;2 :1 ;2

3 :1 ;2 ;3 ± / ; :1 ;2 : ; : : 2 2, 3 : / ; : 4 ± ; : 4.1 / ; β : ± ; [1] 4 : / ; : ± ; : / ; β - [3] : ± ; [5] [6] (1) [14-16] 1 : (NSAID) 24h [14-15] 4~7d NSAID 2 : 4~7d;,, 2 NSAID, NSAID [16] 3 :,, [6] (2) : 807. ( ) Oddi,, [7] , 1 7d 72 : h, ±, 6 [7] / ; : ; : (1): CCI(Charlson )ASA-PS( ) 2

4 (laparoscopiccholecystecto- (5) my,lc), (2) : CCIASA-PS LC, /L, /L ; /L (7) ICU 4.2 (3) : (1) 1, CCI : ASA-PS ; : ( ) : LC :, ;, ;, ; [17] : : ( ) ( ) : :, ; ; (2), 30%, 1 : : ( ) : (1) ( :, ; ;, 2 : () ), : ( ), [18] (2) /, : ;, [19] (3) (1) : [20] (4) (6) ; : (),

5 ERCP :,10g(1)/,2~3/d (2) :, ; :5/,3/d, (3) : ; :6/,3/d (4) : ;, :5 /,2~3/d (5) :,,,, :4 /,3 /d,30d1 (6) : 5, 5.1 ; : :5~6/,3/d (7) ; : ; : ; :, [3] ; 5.2 :5/,3/d : (1) : ; :, 3~5 ( <4cm) <3 mm min 1 20~30 min ; : [21-22] (2) ( 10g; 10g; 1g; 10g; ), 1,5 [23] d1 4.3 ; >3 mm ; : ( ) [3] 6g, (0 Ⅰ Ⅱ Ⅲ) : ( %);2 : (70% <95%);3 : (30%

6 <70%);4 : andflowchartforacutecholangitis[j].jhepatobiliary ( <30%) PancreatSci,2018,25(1): [6] (%) GomiH,SolomkinJS,SchlossbergD,etal.Tokyo Guidelines 2018:antimicrobial therapy for acute = [( - )/ ] cholangitisandcholecystitis[j].j Hepatobiliary Pan- 100% ( ) creatsci,2018,25(1):3-16. [7] OkamotoK,SuzukiK,TakadaT,etal.TokyoGuide- [3] 5.4 lines2018:flowchartforthemanagementofacutecho- 0 Ⅰ Ⅱ Ⅲ4 lecystitis[j].j Hepatobiliary PancreatSci,2018,25 0: ;Ⅰ : (1): ;Ⅱ: ;Ⅲ:[8],. [M].,2013: [9] :1 : ;2 : Eskelinen M,IkonenJ,LipponenP.Diagnosticapproa- chesinacutecholecystitis;aprospectivestudyof1333, 0 ;3 : patients withacuteabdominalpain[j].theorsurg,, Ⅱ Ⅰ ;4 : 1993,8: [10]StanilandJR,DitchburnJ,DeDombalF T.Clinical presentationofacuteabdomen:studyof600patients : [J].BrMedJ,1972,3: : ( ): 2003,289(1): [12] MiuraF,TakadaT,KawaradaY,NimuraY,Wada K,Hirota M,etal.Flowchartsforthediagnosisand treatmentofacutecholangitisandcholecystitis:tokyo Guidelines[J].J Hepatobiliary PancreatSurg,2007, 14:27-34.(clinicalpracticeguidelines:CPGs) [13]OkamotoK,SuzukiK,TakadaT,etal.TokyoGuide- lines2018:flowchartforthemanagementofacutecho- lecystitis[j].j Hepatobiliary PancreatSci,2018,25 (1): [14] Akriviadis E A,Hatzigavriel M,Kapnias D,etal. Treatmentofbiliarycolic withdiclofenac:arandom- ized,double-blind,placebo-controledstudy.gastroen- terology,1997,113: [1]. [15]KumarA,DeedJS,BhasinB,etal.Comparisonofthe (2011)[J]. efectofdiclofenac with hyoscine-n-butylbromidein,2011,10(1):9-13. thesymptomatictreatmentofacutebiliarycolic[j]. [2] MiuraF,TakadaT,StrasbergS M,etal.TG13flow- AustNZJSurg,2004,74: chartforthemanagementofacutecholangitisandcho- [16]GoldmanG,KahnPJ,AlonR,etal.Biliarycolictreat- lecystitis[j].j HepatobiliaryPancreatSci.,2013,20 mentandacutecholecystitispreventionbyprostaglan- (1): dininhibitor[j].digdissci,1989,34: [3],. (2017) [17]Hasbah ec M,Al moluo,ba 爧 akf,etal.reviewof [J].,2017,25(4):241- clinicalexperience withacutecholecystitisonthede velopmentofsubsequent galstone-related complica- [4] Yokoe M,HataJ,TakadaT,etal.TokyoGuidelines tions.[j].turkjmedsci,2014,44(5): diagnosticcriteriaandseveritygradingofacute [18]RhodesA,EvansL E,AlhazzaniW,etal.Surviving cholecystitis(withvideos)[j].jhepatobiliarypancreat SepsisCampaign:InternationalGuidelinesforManage- Sci,2018,25(1): mentofsepsisand SepticShock:2016[J].Intensive [5] MiuraF,OkamotoK,TakadaT,etal.TokyoGuide- CareMed,2017,43(3): lines2018:initialmanagementofacutebiliaryinfection [11]TrowbridgeRL,RutkowskiN K,ShojaniaK G.Does this patient have acute cholecystitis[j].jama, [19]ChoYJ,MoonJY,ShinES,etal.KoreanSocietyof

7 811. CriticalCareMedicine.KoreanAcademyofTuberculo- sisandrespiratorydiseasesconsensusgroup.clinical PracticeGuidelineofAcuteRespiratoryDistressSyn- drome[j].tubercrespirdis(seoul),2016,79(4): [20]ChawlaLS,BelomoR,BihoracA,etal.AcuteDis- easequalityinitiative Workgroup16.Acutekidneydis- easeandrenalrecovery:consensusreportoftheacute DiseaseQualityInitiative(ADQI)16 Workgroup[J]. NatRevNephrol,2017,13(4): [21],,. [J].,2011,45 (9): [22],. [J].,2013,15(6): [23],,. 30[J].,2015,6(46): ,: ( ) 1, /,TC/(mmol L -1 ) 1 3 P ( 200)

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