Abstract: Objective　To study the early-warning indexes for the urgent relief of obstruction within 48 hours in patients with biliary obstruction caused by choledocholithiasis.Methods　From September 2014 to January 2015,we enrolled 27 patients with biliary obstruction caused by acute choledocholithiasis who accorded with inclusion criteria and were admitted into the Department of Emergency of Beijing Friendship Hospital,Capital Medical University.According to whether urgent relief of obstruction was performed,the patients were divided into nonemergent intervention group （n=17） and emergent intervention group （n=10）.Gender,age,situation of fever,WBC,the levels of ALT,AST,TBiL,DBiL and AMY and the score of faces pain scale-revised（FPS-R） were recorded.Results　The two groups were not significantly different in gender,age,fever rate and the levels of AST,TBiL,DBiL and AMY （P>0.05）;the two groups were significantly different in WBC,the level of ALT and the score of FPS-R （P<0.05）.Logistic regression analysis showed that the score of FPS-R was an early-warning index for the urgent relief of obstruction.Conclusion　The score of FPS-R is an early-warning index for the urgent relief of obstruction within 48 hours in patients with biliary obstruction caused by choledocholithiasis,and WBC and the level of ALT may also be early-warning indexes.

Key words: Cholestasis, Choledocholithiasis, Faces pain scale-revised, Root cause analysis

摘要： 目的　探讨胆总管结石所致胆管梗阻患者48 h内紧急解除梗阻的预警因素。方法　选取2014年9月—2015年1月首都医科大学附属北京友谊医院急诊科收治的符合纳入标准的胆总管结石所致胆管梗阻患者27例为研究对象。根据是否采取紧急解除梗阻术将患者分为未紧急干预组（17例）和紧急干预组（10例）。记录患者的性别、年龄、发热情况、白细胞计数（WBC）、丙氨酸氨基转移酶（ALT）水平、天冬氨酸氨基转移酶（AST）水平、总胆红素（TBiL）水平、直接胆红素（DBiL）水平、血清淀粉酶（AMY）水平、修订版面部表情疼痛量表（FPS-R）评分。结果　两组患者性别、年龄、发热率、AST水平、TBiL水平、DBiL水平、AMY水平比较，差异无统计学意义（P>0.05）；两组患者WBC、ALT水平、FPS-R评分比较，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，FPS-R评分是紧急解除梗阻的预警因素（P<0.05）。结论　FPS-R评分是预警胆总管结石所致胆管梗阻患者48 h内紧急解除梗阻的预警因素，WBC、ALT水平可能是胆总管结石所致胆管梗阻患者紧急解除梗阻的预警因素。

关键词: 胆汁淤积, 胆总管结石, 修订版面部表情疼痛量表, 影响因素分析