2002－2007年における当院市中肺炎入院症例の臨床的研究

当院に入院した市中肺炎症例の臨床像を明らかにし, 日本呼吸器学会2007年成人市中肺炎診療ガイドラインによる市中肺炎の重症度分類の妥当性を検討した｡2002年４月から2007年３月までの過去５年間に当院に入院した, 30歳から95歳までの市中肺炎109名142例 (男性72名102例, 女性37名40例) を対象に, その臨床像を検討した｡平均年齢は74.8歳で,65歳未満26例, 65歳以上75歳未満の前期高齢者30例, 75歳以上の後期高齢者86例であった｡ 肺炎重症度は軽症21例, 中等症99例, 重症17例, 超重症５例であった｡抗菌薬の選択に関して軽症では21例中18例, 中等症では99例中92例, 重症では17例中16例がガイドラインに準じていたが, 超重症では全例でガイドラインに準じていなかった｡平均入院日数は軽症28.4日,中等症39.9日, 重症48.5日, 超重症45.2日であった｡死亡例は, 軽症では無く, 中等症群７例, 重症群４例, 超重症群３例の計14例で, 死亡例の平均年齢は81.8歳であった｡重症度が悪化するにつれ, 高齢, BUN高値, 低酸素血症, 意識障害, 低血圧の頻度は増加傾向にあった｡79例で慢性呼吸器疾患を合併し, 慢性呼吸器疾患合併群では有意に呼吸器関連死亡が多かった｡日本呼吸器学会2007年成人市中肺炎診療ガイドラインは, 本邦の肺炎の重症度別症 例解析に適していると考えられた｡

The purpose of the study was to record clinically relevant medical outcomes in patients with community-acquired pneumonia and evaluate the performance of severity scores with the Guideline for community-acquired pneumonia edited by the Japanese Respiratory Society. During a 5-year period from April 2002 to March 2007, 142 patients with community-acquired pneumonia (40 females and 102 males) between 30 and 95 years of age who were admitted to our hospital were retrospectively included in this study. The mean age of the patients was 74.8 years. Twenty six patients were between 30 and 64 years of age, 30 patients were between 65 and 74 years of age, and 86 patients were between 75 and 95 years of age . The numbers of admission in each of the severity scores were：mild, 21； moderate, 99；severe, 17；and super severe, ５.The adherence to the Guideline for communityacquired pneumonia edited by the Japanese Respiratory Society for the initial antibiotics choice was high in mild, moderate and severe pneumonia (85.7％, 92.9％ and 94.1％) but was low in super severe pneumonia ( ０ ％) . The mean durations of hospitalization in each of the severity scores were：mild, 28.4 days；moderate, 39.9 days；severe, 48.5 days；and super severe, 45.2 days. Fourteen patients died. The numbers of death in each of the severity scores were： mild, ０；moderate, ７；severe, ４；and super severe, ３. The mean age of those who died was 81.8 years. Elderly, elevated blood urea nitrogen level, hypoxia, orientation disturbance, and hypotension were more frequent when the severity scores were elevated. Of the 142 patients with community-acquired pneumonia, 79 had chronic pulmonary disease and more respiratory system-related death. Our study indicated that the Guideline for community-acquired pneumonia edited by the Japanese Respiratory Society is a very useful tool for analyzing cases with community-acquired pneumonia in Japan.