Risk Factors Of Acute Acalculous Cholecystitis In Critically Ill Patients

Objectives To investigate the risk factors for acute acalculous cholecystitis(AAC)during the treatment of intensive care unit(ICU).For the patients with risk factors,the clinicians should be reminded to strengthen the monitoring of the gallbladder to achieve early detection and early diagnosis of AAC,to help early intervention treatment,to reduce the time for ICU to stay in patients and to reduce the mortality of AAC in ICU patients.Methods The clinical data of 22 patients with AAC during ICU treatment from January 2015 to December 2017 were retrospectively analyzed.44 non-AAC patients who matched the age and sex of the case group at the same time in the ICU were randomly selected as the control group.The patient's gender,age,APACHE II score,previous illness,major surgery and severe trauma,shock and duration,vasoactive drug use time and dose,ventilator use time,sedative drug use time,and intravenous nutrition time were recorded.The number of white blood cells within 24 hours of entering the ICU and the amount of serum C-reactive protein within 24 hours of entering the ICU.Firstly,single factor analysis method was used to compare whether there was significant difference between the two groups.Then the index with significant difference was analyzed by unconditional binary logistic regression model to obtain the regression equation.Results Comparing the clinical data of case group and control group,APACHE II score,time of shock,use of vasoactive drugs,vasoactive drug use time,sedation time,ventilator use time,white blood cell count within hours of entering ICU24,serum C-reactive protein levels within hours of ICU24 were significant in case group.Higher than the control group(P < 0.05).Respectively statistically different factors were brought into the unconditional binary logistic regression model to obtain the regression coefficient b.The results showed a white blood cell count(OR = 1.436,P = 0.012,95% confidence interval for the OR value was 1.078 ~ 1.912),ventilator use time(OR = 1.213,P = 0.020,95% confidence interval for the OR 1.031 to 1.426),serum CRP levels(OR = 1.013,P = 0.035,95% confidence interval for OR values 1.001 ~ 1.025)and vasoactive drug use dose(OR = 1.011,P = 0.032,OR = 95 The % confidence interval was 1.001~1.022)with statistical significance.The regression equation obtained was y=0.362x10+0.0193x7+0.013x11+0.011x4-10.217(x10=blood WBC count,x7= respirator use time,x11 = Serum CRP amount,x4 = dose of vasoactive drug used).Conclusions There are many factors affecting AAC in patients with ICU.Among them,white blood cell count,ventilator use time,serum CRP dose,and vasoactive drug use dose are risk factors for AAC in ICU patients.In clinical treatment,special attention should be paid to the monitoring of gallbladder changes in patients with these risk factors for early detection,early diagnosis,and early treatment.